Medicaid Redetermination: Why We Must Engage and Educate Members to Ensure Continuity of Care

Medicaid enrollment has risen sharply – by more than 18 million people from February 2020 to June 2022. The spike is due mostly to job losses during the pandemic together with the Families First Coronavirus Response Act, which requires states to suspend Medicaid disenrollments during the federally declared public health emergency (PHE).

Once the PHE ends, state Medicaid programs will check the eligibility status of all Medicaid enrollees, and people who no longer meet program criteria will be disenrolled. Policy analysts project that Medicaid enrollment could fall by approximately 16 million people during the 14 months after the PHE ends, with many unaware of the need to reconfirm eligibility or explore alternative coverage.

States and managed care organizations (MCOs) have an obligation to prevent people from falling through the cracks due to lack of information or awareness. We must make every effort to inform Medicaid enrollees about how to maintain coverage, either through redetermined Medicaid eligibility or obtaining other coverage through the Health Insurance Marketplace at healthcare.gov.

Why Continuity of Care Matters

Enrollment in health insurance is critical for several reasons. When people lose health care coverage, they are more likely to delay routine wellness visits and screening tests like annual mammograms. For people with chronic disease like diabetes or hypertension, regular check-ups are vital to effectively managing their condition; and for those dependent on care management programs for complex illness, loss of coverage disrupts treatment plan progress.??

In each of these examples, the risks are high for poor health outcomes and increased health care costs. Our commitments to member health improvement and responsible stewardship of public resources demand we do all we can to ensure eligible people stay enrolled in Medicaid and those no longer eligible find other affordable options for coverage.

Interruptions in coverage can also impact health care providers. Whether a pharmacist or a hospital registration clerk or a physician office manager, providers are likely to experience significant disruption of daily operations due to patients who are either unaware or unclear about their loss of Medicaid coverage. ??

Activity is well underway to ensure eligible individuals remain enrolled in Medicaid after the PHE ends. The Centers for Medicare & Medicaid Services (CMS) is allowing states up to 14 months to complete all redeterminations when the PHE ends and recommends that states collaborate with MCOs during the process.

Partnering for Success

Collaborative relationships between state Medicaid agencies and MCOs will help people maintain coverage—whether they continue on their current Medicaid plan or transition to a health plan on a health insurance marketplace (Aetna CVS Health plans, for example, are on the ACA Marketplace in 12 states) or to an employer-based plan. To ensure coverage is maintained, we must help members know what their options are.?

Some core components of our strategy and recommendations are:

1. Identifying individuals unlikely to meet standard eligibility criteria early

States and MCOs can work together to assess which Medicaid beneficiaries might lose coverage, then educate them and, where appropriate, help them understand their options. In partnership with state Medicaid agencies, we’ll identify members within this group as early as possible.

2. Reaching out to those who are eligible but are hard to reach or uninformed

We’re being proactive by reminding our members about updating their current contact information with the state Medicaid agency, so they’ll receive essential information about their eligibility status. We recommend states adopt or continue the practice of comparing Medicaid records to the U.S. Postal Service’s National Change of Address Database. By using a wide range of communication channels including direct mail, email, phone calls and digital media, we’ll have broader reach.

3. Leveraging data

There are several ways states and MCOs can use available data to optimize outreach.

• ?States are required to use other data sources to conduct “ex parte” or auto Medicaid eligibility renewals before sending renewal paperwork to Medicaid beneficiaries. However, individual states have varying capacities to conduct ex parte renewals and might struggle if they have limited resources. We encourage states to use all available data in assessing beneficiary eligibility, such as state income tax records and marriage/birth/death certificates. This will reduce the number of individuals who have to physically complete paperwork to renew their Medicaid eligibility.
• States notify MCOs of their membership population through an electronic data interchange known as an 834 file transfer. Although the 834 format is standard, the amount and quality of available data for MCO consumption varies by state. States and MCOs have an opportunity to partner in optimizing 834s for redetermination efforts.
• MCOs have extensive information about our members to help build communication strategy. For example, Aetna is analyzing our claims, authorization and care management data to identify members with chronic illness and ensure they are well-informed about the importance of redetermination. Examples range from children with asthma who rely on daily inhalers, to seniors dependent on long-term services and supports, to people undergoing cancer treatment. We’ll intensify our focus in reaching these individuals.?

Education is Key

To ensure PHE aftermath doesn’t create a coverage crisis in America, educating beneficiaries is key. Working in partnership with state Medicaid agencies, Aetna Better Health stands ready to ensure that member experiences and engagement remain excellent. All of us here, from company executives to community health workers, are working hard to prevent unnecessary and avoidable disruption in health care coverage for the Medicaid members we serve through the power of education, especially for those with ongoing chronic health care needs.?