The 2023 Consolidated Appropriations Act provides March 31, 2023 as the end date for the Medicaid continuous coverage guarantee under the Families First Coronavirus Response Act (FFCRA), setting in motion the long-awaited “unwinding” process.

Unwinding will trigger the largest coverage transition since the Affordable Care Act took effect. More people are projected to leave Medicaid than currently have marketplace coverage, creating a great risk of coverage loss but also a huge enrollment opportunity for marketplaces.

Transitions from Medicaid to marketplace coverage have historically been marred by coverage gaps and high rates of attrition. This is partially because consumers losing Medicaid may have an extremely short runway to complete the marketplace application without experiencing a gap—or losing coverage altogether.

Fortunately, states have options to support continuity of coverage. This piece highlights state strategies to maximize continuity of coverage for consumers coming off Medicaid and needing to transition to the marketplace. It focuses both on minimizing gaps in coverage and on maximizing successful enrollment overall. Some of the ideas require modest changes or adjustments, while others are a heavier lift, especially given healthcare officials’ already long to-do lists. State policymakers should consider them in light of their specific capacity and goals.