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Millions are losing Medicaid coverage due to complex eligibility processes.

Between April and October 2023, more than 9 million people lost their Medicaid coverage. According to national data, 70% of disenrollments have been due to procedural issues, where states can’t confirm eligibility information. This is notably different from states identifying individuals who no longer qualify for coverage. Children are disproportionately affected by the loss of coverage due to procedural issues.

In late August, CMS took actions to slow the wave of procedural disenrollments. After a review of state auto-renewal systems, 29 states and the District of Columbia paused procedural disenrollments. But states like California have helped slow procedural disenrollments with strong redetermination processes and partnerships with payers.

Insights from CAHP: How California Mitigated Medi-Cal Redetermination Issues

During a session at CAHP (California Association of Health Plans) titled “Medi-Cal Redeterminations: Reports from the Field,” a panel comprised of health payers and government agencies discussed California’s effective strategies for mitigating the loss of coverage during Medicaid redeterminations.

California stands out as a state with one of the highest percentages of its population covered by Medicaid/CHIP, 26%.

Roshena Duree, Deputy Director of Self Sufficiency Policy at the County Welfare Directors Association of California, emphasized the increasing importance of Medicaid in providing affordable coverage to residents. Notably, California insures 15% of the entire national Medicaid population, and Medi-Cal members account for 50% of all births in the state.

California’s success can be attributed to their robust Medicaid unwinding plan and partnerships with health plans. Their prioritization of a scalable eligibility confirmation process, member outreach, and alternative avenues to coverage curbed coverage loss.

According to speakers at CAHP, California achieved a lower Medicaid disenrollment rate compared to other states, ~15%. Let’s dive into why.

Collaborating with Health Plans to Stem Coverage Loss

States have successfully prevented mass disenrollments by partnering with health plans and community organizations to reach vulnerable members.

Michael Hunn, CEO of CalOptima Health, highlighted CalOptima’s successful collaboration with Orange County’s social service agency. CalOptima, responsible for insuring one-third of Orange County’s population, faced a significant surge in inquiries since disenrollments resumed. Hunn shares that ~30% of CalOptima’s call center calls were related to the redetermination process.

CalOptima allocated $6 million for hiring 40 health navigators. Navigators played a pivotal role in assisting individuals with the redetermination process. Prior to the reassessment period, projections noted a potential 20% drop in enrollment for CalOptima. However, expanded internal resources and direct communication with members have successfully minimized enrollment losses.

Jarrod McNaughton, CEO of Inland Empire Health Plan, shared a similar approach. Inland Empire proactively addressed coverage losses during the redetermination process by recruiting 60 full-time employees dedicated solely to reassessment efforts.

These collaborative efforts between states, health plans, and community organizations contribute to California’s lower rate of Medicaid disenrollment.

Improving Access to Accurate Contact Data

Member support and outreach fails when states don’t have accurate contact information.

California is facing challenges finding accurate contact data. And it is only getting harder. During the pandemic, accurate member contact data went up to 60%, and has now dropped to 12%.

Managed Care Organizations (MCOs), brokers, and community partners are vital resources for getting in touch with members. However, those who are hardest to reach often have limited points of contact, and data from community and provider perspectives can be sparse.

Recognizing the urgency of this issue, Medicaid agencies are pursuing federal funding to enhance electronic, automated data-sharing systems that can streamline changes to individual eligibility. Achieving this necessitates close collaboration between identity and income data sets, state Medicaid agencies, and community support systems.

The availability of a 90/10 match for IT initiatives linked to eligibility and enrollment systems provides a significant incentive for tech-driven solutions.

Assist in Transitioning to Alternative Forms of Coverage

For those who no longer qualify for Medicaid coverage, California has helped prevent growth in uninsured rates by supporting the transition to Marketplace coverage.

A small but meaningful number of individuals are moving from Medicaid to Marketplace. As of June 2023, more than 291,000 former Medicaid enrollees have made the transition to Marketplace-qualified health plans (QHPs) through Additionally, over 63,000 individuals have chosen QHPs through state-based marketplaces.

California is one of 4 states to have implemented auto-enrollment protocols for at least some people whose Medicaid is terminated during redeterminations. This eliminates the need for members to select and actively enroll in a QHP.

However, the need for enhanced integration between Medicaid and Marketplace systems remains. This collaboration should prioritize data sharing and ensure consistent messaging to members throughout the transition process. But breakdowns in data silos can be tough, especially for states and plans operating on the Federally Facilitated Marketplace.

Inconsistent infrastructure and data siloing limit the ability of Medicaid systems and Marketplaces to communicate. The exchange between Medicaid and Marketplaces is highly variable across the country. Monolithic systems cannot communicate the way states need them to.

An effective, coordinated approach will be essential in easing the transition and mitigating the potential loss of coverage for vulnerable individuals.

To learn more about how states and health plans are using technology to transition individuals between coverage types, reach out to start a conversation.