Medicaid Redetermination: A Watershed Moment to Improve Engagement and Extend Coverage

At the Institute for Medicaid Innovation (IMI), our leadership, Board members, and community partners are working together to share their perspectives on the national Medicaid redetermination process currently underway. This post is co-authored by IMI Governing Board Member, Chair of IMI’s National Advisory Board and Senior Director of Policy, Medicaid at UnitedHealthcare Community & State Nicole T. , and her colleague, IMI Behavioral Health Subcommittee Member and Vice President of Clinical Strategy, UnitedHealthcare Community and State, Dr. Arethusa Stevens Kirk M.D. . It was developed in partnership with Molly Gotobed , Program Director at the Kansas Assistance Network, LLC.

Connecting with eligible people to ensure they maintain their Medicaid coverage has long been a challenge, well before the impacts of the COVID-19 Public Health Emergency (PHE).

That’s because many people covered by Medicaid live in poverty and oftentimes have to navigate a host of issues like housing and food insecurity that require a significant investment of time and energy, every single day.

With the national Medicaid redetermination process, these challenges have taken on epic proportions due to the large numbers of people who became eligible for Medicaid and maintained their coverage due to the continuous enrollment provision that went into effect during the PHE. The massive, national redetermination effort currently underway has opened the aperture more widely on the urgent need to find more effective ways to reach and engage members.

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Making engagement easier

According to Molly Gotobed, Program Director at the Kansas Assistance Network, LLC, “The recertification process creates unnecessary stress in families' lives. Our immigrant families who may not speak English don't understand what's going on, especially those who speak languages other than Spanish.”

Gotobed adds that families living in rural communities have a unique set of challenges. “In rural communities, there's [typically] no one to help people in person, so they rely heavily on phone and online assistance. There's no good way to help clients virtually.”

When it comes to engaging eligible people for any reason, including eligibility for redetermination, it's important to take a “no wrong door” approach. It is especially important to address the needs of people in rural communities and those who speak languages other than English. “No wrong door” means using a variety of outreach methods – postal mail, text, email, visual and media campaigns, community events – and every in-person or virtual appointment for medical, behavioral, home health, and social support services where language support service can be made available. ?

At UnitedHealthcare Community and State, our national team coordinates multifaceted, market-driven approaches that include outreach to community-based and religious organizations, school partnerships, federally qualified health centers, providers and other resources. At each of these touchpoints, we provide opportunities to remind eligible people to recertify their Medicaid coverage in ways that are convenient for them.

But more can be done. There is an untapped opportunity to link multiple eligibility systems together, like those used for the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutritional Assistance Program for Women, Infants and Children (WIC), and Temporary Assistance for Needy Families (TANF). It makes sense to align these programs in ways that make it simpler, and easier, for eligible people to access services and maintain accurate contact information.

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Continuous coverage helps to ensure a lifetime of good health

Imagine you’re a single parent or guardian of three children, you’re on Medicaid, and no one in your household has coverage with the same health plan. Each member of your family has a different recertification date, which is not linked to a memorable milestone, like a birthday or anniversary. And to make it more challenging, the date is sometimes difficult to find on your health insurance card. Add in the fact that you may have had to move residence since the last time you made a submission for eligibility.

If you have Medicaid insurance, keeping you and your eligible family members covered requires significant effort and planning. Navigating this effort can be monumental if you or your family experienced several changes (like moving residence) since you last applied for or recertified your coverage. If you forget, or don’t complete your paperwork on time, you or your children will lose coverage, which can have a significant negative impact on health for the whole family.

Gotobed and her team witness this impact, every day.? “Children are definitely being affected the most. They are losing their coverage even though they [may] still be eligible. Many parents have called us frantic because they only learned they lost their coverage while trying to obtain care at doctors' visits or the pharmacy.”

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The case for continuous for coverage

These are among the many reasons for states to advocate for continuous, multi-year coverage, especially for children.

The first five years represent one of the most critical times in a child’s life. Routine checkups and early interventions are essential for putting them on track for a lifetime of good health.

As of January 1, 2024, all states will be required to provide 12 months of continuous coverage for children up to the age of 19 who are covered by Medicaid or CHIP. Some states have already approved or are considering keeping children continuously insured for even longer periods.

Extending continuous coverage beyond 12 months ensures that more children and families receive access to the preventive care, health screenings and treatment needed to support their development, for longer.

The national redetermination process that is currently underway is a watershed moment. Key stakeholders are increasingly realizing the impact we can have when we work together to remove barriers to make it easier for people covered by Medicaid to access essential health services. This is true in Kansas, where we are partnering with the state and organizations like the Kansas Assistance Network to reduce obstacles for Kansans as they navigate the redetermination process.

Maintaining your insurance coverage is critical, especially for those most in need of support. By placing people covered by Medicaid at the center of our collective decision making, we give children, parents, families and communities a better chance at a healthier life.