On the Ground with State Agency Partners Navigating the Medicaid Unwinding

By: Miriam Lipschutz, Policy Manager

Webinar Recording
Medicaid Strategies Making a Difference: A Spotlight on Rhode Island
In a webinar highlighting one of the states in our Medicaid Churn Learning Collaborative, we share key tactics around outreach to participants and automated – or ex parte – renewal processes that the state of Rhode Island is using to help eligible people stay covered.

In the past few months, several members of BDT’s Policy and Research teams, including myself, crisscrossed the country to meet in person with staff from several state Medicaid agencies that Benefits Data Trust (BDT) is working with to help eligible families stay covered by Medicaid. When eligible people lose their Medicaid coverage only to apply again and get re-enrolled, it increases both administrative and healthcare costs, as well as results in poor health outcomes for the people whose healthcare coverage is interrupted.  

My colleagues Jamila McLean, Lucas Caldwell-McMillan, Jillian Humphries, Alexis Clark, and I packed our bags and spread out nationwide, headed to Medicaid agency offices in California, North Dakota, Rhode Island, South Carolina, and Washington state to help their teams build plans and take steps to reduce what’s known as Medicaid churn.

Left Image: BDT's Jamila McLean, Miriam Lipschutz, and Alexis Clark with the California Dept. of Healthcare Services; Right Image: BDT's Jamila McLean and Alexis Clark with the Washington State Health Care Authority

For the last year, with funding from the Robert Wood Johnson Foundation, we have met at least monthly with each state on different strategies, all toward the goal of streamlining the Medicaid renewal process for agency staff and participants alike. 

The work underway in each of these states is more critical now than ever as 93 million people, the largest number of Medicaid recipients in history, must renew their health insurance coverage for the first time in three years, following the end of the federal government’s continuous coverage requirement. New national data indicates that over 3.7 million Medicaid members have lost coverage just since April when this process began – 74% of which have been due to procedural reasons like not returning a renewal packet.

Left Image: BDT's Lucas Caldwell-McMillan and Jillian Humphries with the North Dakota Department of Human Services; Right Image: BDT's Jamila McLean, Jillian Humphries, and Alexis Clark with the South Carolina Dept. of Health & Human Services

The ethos of our Medicaid Churn Learning Collaborative is about making changes that will impact agencies’ processes for the long term – beyond the Medicaid unwinding process of this year.  

States across the country have limited resources to address these immense challenges with the urgency they demand. Still, Medicaid agencies have made significant investments in outreach campaigns, system enhancements, and staff training to combat churn and mitigate the number of eligible people losing coverage and having to reapply.

BDT's Lucas Caldwell-McMillan and Miriam Lipschutz with the Rhode Island Executive Office of Health and Human Services

Our in-person conversations at the offices of our state partners this summer made three things clear: 

  1. Dedicated work time on a larger churn strategy can pay dividends. Dedicated work time together among Medicaid staff is rare and can be key to creating long term changes. Now more than ever, agency staff have their days tied up addressing time-sensitive challenges. It is a rare opportunity for teams to have a full day to zoom out and examine trends with each other, create links between initiatives in different departments, and strategize knocking down long-lingering roadblocks. Creating regular and focused space that addresses larger strategy can help balance short-term crises and long-term initiatives. 
  2. States want to learn from one another. Many states are struggling with similar challenges, and learning from peers is critical to seeing not only what solutions exist, but how they got done. Questions we hear often are: “How does our Medicaid program compare to other states? What can I learn to make improvements here?” During our visits to some states this summer, we arranged for other state leaders in the collaborative to join virtually and present solutions they’ve implemented well. During one visit, partners at State Health Access Data Assistance Center (SHADAC) shared examples of actionable state data dashboards and effective data communication.  
  3. States are looking to carry new innovations beyond the Medicaid unwinding. While states have temporary flexibilities to streamline the renewal process for the unwinding, many view the resumption of renewals as an opportunity to do things differently in the long term and keep the innovations that work. Rhode Island and South Carolina are texting their members due for renewal to help them stay on top of deadlines and keep an eye out for important mail. California has invested in a team of Health Enrollment Navigators, who are closely connected on the community level, to help members with renewals.  

The energy to implement changes that improve member experience was tangible during each of our visits with states. 

We look forward to seeing our state partners in person again this fall – and facilitating more cross-state learning – when we welcome them to our offices in Philadelphia to continue honing best practices to reduce churn.