In recent weeks it has been reported that the COVID-19 relief laws Congress enacted in 2020, which prohibit states from removing people from Medicaid, will end next month, meaning that local governments can resume eliminating people who no longer qualify for the program or do not furnish the required personal information, including address, income, and household size.
This process, known as Medicaid redetermination or Medicaid renewal, removes people who can no longer prove their eligibility within the required timeframe from Medicaid entirely. The Kaiser Family Foundation estimates that between 5 and 14 million people could lose their Medicaid coverage once the continuous enrollment provision ends.
Despite the far-reaching and potentially devastating consequences of this Medicaid eligibility change, approximately 64% of Medicaid members have heard nothing at all about upcoming enrollment requirements. From both a population health and a health equity perspective, this is discouraging news.
Disenrollment threatens already thin margins
People who are uninsured are less likely to seek care, which can lead to late diagnoses, high ED usage, and other adverse consequences that not only result in poor health outcomes but higher healthcare costs overall. As an industry, it is our duty to provide access to preventative care, chronic care and acute treatment when and where needed; by neglecting to inform and engage these populations to reenroll in their Medicaid plans, we are failing to practice what we preach.
Patients aren’t the only ones who will be affected by upcoming Medicaid redetermination requirements. Health systems and medical groups facing slim to negative operating margins risk further adverse financial impact with declining enrollees. Many expect to increase staffing for point-of-care enrollment, adding to cost and inefficiency. Medicaid managed care plans expect to see significant month-over-month variability in enrollment rates and up to 20-35% of revenue at risk.
There are both clinical and financial incentives to keep patients enrolled for all parties involved. Persistent enrollment promotes quality through preventative care and protects reimbursement when patients seek care. Healthcare systems reduce risk and improve efficiency by preventing patients from losing coverage, eliminating the additional burdens that come with reenrolling patients again and again in the future.
Connecting with the Medicaid population to make them aware of these changes and encouraging them to validate their qualification can also be a daunting task, especially after years of potentially lapsed contact.
Connecting with patients through digital engagement
To prevent these risks, states should reexamine how they engage with their Medicaid populations, including taking a closer look at individuals’ specific needs and preferences. And a one-size-fits-all approach to communicating with this audience will likely prove unsuccessful at the necessary scale.
We cannot overlook the need for multilingual, culturally-sensitive content unique to each person’s motivations. Educating each patient in advance of their redetermination date and activating those still at risk when the deadline looms through an omnichannel approach could tremendously improve effectiveness, ensuring that people don’t get lost in the system.
We have seen firsthand how leveraging digital communications in partnership with human efforts maximize patient engagement results and at scale — and this is a critical moment to embrace that approach.