The Latest on Medicaid Redetermination and the Impacts for Your Organization

State health departments, payers, and providers have been working on Medicaid redetermination for months. After all, continuous Medicaid coverage expired on May 11 of this year. While much of the workload to re-enroll or decline recipients has fallen on state administrators, payers and providers should be actively engaged with their members and patients to help them through the process. But where are we in that process? And how will redetermination continue to impact your organization?


Where are we in the Medicaid redetermination process?

There has been some progress since earlier in the summer, but it’s been hampered by issues. This is illustrated by looking at the latest news from several states. 

In Texas, for example, over 500,000 people have been dropped from coverage for “procedural reasons, like not responding to messages from the state.” The entire process has proven to be quite complex. “Now, hundreds of thousands of Texans are scrambling after suddenly losing health insurance—and the consistent care from trusted health care providers that it enabled them to access. Meanwhile, advocates say many of the people who lost coverage may actually still be eligible, and they’re calling for the state to pause redeterminations until they can ensure low-income children don’t fall through the newly apparent cracks in the renewal system.”

In Indiana, Kentucky, and Ohio, it’s much the same, with procedural errors leading to mass loss in coverage. State administrators even received a letter from the Centers for Medicare & Medicaid services, expressing concern and stating, “We urge you to take further action to reduce the number of terminations for procedural reasons as quickly as possible.” A significant part of the issue is simple: the fact that recipients are unaware that they must re-enroll. Already a generally difficult population to reach, many individuals moved during COVID-19, and didn’t update their contact information.

If there’s a silver lining, it’s that problems have been identified, and solutions are being developed. States are working with the federal government to overcome challenges. And more payers and providers, such as Blue Cross Blue Shield, are proactively reaching out to patients, educating them, and walking them through the process. This joint effort will be the most effective way to prevent millions more from losing Medicaid and having to scramble to find alternative coverage.


How will this impact your organization?

There’s a long list of concerns for payers and providers, but the primary two are that patients will lose coverage, possibly compromising their well-being, while organizations will lose revenue and reimbursements related to patient care. Medicaid redetermination will also undoubtedly have a negative financial effect on hospitals and health systems, driving more emergency department traffic and leading to more charity care. Payers and providers must be proactive in order to alleviate this negative effect.

Fortunately, as outlined in our previous article, “Six Steps to Manage Medicaid Redetermination and Help Individuals Maintain Coverage,” there are steps you can take to understand the ins and outs of redetermination, get in touch with your recipients, and guide them through the process.

Continue to follow your state’s 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 changes so that you can better advise beneficiaries.

Update policyholder information.

Outdated policyholder information can make reaching current and continuous Medicaid recipients difficult. 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.

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 process, leaving people without proper healthcare coverage. Rely on an experienced staffing partner such as Medix to find the flexible, temporary customer and member service representatives, financial counselors, and social workers you need during redetermination.

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.

Publish helpful content.

Sometimes, you must go beyond phone calls and emails to reach policyholders. Now is an excellent time to publish content related to Medicaid redetermination. Update your website to notify policyholders of the Medicaid redetermination requirements, and share news from local officials on your social media sites.

Medicaid redetermination has moved slowly, delayed by a number of issues. While unfortunate, that has also meant more time for payers and providers to get involved—to assist their respective states by helping individuals go through the redetermination process, and even find alternative coverage when former recipients are declined. Understand what’s happening in your state, increase your staff, and engage with your recipients before more are left without coverage and care.

To find the temporary staff you need to engage with your Medicaid recipients, and allow your permanent staff to focus on their day-to-day responsibilities, contact us today.

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