Simple Outreach Tactics Plug Medicaid Redetermination Gaps

The unwinding of Medicaid’s continuous enrollment and resulting redetermination activities were supposed to be nearly complete by spring 2024. Now, the initiative may be pushed into the summer of 2024. In September 2023, the Centers for Medicare & Medicaid Services (CMS) ordered 30 states to pause their unwinding activities until they fixed operational errors causing still-eligible Medicaid members to lose coverage. As of late 2023, states reviewed just 28 million of the country’s 93 million Medicaid recipients.¹ More than 12.5 million people were dropped from Medicaid rolls by mid-December, and 71% of them due to procedural errors, which included failure to respond to a letter even if CMS sent it to an outdated address²

Losing eligible Medicaid members because of procedural or operational snafus at the state level hurts providers and health plans. Providers, many already operating with thin margins, need help to afford to see payer mixes shift toward increasing in uninsured patients. Payers don’t want to see their Medicaid-covered populations and contracts shrink. Payer-provider organizations, specifically those combining health plans and health systems, face both these risks.

Most importantly, patients and their families face potential gaps in care if they fall through the redetermination cracks. Research shows patients who lose coverage often delay getting the care they need, which can easily lead to exacerbations of chronic conditions or a minor health ailment becoming a major problem.³ When patients suffer from poorer outcomes, all industry stakeholders face the consequences of higher care costs.

With the CMS pause, there’s time for payers to take a larger role in helping their Medicaid members retain coverage or enroll in other appropriate coverage if they are no longer eligible for the program. Here are key steps your plan can take now:

1. Develop a digital-first, member-oriented outreach campaign. Research shows 96% of Medicaid members⁴ access the internet via their smartphones. Reaching out to members via text and email will deliver more value and be more effective than traditional mail. Digital outreach also enables members to respond conveniently when your plan builds in easy response options. Online resources and web microsites allow members to update their demographic data 24/7. Use hyperlinks and/or QR codes in texts and emails that take members to a state’s renewal portal or your plan’s information site and/or phone number.
2. Focus on texting but incorporate voice and outbound calling. More than 55% of members will respond to texts vs email, but some may still need to be reached via phone.5 Also, many Medicaid members still want a human touch when it’s time to complete renewal/re-enrollment tasks. Be ready with guided enrollment and determine whether your agents can help non-eligible members get coverage through an ACA marketplace plan. Voice options range from a toll-free helpline to two-way collaboration for members and live agents with HIPAA-compliant video-calling, co-browsing, screen sharing, and file-sharing tools. These can be done without requiring members to download or install apps or software. If appropriate for your member population, offer multiple language options.
3. Concurrently, clean up your member contact lists. Consider partnering with your key providers to capture the most recent member data. Providers may see patients your plan has yet to contact, so they may be the best source of up-to-date data. Other current data sources include RND, USPS, LexisNexis, state agencies, and other database providers. Working with organizations specializing in contact list enrichment and in compliance with state regulations is the most efficient way to ensure that mobile numbers are as recent as possible. Also, check to see which Medicaid members moved to commercial coverage so your efforts target the right members.
4. Use analytics to fine-tune the campaign. Your plan may send 3 or more texts and/or emails before a member responds. Analytics programs let you track click-through rates and evaluate the effectiveness of different tactics and messages against various demographics, such as age, location, utilization history, etc. Try different wording in texts and emails to keep messages fresh and attention-getting.
5. Use state resources when available. These may range from re-enrollment kits you can customize with your branding and messages to member renewal dates. Access to renewal dates enables you to batch renewal activities by those dates, so activities aren’t overwhelming.
6. Broaden your outreach activities. Community events, food drives, and school activities are good locations for flyers and posters with renewal/re-enrollment QR codes, helpline numbers, and/or information booths. Running local media campaigns will reinforce your digital outreach efforts.

Few would argue with the fact that state agencies are overwhelmed by Medicaid redetermination volumes. That means your plan’s outreach activities may be key to preserving managed Medicaid numbers. Effective outreach strengthens all stakeholders, helping network providers minimize their self-pay volume and preserving continuity of care and better outcomes for your members.

References

1. Galewitz P, Houghton K, Kelman B, Liss S. ‘Worse than people can imagine’: Medicaid ‘unwinding’ breeds chaos in States. KFF Health. Published November 2, 2023. Accessed December 20, 2023. https://kffhealthnews.org/news/article/medicaid-unwinding-disenrollment-redetermination-state-delays/
2. Medicaid enrollment and unwinding tracker. KFF Health. Published May 3, 2023. Updated December 13, 2023. Accessed December 20, 2023. https://www.kff.org/report-section/medicaid-enrollment-and-unwinding-tracker-overview/
3. Tolbert J, Drake P, Damico A. Key facts about the uninsured population. KFF Health. Published December 18, 2023. Accessed December 20, 2023. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
4. Vura-Weis L, Zaidi K, Shaffer B, et al. Reaching Medicaid members where they are: Online and on their smartphones. Boston Consulting Group. Published October 2022. Accessed December 20, 2023. https://media-publications.bcg.com/Reaching-Medical-Members-Where-They-Are.pdf
5. Firstsource internal data. Firstsource. 2023