A procedural move by the federal government to end the public health emergency associated with the Covid-19 pandemic could lead to millions of Medicaid patients losing their coverage and becoming uninsured – including many who are still eligible for Medicaid.
For health systems, the so-called “unwinding” of the Medicaid continuous coverage provision highlights the urgent need to engage this vulnerable population to ensure that they maintain stable insurance coverage, which is necessary for delivering preventative care, protecting ongoing treatment for people with chronic illnesses and disabilities, and managing long term outcomes and cost of care.
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Anna Basevich Anna Basevich is Vice President of Enterprise Partnerships at Arcadia, the leading population health management and health intelligence platform. In this role, she drives the transformative impact of Arcadia’s analytics platform and embraces the opportunity for organizations to adopt effective population health strategies. Anna recently led the expansion of Arcadia’s customer training program, […]
“Unwinding,” which refers to the process by which states will resume annual Medicaid eligibility reviews after the public health emergency ends, could begin as soon as Aug. 1, so it’s important that providers develop plans now to assist patients who may be affected.
Millions at risk when eligibility redeterminations resume
When the federal government officially declared the pandemic a “public health emergency,” Congress extended additional federal Medicaid payments to states during the emergency, provided that states maintain “continuous coverage” for people were enrolled in Medicaid when the emergency began. As a result of the continuous coverage provision, states stopped performing Medicaid eligibility redeterminations, which prevented large volumes of patients from losing coverage during the pandemic.
Medicaid eligibility redeterminations refer to a requirement that states must verify patients’ eligibility for Medicaid at least annually. Over 10 percent of Medicaid enrollees gain or lose coverage over the course of the year due to periodic redeterminations and midcycle changes in eligibility. A portion of this churn is the result of “procedural reasons” such as a lack of required paperwork because beneficiaries have moved or have challenges securing proof of their earnings, according to Commonwealth Fund. Medicaid patients who lose coverage may regain it eventually, but often must endure gaps in care.
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Once the public health emergency expires, states will be tasked with resuming eligibility redeterminations. The federal government has pledged to give states at least 60 days’ notice before the public health emergency expires (as of this writing, the PHE is scheduled to end in mid-July but expected to be extended to mid-October). After the emergency ends, nearly all 84 million people enrolled in Medicaid will need to have their eligibility redetermined – a massive challenge for states that could result in procedural problems that cause patients who are eligible for Medicaid to lose coverage.
Three steps towards better patient engagement
To help prevent vulnerable patients from losing the coverage they need and deserve, health systems can take the following three steps to improve patient engagement:
1. Inform Medicaid patients of the need to re-enroll: When attempting to redetermine eligibility, Medicaid agencies will first attempt to perform an automatic renewal based on information available to them, such as wage information from state databases. If that fails, states will then send renewal notices and eligibility forms to patients, who must respond in a timely manner. For patients whose redeterminations are denied or whom states are unable to contact, Medicaid eligibility will expire.
Providers must work with their patients to educate them about the redetermination process. For example, some enrollees may have moved during the pandemic and will not receive notice that their renewal is due if the state does not have their current contact information. Additionally, renewal forms are often confusing, and action steps for enrollees may not be clear. Further, not all states allow enrollees to complete their renewal online or over the phone, according to Commonwealth Fund. Providers can partner with their patients to ease these burdens, reminding patients to keep an eye out for critical paperwork and offering resources to support them through the process.
2. Take the opportunity to strengthen the patient–provider relationship: Health systems can use the need for patient education around Medicaid eligibility redeterminations as an outreach opportunity to strengthen or re-establish relationships with patients, offering them the ability to enroll in care management programs, for example.
Patient navigators can play a significant role in strengthening relationships by helping them successfully renew their coverage. Navigators can assist in numerous ways, including: helping enrollees update contact information with their state’s Medicaid agency before the emergency ends; informing enrollees that must renew their coverage in 2022 to be on the lookout for mail from the Medicaid agency, and respond to any requests on a timely basis; and helping people who are no longer eligible for Medicaid apply for other health insurance coverage. These team members can also help patients schedule appointments with primary care providers and specialists, ensuring continuity in both coverage and care.
3. Ensure outreach campaigns are omnichannel and multilingual: A key component of patient engagement involves communicating to patients on their terms with their preferred communication methods. Omnichannel outreach campaigns can be performed by email, traditional mail, phone calls, and text messages – or any combination of those means. Additionally, providers should offer communication materials in multiple languages, based on the needs of their patient populations. Monitoring the results of outreach campaigns can inform health system initiatives by highlighting effective campaigns that can be expanded and identifying disengaged populations where more creative engagement efforts may be required.
While no one is exactly sure when the officially designated public health emergency will end, it’s almost certainly coming soon, and then, the “unwinding” will begin. Before it does, providers should examine ways to boost patient engagement, such as informing Medicaid patients of their need to re-enroll, re-establishing strong patient–provider relationships, and performing omnichannel, multilingual outreach.
Anna Basevich is Vice President of Enterprise Partnerships at Arcadia, the leading population health management and health intelligence platform. In this role, she drives the transformative impact of Arcadia’s analytics platform and embraces the opportunity for organizations to adopt effective population health strategies. Anna recently led the expansion of Arcadia’s customer training program, enabling Arcadia customers to accelerate their value-based care outcomes.
Previously, Anna managed implementations and client services at Arcadia and at Deloitte Consulting, including numerous programs around health system quality improvement under ACO and risk-based contracts, accuracy and completeness of documentation for risk adjustment, state health insurance exchanges, Patient Centered Medical Home transformations, Health Information Exchange strategy and analytics, and large-scale health IT with local and national health systems and plans. Her experience has resulted in the successful adoption of value-based care strategies for health plans, ACOs, independent physician groups, IDNs, and life sciences organizations.
