Skip to main content

Are you struggling with having to reassess millions in the next few months? Learn how other states are approaching this daunting reality.

Tight budgets, staffing limits, and the need to meet the needs of your state means Medicaid agencies need to think outside the box.

Some states – given the complexity of reassessing nearly 100 million Medicaid recipients in 12 to 14 months – are creating redetermination processes with two critical tenets:

  1. Scalability. Millions of people need to be communicated with and reassessed. Most states have limited budgets to complete the redetermination process, so they are seeking automated processes that eliminate the need for investment in additional overhead. Processes that can then be scaled back once the Medicaid unwinding period is over.
  1. Personalization. Most Medicaid enrollees have no knowledge of the redetermination process, and Medicaid unwinding is expected to result in the loss of coverage for as many as 15 million people, including 5.3 million children. Some states are trying to mitigate this confusion and the potential loss of health insurance through communication and custom unwinding plans.

The stakes are high. Afterall, Medicaid and Children’s Health Insurance Program (CHIP) enrollment has grown to 91.3 million people as of October 2022, an increase of 20.2 million since the start of the COVID-19 pandemic. State agencies, many of which are understaffed and under-resourced, will need to review the records of all 91.3 million recipients within 12 to 14 months to determine if they remain eligible to receive Medicaid coverage.

Most Medicaid Enrollees Have No Knowledge About the Upcoming Medicaid Reassessments: Stretching Out the Time Span

It’s safe to say most Medicaid enrollees are not expecting their state to initiate a process to determine whether they are still eligible.

A December 2022 survey by the Robert Wood Johnson Foundation determined 64.3 percent of adults enrolled in Medicaid or with an enrolled spouse, partner, or child had heard nothing at all about the upcoming redetermination process. An estimated 5.1 percent had heard a lot, 13.9 percent had heard some, and 16.0 percent had heard only a little. The December 2022 survey results closely mirror the June 2022 findings.

Adults with Family Medicaid That Did Not Know
about Medicaid Renewals Resuming
How States Are Using Scalability and Personalization to Reassess Millions

As the result of a provision in the 2022 year-end omnibus spending bill, states can begin their Medicaid renewals and redeterminations as early as April 1, 2023. States have 12-14 months to ‘unwind’ their Medicaid and CHIP populations. No more than 1/9 of the population can be removed in any month. 

Some states, such as Arkansas, are moving to reassess their populations in only 6 to 9 months. Unlike many states, Arkansas “continued to conduct renewals and redeterminations” during the COVID-19 public health emergency and “identified more than 420,000 people who appear to be ineligible for Medicaid and need to go through the renewal process by the end of September to determine whether they qualify.” The state’s interim work combined with the initiation of renewal letters in February is likely to “make the process of conducting renewals an easier, though still daunting, task.”

Five Ways to Achieve Scalability and Personalization

States are using these five ways to achieve scalability and personalization while saving resources, reducing Medicaid staff administration burden, and ensuring the right people stay enrolled.

  1. Stagger and stage redeterminations and use member data to create a custom Medicaid unwinding plan

In lieu of a time-based approach, states can deploy a population-based renewal approach that recognizes risk. Starting with ‘low-risk’ populations allows eligibility workers to expedite reassessments, e.g., people who have moved out of state. Higher risk populations such as members undergoing expensive, life-saving treatments, can be pushed out to allow for additional attention.

Delaware, for example, is pursuing a State Plan Amendment to allow for 12-month continuous coverage for pregnant women, which would have the effect of moving those women to the latter half of the redetermination process.

Oregon is prioritizing easier renewals so long-term care residents, enrollees with no permanent address, and those whose primary language is not English will have more time to respond to outreach efforts.

  1. Streamline 65+% of redeterminations with ex parte renewals

Ex parte renewals use pre-existing data sources rather than the submission of a renewal form to manage redeterminations. It reduces the administration burden for Medicaid enrollees and agency staff. Partnering with a vendor can enable states to improve their access to data sources and ultimately increase their rate of ex parte renewals.

As Jack Rollins, the director of federal policy for the National Association of Medicaid Directors, observed, “The more that states can maximize the success rate of the automatic enrollment process, the more that state will be able to alleviate the workload on those frontline eligibility workers, which is pretty important because what our members are trying to gear up for is having sufficient staffing and resources.”

  1. Scale communication efforts – update templates and partner with member touchpoints

States such as Louisiana are confirming member information now. The state has two million Medicaid recipients, up by 442,000 since February 2020. That’s 42 percent of the state’s entire population. The first step in their 12-month process is to send letters in March to all Medicaid enrollees in an attempt to verify their contact information. The letters will be pink in the hope people will pay attention.

Tara LeBlanc, the executive director for Louisiana’s Medicaid program and leader in the unwinding process in her state, emphasized, “[The letter] tells the member they need to keep their contact information up to date and to start watching their mail and they need to read the mail and respond accordingly.” No immediate action is needed, but Medicaid recipients “should watch their mail closely for more information about their enrollment status to arrive.”

Other states like Ohio are partnering with managed care organizations (MCOs) who often have more frequent communication with enrollees. MCOs are able to provide more current contact information, outreach to targeted enrollees due for renewal, and help enrollees who no longer qualify for Medicaid coverage to transition to a comparable, low-cost marketplace plan.

North Carolina currently has 2.9 million Medicaid recipients and estimates up to 300,000 beneficiaries could lose full coverage due to reassessments. The state has created a toolkit of communication messages for health plans, community partners and advocates to help increase enrollee awareness. (Note: in early March, North Carolina legislators reached a deal to expand Medicaid to additional low-income adults. If enacted, expanded Medicaid coverage would begin in January 2024.)

  1. Improve the user journey and remove renewal pain points through automated client interactions

States are pushing enrollees to renew their coverage online via a portal or over the phone. Automated customer service channels with interactive voice response (IVR) can help reduce call center backlogs. The analytics that come with a digital engagement strategy allow states to monitor the number of enrollees that abandon the renewal process before completing it.

In South Carolina, for example, members are encouraged to update their address, phone number and email address online. Michigan, in addition to creating action teams to collaborate with health plans, community mental health organizations, and other partners, has developed a web portal to keep residents up to date with information about their Medicaid benefits. Nevada uses a mobile app to communicate with members, but less than 2 percent of enrollees have signed up.

  1. Lean on technology vendors to expedite redeterminations and move towards integration

Vendors are helping states automate eligibility determinations through customizable business rules. For example, members eligible for SNAP are often also eligible for Medicaid. Designating this population as ‘low risk’ (see #1) and expediting those who receive SNAP can reduce reassessment workloads.

The Centers for Medicare and Medicaid Services (CMS) is requiring states to create unwinding plans. As of February 3, 2023, 41 states had publicly posted their full plan or a summary.

Softheon’s Medicaid experts are available to discuss your state’s unwinding plan. To schedule a call, click here.

For state agencies looking to solidify their Medicaid unwinding plan, email to schedule a call.