Six Steps to Manage Medicaid Redetermination and Help Individuals Maintain Coverage

This year, with the Families First Coronavirus Response Act’s Medicaid Continuous Enrollment Provision ending on March 31, states must review the eligibility of their current Medicaid recipients through a redetermination process. Some states may refer to the Medicaid redetermination process as eligibility redetermination, renewal, or recertification. Before we get to the six steps to help your health plan or provider organization manage Medicaid Redetermination, let’s cover a few things you and your staff need to know.

The provision led to higher enrollment. The number of Americans enrolled in Medicaid in February 2020 (before the COVID-19 pandemic) was 71.1 million; by October 2022, that figure grew to 91.3 million. In 2021, only 8.6% of Americans were uninsured, matching an all-time low. But the tide has turned. Today, experts estimate that anywhere between five and 14 million Americans will lose healthcare coverage in the 12 months following states reactivating Medicaid redeterminations. The U.S. Department of Health and Human Services also estimates that close to 6.8 million who lose Medicaid benefits will still be eligible.

While the Centers for Medicare & Medicaid Services require states to create a renewal redistribution plan for phasing out the continuous Medicaid provision which outlines how to reduce insurance coverage gaps, there are plenty of steps that your organization can take to make the redetermination process smoother for recipients and to maintain revenue.

Stay up-to-date on state laws.

The Medicaid redetermination process is mainly dependent on your state. Not only do Medicaid requirements vary among states, but so does the redetermination process. It’s essential to stay up-to-date on your state’s rules and timelines so that you can better advise beneficiaries. Some of the most common questions of those undergoing the Medicaid redetermination process will relate to income and timelines.
One of the most pressing Medicaid topics across states has been the expansion of Medicaid and all of the state-based laws around it (see a status update here). In the world of healthcare, things are constantly changing, and state Medicaid programs are not immune to the change.

Update policyholder information.

One of the biggest challenges of the Medicaid redetermination process will be reaching and informing people. Outdated policyholder information can make reaching current and continuous Medicaid recipients difficult. With COVID-19 pushing back Medicaid redetermination, some agencies haven’t communicated with policyholders in almost three years.

Additionally, many people moved during this time, leading to significantly outdated information. The financial difficulties that the pandemic caused also led to many Americans using Medicaid for the first time, and they may not be aware of the recertification requirements. It’s worth noting, some state Medicaid programs do partner with the U.S. Postal Service to coordinate address change information.

Create a contact strategy.

Reaching out to thousands of individuals to complete the redetermination process is a huge task that requires a strategy. Creating a plan can improve the process, making it timelier and more convenient for your staff and policyholders. A practical approach for tracking outreach efforts is detailed, organized, and data-driven. A planning guide makes it easier for staff to know who they must follow up with and who has already completed the redetermination.

It can also be helpful to create a list of healthcare recommendations for those who may lose their Medicaid eligibility. Sharing this list with your staff ensures those disqualified for Medicaid understand their options. People who lose their continuous Medicaid eligibility may have never shopped for healthcare insurance, meaning they will likely have many questions.

Increase your staff.

Some states require specific staffing levels or experience to accommodate the redetermination process. High vacancy rates and many new hires with limited experience can significantly slow the Medicaid redetermination process, leaving people without proper healthcare coverage. A healthcare staffing partner can help you add extra staff to prepare for Medicaid redetermination, lowering wait times and ensuring all policyholders receive the assistance they need.

The additional staff, including customer and member service representatives, financial counselors, and even social workers, can focus on updating policyholder contact information and getting the word out about redetermination. You can expect a significant increase in phone calls, making extra staff helpful. Follow-up is also essential in the Medicaid redetermination process. Many states automatically unenroll beneficiaries if they don’t complete the redetermination process. Thousands of people in each state who still qualify for Medicaid may not be enrolled because they didn’t receive communication about the redetermination process, leaving them scrambling.

Identify high-risk enrollees.

Identifying Medicaid recipients at the highest risk of losing eligibility can help you reach out to them faster. Using data, you can pinpoint which policyholders were previously on the cusp of income limits. Some data predictors also use education and credit scores to determine which Medicaid recipients will most likely lose their eligibility this year. Oftentimes, these individuals will need guidance and reassurance as it relates to their coverage options.

Publish helpful content.

Sometimes, you must go beyond phone calls and emails to reach policyholders. Many Americans don’t answer phone calls from numbers they don’t know, and spam filters may prevent them from ever viewing your email communications. Now is an excellent time to publish content related to Medicaid redetermination. Update your website to notify policyholders of the Medicaid redetermination requirements. Post or share news from local officials on your social media sites.

Millions of Medicaid recipients could lose health insurance. Now is the time for health plans and providers to reach as many recipients as possible. Increased staff and data are critical to this process. Are you in a position to help recipients maintain coverage and care? And to ensure your organization sees the associated revenue?

For more on overcoming the challenges of Medicaid redetermination and preventing gaps in coverage, care and revenue, download our guide

Work with a Trusted Healthcare and Life Sciences Staffing Agency.

We help companies find great talent — and great talent find great jobs.