The following is a guest article by Ashley Perry, MPH, Chief Strategy and Solutions Officer at Socially Determined
When Congress passed the Consolidated Appropriations Act of 2023, it decoupled the Public Health Emergency (PHE) from the Medicaid program’s continuous enrollment provision, which was implemented as part of the PHE in March 2020. It also established April 1, 2023 as the date on which the Medicaid redetermination process would resume nationwide.
The continuous enrollment provision resulted in substantial growth in Medicaid enrollment nationwide and helped bring the national uninsured rate to an all-time low. These recent gains in coverage are now in jeopardy with the unwinding of the provision. A recent analysis conducted by the Urban Institute projected that 18 million beneficiaries will lose coverage as a result of this process. While for many, this will be because they no longer meet the program’s eligibility criteria, estimates suggest that up to 40 percent of those who lose coverage will still qualify, they simply will not be able to complete the recertification process successfully, due to administrative and/or social barriers.
This will result in a number of negative consequences. Medicaid Managed Care Organizations (MCOs) will experience material reductions in their membership. Health care providers will experience increases in uncompensated care and bad debt. Most concerningly, some of the most vulnerable Medicaid beneficiaries will experience access to care issues and care gaps that could result in poor health outcomes and widening health disparities. To avoid these negative impacts, CMS, state Medicaid agencies and MCOs should leverage data and analytics to minimize the number of eligible Medicaid beneficiaries that lose coverage as a result of the redetermination process. Here are a few areas where a data-driven, analytics-first approach can help:
Updating Member Contact Information
During the three years that the continuous enrollment provision was in place, many Medicaid beneficiaries moved, and as a result, state Medicaid agencies and MCOs may not have current contact information for them. Updating member contact information is a key step in ensuring Medicaid beneficiaries are able to provide the necessary information to confirm their eligibility. There are added benefits for health plans investing in this, as it will also help maximize the reach and impact of existing member outreach campaigns, engagement strategies, care management programs, and other initiatives designed to increase member engagement and improve outcomes.
Assessing the Impact of Health Literacy Challenges and Language Barriers
Health literacy challenges and language barriers will also impact members’ ability to complete the recertification process. A recent study found that non-English speaking Medicaid beneficiaries are five times less likely to successfully recertify than those who cite English as their primary language. In addition, nearly half of all American adults have health literacy levels that may hinder them from comprehending the information requested on recertification forms and being able to complete them fully as required to maintain coverage. Data regarding beneficiaries’ preferred language and risk analytics around health literacy challenges can help MCOs proactively identify subsets of their members that may face these barriers. These insights can then enable plans to proactively reach out to these members to offer language and literacy level-appropriate support in understanding the redetermination process and providing the required information to maintain coverage.
Leveraging Demographic Data and Social Risk Analytics to Inform Outreach Strategies
State Medicaid agencies and MCOs alike are investing in a variety of outreach and education strategies to help eligible beneficiaries retain their coverage. For example, the California Department of Health Services (DHCS) has appointed coverage ambassadors to engage Medi-Cal beneficiaries within their local communities and deliver tailored messages about the process. These ambassadors include traditional health navigators, Community Health Workers (CHWs), Community-Based Organizations (CBOs), and other trusted community members. Texas has hired 1,000 additional employees to help administer the redetermination process for the state’s 6 million-plus Medicaid beneficiaries. Nationwide, many MCOs are making similar investments in member outreach, education and support strategies. Despite these investments, these resources are outmatched by the magnitude of beneficiaries that will be required to complete the process over the coming year. Demographic data and social risk analytics offer a data-driven, analytics-first, equity-focused strategy to proactively identify beneficiaries that face the greatest risk of not recertifying due to social barriers.
Maintaining coverage and access to care for eligible Medicaid beneficiaries should be a top priority for CMS, state Medicaid agencies, MCOs and health care providers to avoid negative health and business consequences alike. Leveraging available contact and demographic data, as well as social risk analytics, that are available through a variety of public and proprietary sources offers a key strategy for achieving this.
