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COVID-19 has disproportionately harmed low-income people, especially Black and Latino populations, seniors, and people with disabilities. Medicaid plays an essential role in providing coverage and access to care for these populations. As COVID-19 disrupted employment, earnings, and insurance coverage, Medicaid enrollment increased, in part because Congress offered states increased Medicaid funding in return for maintaining eligibility and enrollment for the duration of the public health emergency (PHE). At the same time, many states expanded eligibility and streamlined enrollment to assure that people could secure and keep coverage. Such policies resulted in more than 5.3 million more Americans having Medicaid coverage during 2020. However, increased demand for Medicaid during the pandemic’s economic downturn places pressure on state budgets. The secretary of the Department of Health and Human Services (HHS) and Congress should work together to ensure that the Medicaid enhanced federal match and maintenance of effort requirements continue at least through early 2022 to protect coverage for low-income Americans and to help states weather the economic recovery. HHS should rescind all policies that create barriers to enrollment and access to care. State governments should continue to use temporary emergency authorities to expand eligibility and streamline application and enrollment processes and make them permanent when the PHE ends. Congress should either proceed with President Biden’s campaign plan for a federal public option to provide low-cost insurance coverage, particularly important for states that have not expanded Medicaid, or enact an increased federal match for a limited period of time to encourage opt-out states to implement Medicaid expansion. This paper was prepared as part of the COVID-19 Policy Playbook: Legal Recommendations for a Safer, More Equitable Future, a comprehensive report published by Public Health Law Watch in partnership with the de Beaumont Foundation and the American Public Health Association.