Medicaid Redeterminations: ACHP Members’ Efforts to Protect Access to Coverage

October 26, 2023

By Nissa Shaffi

Imagine having to complete a mortgage application every 6-12 months. Now imagine that doing this accurately and on time could mean the difference between having health care or not. 

That is the daunting task that as many as 95 million Americans face this year as states re-evaluate the eligibility of Medicaid beneficiaries post-pandemic, through a process known as redeterminations. Since April, over nine million Americans have lost their Medicaid coverage. That number is expected to at least double by next spring as states across the country complete their redeterminations. And in just 20 states tracking disenrollments by age, about 1.8 million of those that have lost coverage are children. 

Medicaid redeterminations, also known as renewals, were conducted annually pre-pandemic. During the Public Health Emergency, redeterminations were halted to ensure individuals retained access to coverage. The three-year pause spurred historic levels of enrollment in both the Medicaid and Children’s Health Insurance Program (CHIP). States are now unwinding protections, resuming operations to assess the Medicaid eligibility for over 95 million people. 

Medicaid enrollees, many of whom are low income, less educated and often grapple with health literacy and other social factors, face difficulties navigating complicated eligibility forms requiring numerous types of documentation. And for some people with complex needs, this process is required multiple times a year. The rapid rate of disenrollments has placed a significant burden on the entire health care ecosystem, as states, patient advocates and health plans struggle to keep up. Chief among these concerns is preventing gaps in coverage due to disenrollments. 

Compounding these barriers, many beneficiaries enrolled in a Medicaid Managed Care Organization (MCO) are unaware that their coverage is through Medicaid and not the insurer whose card they carry in their wallet. Many are confused about why they are being redetermined and too often ignore requests to renew eligibility. 

With all of these factors in play, states, health plans, community organizations and providers are tasked with the herculean effort to protect access to health care for tens of millions of adults and children. Nonprofit regional plans have implemented a range of creative approaches to inform beneficiaries of redeterminations and guide them toward securing coverage and care. 

Partnering with allies in Washington, DC,  ACHP secured new flexibilities to conduct outreach using various modalities of communication, such as phone, text, email and voice mail, to reach consumers and deter coverage loss. These flexibilities allow consumers to receive critical, timely information to renew their coverage. 

Non-profit health plans have been at the forefront to help their communities throughout the redetermination process. By issuing colored envelopes to distinguish renewal forms, hosting community events and deploying communications campaigns that call on individuals to update their contact information, ACHP member companies have acted swiftly to protect access to coverage. Further, ACHP member companies have leveraged their outreach to streamline eligibility for other social services, such as food and housing needs. 

ACHP member companies used these new flexibilities enabling health plans to assist consumers with their renewal forms. Independent Health established dedicated teams and call centers to ensure consumers are directed to the appropriate agents for their renewals. To assist enrollees with their applications, the Buffalo-based plan certified team members, both in Medicaid and the individual market, to assist consumers with their renewal paperwork and enrollment processes, so that they have a seamless experience in renewing or transitioning to other forms of coverage. 

Other ACHP member companies have capitalized on their long-standing local and state relationships to reach residents who may be losing coverage. In New Mexico, Presbyterian Health Plan has co-branded messaging with the state alerting individuals that their coverage is up for redetermination and what they need to do to stay covered. Presbyterian Health Plan also participates in weekly calls with the state and other Medicaid MCOs to collaborate on consumer outreach and messaging. In DC, ACHP secured flexibilities granting pharmacists and community-based organizations the ability to conduct presumptive eligibility for enrollees.  

Recent Healthcare.gov data show that out of 436,000 individuals who were disenrolled from Medicaid or CHIP coverage in June, 382,000 were determined eligible for marketplace coverage. Although lags in data on transitions to coverage from Medicaid to the individual market persist, these numbers show the power of targeted outreach efforts in keeping people covered. 

Medicaid consumers navigate a host of social and environmental barriers on a daily basis. What this historically disadvantaged population needs most is adequate support and accessible information on how they can maintain their coverage. To build consumer trust, member companies such as Michigan-based Priority Health, have tailored the messaging and frequency of their outreach based on the unique needs of the recipient to maximize impact. For example, individuals requiring greater coordination received personalized phone calls and in-person visits from their care managers regarding their Medicaid renewal. 

The COVID-era pause on Medicaid redeterminations protected millions of working families with affordable coverage and care at a time of great uncertainty. As the nation moves into the post-pandemic phase and states resume redeterminations, it is critical policymakers remain flexible to innovative solutions devised by regional health plans, on the ground, working in their communities. ACHP and our member companies remain steadfast in ensuring individuals have the resources they need to stay covered and healthy.  

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