CMS directs Medicaid agencies to reinstate duals who were downgraded to Medicare Savings Programs only


On Mar 7, 2023 CMS issued a notice to all state Medicaid agencies pursuant to an injunction entered against CMS in a nationwide class action called Carr v Becerra filed in federal district court in Connecticut. The class consisted of people who had been determined eligible for Medicaid after Mar 18, 2020 and who later had their  Medicaid coverage terminated and replaced by just coverage  under Medicaid's Medicare Savings Programs (MSP).  States took this action based on an Interim Final Rule CMS released in Nov 2020 in which CMS changed its earlier interpretation of a federal law enacted on Mar 18, 2020 in response to the COVID-19 public health emergency requiring state Medicaid agencies, as a condition of receiving enhanced federal matching funds, not to terminate Medicaid coverage for individuals enrolled on Mar 18, 2020 or later. On Jan 31, 2023 the court certified a nationwide class and issued a preliminary injunction directing CMS not to enforce this provision of its Nov 2020 Rule with respect to the class, to reinstate its prior guidance, and to notify all state Medicaid agencies. The injunction expires Mar 31, 2023 which is the date the federal statutory requirement to maintain continuous coverage comes to an end. Attached is the original Court order, a later clarifying order from the Court,  and CMS's Mar 7, 2023 letter to the states (CT example) . Also enclosed is a Mar 15 letter from class counsel to each state's Medicaid director (HI example)


Massachusetts implemented the CMS rule which has now been enjoined with respect to the class for 13 months from July 1, 2021 to July 31, 2022. During that time about 2500 individuals lost their prior benefits, and are now entitled to have those benefits reinstated. Attached is a sample of the letter MassHealth mailed out to all affected individuals in late March 2023 (Carr v Becerra Notice Template) that tells the member that MassHealth is reinstating their MassHealth benefits back to the date of termination, keeping their Medicare Savings Program benefits in place, and supplying a phone number for the unit that will be fielding calls and questions. People can also call to opt out and retain only their MSP benefits.  

People will be entitled to their reinstated benefits plus MSP until they receive a renewal notice dated April 1 2023 or later and receive a new determination based on that renewal. In the meantime, they are entitled to MassHealth benefits plus MSP.  People who incurred bills during the retroactive period that MassHealth would have paid had they not been terminated should call the number on the notice for information about how to be reimbursed. Please let us know how this process is working out for your clients.,