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"Unwinding" of Policy Changes due to the COVID-19 Pandemic

Return to ACL's COVID-19 page

The federal Public Health Emergency (PHE) and Major Disaster Declaration (MDD) for COVID-19 ended on May 11, 2023, and federally funded programs returned to normal operations. This transition ended the temporary, but significant, changes made to Medicaid enrollment and eligibility rules, as well as additional pandemic-specific flexibilities extended to State Units on Aging for programs funded through the Older Americans Act.

As trusted community partners and effective messengers, the aging and disability networks have a critical role to play in ensuring millions of low-income older adults, people with disabilities, their families and caregivers retain health coverage.

This HHS fact sheet, released on May 9, 2023, describes flexibilities enabled by the COVID-19 emergency declaration during the PHE and they are impacted by the end of the COVID-19 PHE. on May 11.

Guidance for State Units on Aging

The Aging network has met the needs of older adults and their family caregivers during the COVID-19 pandemic by providing critical Older Americans Act (OAA) services throughout this unprecedented time. Some of these services the network has been able to provide were due to the flexibilities allowed through congressional action during the PHE and MDD periods. This FAQ developed by ACL addresses the unwinding of flexibilities for OAA formula grants to State Units on Aging (SUA) associated with the conclusion of these periods.

Medicaid "Unwinding" Resources

At the beginning of the COVID-19 pandemic, significant changes were made to Medicaid enrollment and eligibility rules to promote continuous health insurance coverage. These changes ended on May 11, 2023. As a result, many older people and people with disabilities are at risk of losing their Medicaid coverage. Disabled people and older adults who are enrolled in Medicaid need to be aware of these changes and how they may be affected, so they can take the actions needed to maintain their health insurance coverage.

This ACL blog post offers important background and details on this "unwinding," explains how it will impact people with disabilities and older adults, and presents six things you should know about the change, along with associated action steps for the disability and aging networks:

  1. Medicaid beneficiaries should make sure their contact information is current with the Medicaid agency, check their mail, and fill out all forms quickly.

  2. All renewal forms and notices must be accessible to people with limited English proficiency and people with disabilities.

  3. Many people will be able to retain Medicaid or will have other coverage options through the Marketplace.

  4. People with Medicaid who became eligible for Medicare may have enrollment problems

  5. If someone disagrees with their state Medicaid agency’s decision to disenroll them or change their Medicaid coverage, they can appeal.

  6. CMS and ACL have a number of other helpful resources available

Guidance on Civil Rights Protections and Language Access

On April 5, 2023, the U.S. Department of Health & Human Services Office for Civil Rights (OCR) reminded states of their obligations under federal civil rights laws as the PHE and the continuous Medicaid coverage comes to an end, and states restart Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews. The letter makes clear that states have independent obligations under federal civil rights laws to ensure that individuals and families continue to have access to Medicaid and CHIP coverage upon the expiration of the continuous enrollment condition.

On May 5, 2023 the U.S. Equal Employment Opportunity Commission (EEOC) issued a number of updates to its COVID-19 technical assistance, “What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws,” including adding a new question and answer about the end of the federal declaration of the COVID-19 public health emergency.

Resource for Grantees and Stakeholders

ACL will continue to update this page with resources to help grantees and stakeholders navigate the "unwinding" process.

Resources from ACL and our Grantees:

Resources from CMS:

Additional Resources:

Other Effects of the PHE Ending

Impact on CDC Activities

Key CDC Activities Affected by the COVID-19 PHE Expiration 

  • COVID Transmission Levels: Percent positivity data, upon which the COVID Transmission Levels rely, will not be available at the county level post-PHE. COVID Transmission Levels will be sunset and removed from COVID Data Tracker on May 11.  
  • COVID-19 Community Levels (CCLs): Due to changes in reporting requirements for case data post-May 11, CDC will no longer be able to calculate COVID-19 Community Levels (CCLs). CCLs will be sunset and removed from COVID Data Tracker on May 11. CDC will provide a new metric for people, organizations, and communities who want information on current COVID-19 risk to help their decision-making. 
  • COVID Data Tracker (CDT): CDC will focus on weekly tracking key public health outcomes as part of an ongoing transition from the emergency phase of COVID-19 response to sustainable public health practice. The agency will prioritize tracking markers of severe illness using surveillance systems with national coverage. Phase 1 changes to CDT will launch on May 11. 
  • Genomic surveillance: Genomic surveillance activities will continue, and data will be published on COVID Data Tracker. The laboratory data source for percent positivity, which is a statistical weighting input for model-based estimates of SARS-CoV-2 variant proportions, will be adjusted. After May 11, reporting will become bi-weekly.
  • Increasing Community Access to Testing (ICATT) Program: CDC will continue to fund pharmacy-based testing through the ICATT program for people who are uninsured. Testing access may be reduced if fewer testing sites are enrolled and available due to insurance and reimbursement adjustments.
  • Vaccine administration data: Receipt of vaccine administration data will be unaffected for jurisdictions with signed data use agreements (DUAs) with CDC to share data, though data completeness and submission timing may be affected. Current updates are weekly, and final update for current pages will be May 11. New COVID Data Tracker vaccine pages and visualizations are planned to launch in June as part of phase 2 updates and will be updated monthly.

Key CDC Activities Unaffected by the COVID-19 PHE Expiration

  • Demographic case data: Demographic case data will be accessible though 
  • Long COVID: CDC’s work on Long COVID is not affected by the end of the PHE and will continue past May 11. 
  • Sentinel surveillance: Sentinel surveillance activities (e.g., COVID-NET) will continue past May 11, and data will continue to be published on COVID Data Tracker.
  • Traveler genomic surveillance: Traveler genomic surveillance activities will continue past May 11, and data will continue to be published on COVID Data Tracker. After May 11, reporting will become bi-weekly. 
  • v-safe: After May 19, those who enrolled and participated in v-safe for COVID-19 vaccines will be unable to add new COVID-19 vaccine doses to their account. Health check-ins for any doses added before May 19 will continue until June 30. CDC is developing a new version of v-safe, launching later this year, which will allow users to share their post-vaccination experiences with new vaccines.   
  • Vaccine effectiveness: Vaccine effectiveness activities are not tied to the PHE and will continue past May 11.
  • Wastewater surveillance: Wastewater surveillance activities will continue past May 11, and data will continue to be published on COVID Data Tracker.

Information/Resources on Other key (non-CDC) Activities Affected by the end of the Public Health Emergency

*Note this information is subject to change. CDC cannot make official statements on behalf of other USG entities or private organizations. Please refer to responsible organizations for the most up-to-date information.  

**The process of transitioning to vaccine commercialization will be overseen by HHS ASPR and will not be affected by the end of the PHE. More information is available here: FAQ - Commercialization of COVID-19 Medical Countermeasures (; COVID-19 Vaccine Program Update to 4/19/23 ACIP Meeting 

Impact on COVID-19 Testing Coverage

The end of the Public Health Emergency on May 11, 2023 may impact insurance coverage for laboratory and over-the-counter COVID-19 tests. This CMS fact sheet (also available in Spanish) describes how unwinding will impact testing coverage for individuals with different forms of insurance.

    Last modified on 05/16/2023

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