Millions of Medicaid beneficiaries have lost health coverage — often without understanding why. It’s the result of the frequently chaotic unwinding of the continuous enrollment provision, which kept people automatically enrolled throughout the COVID-19 public health emergency. Since states relaunched their redeterminations, more than 16 million people have been disenrolled from Medicaid and the Children’s Health Insurance Program. Concerned by the high rate of disenrollments caused by missed renewal notices and other procedural issues, the federal government paused the process in many states.
Given that two-thirds of the unwinding still lies ahead, uncertainty surrounding Medicaid redetermination will likely persist in 2024. These key issues have emerged from the cumbersome process:
Members are confused. More than two-thirds of Medicaid enrollees surveyed in early 2023 were not aware that they could be disenrolled. Not only do some individuals not know why they are receiving renewal documents, but they also cannot understand the complex paperwork. One reason is that Medicaid enrollees are more likely to have limited English proficiency compared with the non-Medicaid population.
Member information is inaccurate. Renewal documents are not reaching some members eligible for re-enrollment because states and health plans lack accurate contact information. These beneficiaries may only learn about their lost coverage when they seek care from a provider.
State systems are overwhelmed. Understaffed state Medicaid agencies, short deadlines to complete paperwork, and technical problems contribute to administrative backlogs. When members cannot complete forms or upload necessary documentation online, they often must wait in person for help at their local office. Calling their agency can also lead to frustratingly long wait times — especially for those whose primary language is not English.
The most vulnerable populations may be the most at risk. More than half (61%) of Medicaid beneficiaries identify as non-white and are more likely to experience health disparities, which could be exacerbated by lost coverage. Although data so far suggests that people of color are not being disproportionately disenrolled, nearly 40% of disenrollments involve children, according to data from 21 states.
Improving the process for members
Plans can create a smoother redetermination process for members by embracing several best practices in the months ahead.
1. Take a state-by-state strategy. Disenrollments vary widely across states, and some states have adopted waivers to reduce procedural disenrollments. Plans should understand the waivers and rules in states where they operate and develop tailored education and outreach campaigns for each region. After the public health emergency ended, one national plan launched a rapid determination campaign across all 50 states to motivate members to submit their materials to avoid losing coverage. The plan adjusted messaging and website content to follow each state’s rules so they could be pre-approved by states. Following approval, the plan delivered approximately 5.5 million texts, 2.7 million interactive voice response calls, and 195,000 emails (in both English and Spanish) to members in less than two weeks.
2. Embrace multichannel methods to help members avoid long phone wait times. Because the vast majority of Medicaid beneficiaries own a smartphone, multichannel redetermination campaigns that include text messages, IVR calls, live agent calls, text messages, and emails can be highly effective. One large national plan conducted 3.9 million redetermination outreaches in 2023, with 3.5 million text messages and the remaining 400,000 IVR calls. The first outreach campaign notified members at 60, 45, and 15 days from their re-enrollment date that they could lose coverage if they failed to complete their paperwork. The second campaign reminded those with procedural disenrollments to contact the state to confirm eligibility and regain coverage. The third campaign will focus on gathering mailing addresses through a secure web-based channel, so the plan can help ensure members were not disenrolled for procedural reasons during the next redetermination.
3. Leverage data to provide personalized education about Medicaid redetermination to the right populations. Many disenrolled members report poor communication with their Medicaid agency. However, health plans can fill the gap by making sure families understand their options, such as enrolling in a subsidized marketplace plan available in Medicaid expansion states. Many forward-thinking plans use an approach that relies on behavioral science and third-party data to motivate members with personalized, actionable messages during redetermination. Rather than using word-for-word translation, using “transcreation” to craft simple, culturally appropriate messages that resonate with a population’s values can also improve the effectiveness of outreach to members with limited English proficiency.
4. Adopt a member-centered approach to build trust throughout the year. Members are more likely to engage during redetermination if the plan has fostered trust through continuous outreach (Figure 1). Year-round opportunities for trust-building include benefit reminders, such as informing pregnant members about the one year of postpartum Medicaid coverage if they live in one of 40 states offering this benefit. Other outreach opportunities include sharing screening reminders on birthdays, care alternatives available via telehealth, and tips to avoid emergency department care.
5. Use redetermination as an opportunity to assess social determinants of health and support a whole person approach to care. Redetermination can be a valuable time for plans to utilize data to support the social needs of members, further build trust, and improve their clinical outcomes. One regional plan uses redetermination IVR calls to contact members 30–60 days before enrollment ends. The IVR call offers to transfer members to a health navigator so members can complete their paperwork or provide information needed to confirm eligibility. The health navigators also assess members’ SDOH, collect data to enhance member health profiles, and direct individuals to appropriate clinical programs and community-based services.
Signs of Success and Hope for 2024
As of the end of January, more than 32 million people had renewed their Medicaid coverage, while high numbers of disenrolled members were picking up marketplace plans and bolstering this year’s record high marketplace enrollment.
This suggests that many plans’ data-driven redetermination strategies in recent months have helped them re-enroll members who were disenrolled for procedural reasons and guide others who were no longer eligible for Medicaid to other plan offerings. Given their early success, these plans have reason to hope that they have mitigated the potential negative impact of Medicaid disenrollments while helping the most vulnerable populations maintain necessary coverage.