Unwinding Guidance and Resources

What is Unwinding?

As COVID-19 becomes less of a threat, states will restart yearly Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews. This means your state will use the information they have to decide if current beneficiaries are still qualified for Medicaid or CHIP coverage. If your state needs more information from beneficiaries to make a coverage decision, they’ll send them a renewal letter in the mail. Please note, most children can still be covered through the Children’s Health Insurance Program.

How have we prepared to keep people covered?

Due to unique barriers in Indian Country, we have educated states and external partners on ways to best reach the AI/AN community. This includes presenting Strengthening Tribal and State Partnerships to Prepare for Unwinding, to the National Association of Medicaid Directors.

In this presentation we highlighted that some AI/AN families share post office boxes and that some Indian reservations post offices are over 100 miles away.  We also explained that broadband services are limited.  According to the Federal Communications Commission (FCC) data, broadband services reach 95.6% of the nation as a whole, but just 79.1% of people on tribal lands – and only 46.5% of tribal households.

To address these barriers, we have continually stressed the importance of partnering with Indian Health Service (IHS), Tribes and Tribal organizations, and urban Indian organizations (collectively, ITU). ITUs are a trusted resource to help with reaching and retaining AI/AN beneficiaries.  They can help communicate with Indian Country and overcome those unique barriers. 

CMS released communication to states in a SHO letter in January 2023, encouraging states to share data with to help with updated contact information for Tribal Medicaid beneficiaries.  They also recently released an FAQ in May 2023 again stressing how states should share enrollment data with ITUs.

States currently working with ITUs by sharing data: Arizona, Colorado, Idaho, Minnesota, Montana, Nevada, Oklahoma, and Oregon

What can you do?

This is an all-hands-on-deck effort!

SPREAD THE WORD: Getting the word out about Medicaid renewals is an all-hands-on-deck effort, and we  are asking for help from Tribal leaders, Tribal health directors, IHCPs, and others in the Tribal communities to get the message out to Medicaid and CHIP enrollees across Indian Country.

HELP PEOPLE WITH THE RENEWAL PROCESS: Partner with your State Medicaid/CHIP agency to provide direct assistance to individuals and families with completing the renewal form.

Unwinding Toolkits

Toolkits are an invaluable resource that teaches users about Unwinding and identifies approaches for addressing potential issues.

Additional Resources

There are many other tools to help you stay informed and to help you ensure continuity of coverage and preventing inappropriate terminations for eligible Medicaid and CHIP beneficiaries.

For more information, including additional resources, tools to support state unwinding efforts, and information shared during All State Calls, please visit

Page Last Modified:
03/20/2024 02:15 PM