Readers Write: What’s Needed to Resolve the Medicaid Redetermination Crisis

What’s Needed to Resolve the Medicaid Redetermination Crisis
By Carrie Kozlowski

Carrie Kozlowski, OT, MBA is co-founder and COO of Upfront Healthcare of Chicago, IL.

More than 90 million Americans, including children, the elderly, people with disabilities, and veterans rely on Medicaid for their health coverage. Many of them are now losing that coverage with the expiration of the COVID-19 relief laws this spring.

According to the Kaiser Family Foundation (KFF), as of mid-July, more than two million people have lost Medicaid coverage since April 1, 2023, with most of them removed from state rolls for technicalities, such as missing the deadline to complete their forms or to file certain required documents. The Centers for Medicare and Medicaid Services’ (CMS) also found that 31% of renewals resulted in someone dropping Medicaid or Children’s Health Insurance Program (CHIP) benefits, with an alarming 79% of the beneficiaries losing coverage due to procedural reasons, not because they no longer qualified due to income or changes in family arrangements.

In total, KFF estimates that 15 million people will be dropped from Medicaid over the course of the year under this “Medicaid unwinding” process. The result? Healthcare enterprises will experience a gap in compensation for care, operational efficiency will suffer, and patients will get sicker during this post-pandemic Medicaid redetermination period.

The federal government is stepping in to try to stem the crisis. On July 19, CMS reported that it has intervened with several states, requiring them to pause procedural terminations and reinstate individuals. Moving forward, the CMS will be closely tracking state data and fielding complaints to identify problems early with renewals and take corrective action, according to the fact sheet “Returning to Regular Medicaid Renewals: Monitoring, Oversight, and Requiring States to Meet Federal Requirements” released by the agency.

More efforts are needed, however. Basic lack of awareness about the changes in the laws is a key part of why the Medicaid unwinding process is turning into a crisis in many states. A Robert Wood Johnson Foundation survey, “Awareness of the Resumption of Medicaid Renewal Processes Remained Low in December 2022,” revealed that approximately 64% of Medicaid members had heard nothing at all about the enrollment requirements, leaving them vulnerable to losing their coverage.

All this is a significant concern, not only from a population health and health equity perspective, but it also because it has far-reaching financial implications for health systems and medical group that are already facing slim to negative operating margins. With declining enrollees, they risk further negative financial impacts and may need to increase staffing to facilitate point-of-care enrollment, adding to the costs and inefficiencies.

It is crucial for health systems to keep patients enrolled in Medicaid, not just for the sake of their health, but for the financial stability of their own operations. Keeping them enrolled ensures that they can continue to receive preventative care, which leads to improved health outcomes, protected reimbursement, and reduced overall healthcare costs.

From an operational standpoint for health systems, it is also in their best interest to keep Medicaid patients covered so they do not lose access to primary care providers, causing delayed time to treatment and sicker patients admitted to hospitals, flooding intensive care units, and causing backlogs in emergency departments that can reverberate through the hospital and can delay elective surgery schedules.

Alarmed by the numbers of people losing insurance, some states are taking a more proactive approach to notifying and educating people about the new verification process for maintaining coverage. But a one-size-fits-all approach will not be effective in communicating with this diverse audience. Connecting with these different populations requires understanding their unique needs and preferences and delivering culturally sensitive content in multiple languages. Digital health solutions are well positioned to help states and providers achieve their shared goal of engaging Medicaid patients.

Combining digital communications with human efforts is critical to achieving this daunting task. Trust plays a role as well, as more people with Medicaid express wariness about their providers. The report “A Two-Way Street: Building Trust Between People with Medicaid and Primary Care Doctors” published by Public Agenda found that four in 10 say doctors need to earn their trust. Communicating with these patients in culturally sensitive and health literate language should be central to the strategy for engaging them to play a more proactive role in their healthcare.

By leveraging patient data and insights, technology can help personalize the content and optimize the outreach by channel, ultimately improving effectiveness and ensuring that patients do not get lost, while building a greater bond of trust between them and their providers.

As states continue to unwind the Medicaid continuous enrollment provision, there are opportunities to promote continuity of coverage among enrollees who remain eligible by implementing a patient engagement strategy that leverages digital communications along with human efforts to reach, educate, and activate patients.