Medicaid Redetermination: Ongoing Challenges Present Opportunities for Health Plans and Providers

Medicaid redetermination is happening as we speak, yet millions of Americans have lost or are expected to lose coverage. In fact, the Department of Health and Human Services has predicted 15 million will lose Medicaid, and that nearly half of them would maintain coverage if they simply re-enrolled. Why is this happening? And what can you do to help? Let’s take a look.

For over three years, Medicaid coverage had been continuous for tens of millions of recipients, thanks to the Department of Health and Human Services’ COVID-19 Public Health Emergency declaration. However, this protection expired on May 11, 2023, kicking off Medicaid redetermination. Today, states are in the thick of it, working to determine the eligibility of recipients.

The problem is, millions of recipients either don’t know they need to re-enroll or haven’t taken action. They may not have received their respective state’s communication in the mail or ignored the mail altogether. Traditionally, because of lower incomes and less access to resources, Medicaid recipients have been difficult to reach, exacerbating the issue. States are aware of this, and some are even offering 90-day grace periods to re-enroll. Still, something has to give.


Healthcare Organizations Helping Medicaid Recipients and State Administrators

Many healthcare organizations, including health plans, are taking action to help current recipients maintain coverage or enroll in new coverage if they no longer qualify for Medicaid. We’re seeing this the most at facilities which serve a high volume of Medicaid patients, including Federally Qualified Health Centers (FQHCs), Disproportionate Share Hospitals (DHSs), and community health centers.

In Louisville, Park DuValle Community Health Center has community advocates and other staff in place to help not just their patients, but any Kentucky Medicaid recipient, with their re-enrollment paperwork. They’ve had a strong media push in an effort to supplement the state’s outreach efforts.

Some healthcare organizations and state officials are collaborating. The state of Maryland, for example, is using CRISP, its health information exchange, to send managed care organizations (MCOs) and provider organizations secure reports of their patients who face redetermination in the next 90 days.


Steps Your Healthcare Organization or Health Plan Can Take to Help

Here are six steps you can take to help your patients or members go through the redetermination process:

  • Stay up-to-date on state laws.

Medicaid redetermination requirements vary among states. It’s essential to stay up-to-date on your state’s specific expectations, rules, and timelines.

  • Update policyholder information.

Outdated policyholder information can make reaching Medicaid recipients difficult. See if your state can help, as some partner with the U.S. Postal Service to coordinate address changes.

  • Create a contact strategy.

A practical approach for tracking outreach efforts is detailed and organized. Make it easy for your staff to know who they must follow up with and who has already completed their paperwork.

  • Increase your staff.

Additional staff, including customer service representatives, financial counselors, patient advocates, and social workers, can focus on members or patients in need. Keeping individuals enrolled means continuing to capture the associated revenue.

  • Identify high-risk enrollees.

Identifying Medicaid recipients at the highest risk of losing eligibility can help you reach out to them faster. Use data to pinpoint which policyholders were previously on the cusp of income limits.

  • Publish helpful content.

Now is the time to publish content related to Medicaid redetermination. Update your website to notify policyholders of the redetermination requirements.

For much more detail around each of these steps, read our article: “Six Steps to Manage Medicaid Redetermination and Help Individuals Maintain Coverage.”


The Type of Staff Our Clients Are Hiring for Medicaid Redetermination Efforts

Our Medicaid clients—which are largely comprised of health plans, FQHCs, and MCOs—are proactively hiring staff based on their planned activities. At this point, many of our clients are continuing to focus on outreach, with a heavy emphasis on direct mail and texts. This has translated to various administrative needs, including staff to execute the outreach and experienced people in financial counseling and patient advocacy to manage the replies and walk recipients through the re-enrollment process. 

We’re also starting to see an increased demand for professionals to help conduct a potential large influx of post-eligibility reviews, to ensure recipients are either successfully re-enrolled in Medicaid or enrolled in another form of insurance.

Medicaid redetermination has proven to be a challenge. The number of people who have already lost coverage has triggered a sense of angst for states. But states can’t be in this alone. Health plans and providers need to continue to step forward and engage with their members and patients. Many of these individuals need step-by-step assistance to either re-enroll or find alternative coverage. There’s too much at stake from a revenue standpoint, and more importantly, from a patient care management standpoint, not to be involved.

We’ve worked closely with our clients throughout this process and are following redetermination every day. If you need staff to help with outreach and advocacy, we’re here to help.

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