Key Strategies to Help States Prevent a Potentially Historic Loss in Health Insurance Coverage Nationwide

By: Jamila McLean, Senior Healthcare Policy Manager

Medicaid — the nation’s largest insurance provider — helps millions of families afford access to healthcare each year. With a wave of health insurance loss expected over the next 12-14 months, due to the expiration of continuous coverage protections for Medicaid recipients, families and individuals across the country are at risk.  

In December, Congress passed a bill allowing states to resume Medicaid redeterminations beginning next month. As a result, experts estimate that millions of individuals will remain eligible for Medicaid, but may lose coverage or “churn” off the program for not submitting paperwork on time, or other administrative reasons.  

There are several policy and process strategies states can implement to reduce the likelihood of churn within their Medicaid population. Benefits Data Trust (BDT) has been working closely with states across the country, and below are three key strategies we believe will help streamline the transition for government staff and Medicaid recipients.  

Streamline renewals using available data 

Medicaid regulations require that state Medicaid agencies first attempt to renew a Medicaid enrollee automatically using all available, reliable data without requiring information from the enrollee. This process is known as ex parte, automated, administrative, or passive renewals. States have significant flexibility in determining what data sources are deemed reliable and can be used to streamline renewals. Steps states can take include: 

  1. Ensure all Medicaid enrollees are included in the ex parte process. Populations that are often noticeably excluded are seniors and people with disabilities. Challenges verifying eligibility factors — like income and assets — often complicate the process for these populations. To help states increase ex parte renewals for them, BDT has developed a memo detailing policy and process options.  
  2. Leverage as many data sources as possible: States should review their eligibility system design documents to ensure they are maximizing the ex parte process by using all the data sources possible (e.g., Supplemental Nutrition Assistance Program, Quarterly Wage Data), and exploring options to increase the number of data sources used. 
  3. Assess and adjust the reasonable compatibility threshold for income and assets. Reasonable compatibility allows states to accept the information an enrollee provides if it does not vary significantly from the information received from a data match. Guidance from the Centers for Medicare & Medicaid Services recommends states set a reasonable compatibility threshold of 20 percent for income.  

Update mailing addresses 

Prior to the pandemic, Medicaid enrollees would often lose coverage because they did not return their renewal packets. Medicaid recipients experiencing housing instability may change addresses frequently, increasing the likelihood of mail not being received. To reduce the likelihood of returned mail or mail being delivered to incorrect addresses, states should make a consistent effort to ensure all enrollee contact information is updated and accurate, including  

  1. Accept address changes from managed care organizations, which have demonstrated strong relationships with their clients, reliable information, and ample resources. As such, states should ensure they are leveraging this temporary waiver flexibility to update enrollee information.  
  2. Develop a robust communications and outreach strategy to encourage enrollees to update their contact information. Enrollees should be given the opportunity to update their information by all means possible — including online, in person, or over the phone — and should have clear directions on how to access additional support, if needed. Ensuring that messaging is consistent and displayed on prominent platforms like state websites is a great first step. BDT has compiled some best practices for states to collect updated addresses based on existing state examples.  
  3. Equip stakeholders with outreach and communications resources. Key stakeholders, such as community partners, are able to assist in this unwinding process. By working with trusted community partners, states can amplify their message while maintaining consistency. California and Pennsylvania have already developed toolkits and resources for external partners.  

Catch Problems Early 

To track the progress of states’ unwinding efforts, new provisions in the 2023 spending bill require states to submit a baseline report and monthly reports and make that data publicly available. The data collected can be used to catch problems early and course correct as needed. Quantitative measures like call center volume and return rates for mail can help states identify a need for more outreach or support. Additionally, qualitative data from community partners that assist Medicaid enrollees in the application or recertification process can provide vital and timely information that can be used to ensure vulnerable communities are not being left behind in the unwinding process.  

States should also consider additional opportunities to collect data to evaluate their unwinding efforts. If states implement large scale outreach campaigns across multiple modalities including mail, text, and paid media, there is a unique opportunity to understand the efficacy of their outreach and communications efforts. Insight on which types of outreach are most effective across different populations can inform how states approach communications in the future, improving equity and helping to protect coverage for Medicaid enrollees beyond the unwinding.