March 29, 2023

States are Not Alone in Solving the Challenges of Medicaid Redeterminations

April 1st is upon us and states are starting the redeterminations process for Medicaid, which has been referred to as one of the “biggest administrative burdens” states have faced to date from the pandemic. 

From now through the end of the year, the impacts to Medicaid beneficiaries as well as internal state operations, providers, and stakeholders will come to the forefront. The early months will bring to light challenges and broader impacts than perhaps the most thoughtful and deliberate state plans could have anticipated.

The good news for states, however, is that they do not have to face these challenges alone.

How can partnership play a role in resolving redeterminations?

States are looking to their long-term partners who currently have roles in their day-to-day Medicaid operations. These partners know the state policies and practices, have daily communications with beneficiaries, providers, and stakeholders, and are viewed as an extension of the state’s team in planning and problem-solving communication challenges, as well as other emerging challenges.

Partners perform various functions for states including claims processing and enrollment, as well as a variety of clinical operations ranging from utilization management, case management, and care coordination, to clinical assessments for waiver programs, provider network credentialing and enrollment, and numerous other functions. Many partners work with numerous states and some have a national footprint, placing them in a unique position to bring ideas to the discussion, share experiences from other states, and help states plan their paths forward.  

Infographic CTA 3 (1)-1

Opportunities to Overcome Challenges with Awareness-Building Efforts

Raising beneficiary awareness is the first of many challenges to overcome. For example, in December 2022, nearly two-thirds (64.3 percent) of adults enrolled in Medicaid or with an enrolled spouse, partner, or child had heard nothing about the reinstatement of redeterminations, according to Urban Institute’s Well Being and Basic Needs survey.

As states begin preparing to reinstate the redetermination process, it is imperative they rely on partners to help them update all contact information in order to give the states and the beneficiaries the best opportunity for success in this redetermination process, including reduced friction in beneficiary participation and reduced overall churn resulting from the process.

States should further consider their partner’s touchpoints with beneficiaries, providers, and stakeholders. Partners have existing infrastructure that can be used for outreach and location of beneficiaries.

In addition, states should craft a compelling call to action. The more compelling the state campaigns can be for their beneficiaries to engage in the redetermination process, the more beneficiaries will participate in the process, increasing the likelihood that they stay enrolled should they continue to remain eligible for Medicaid. And those who are no longer eligible will likely having a smoother experience seeking coverage through other channels.

Last but not least, from a care coordination and care management perspective, states can improve awareness and communications through partners who work directly with higher-risk beneficiaries to ensure they are receiving the right care. As they work with the beneficiaries, the scope of their conversations can include redeterminations and address updates. These interactions also have the potential to provide insights on the unreachable population.

Nearly two-thirds (64.3 percent) of adults enrolled in Medicaid or with an enrolled spouse, partner, or child had heard nothing about the reinstatement of redeterminations.
- Urban Institute Well Being and Basic Needs Survey
The Path Forward After Navigating the Initial Challenges:

In the months ahead, the challenges facing states are likely to change. Some challenges may be predictable, such as finding the unreachable population and helping people access new forms of health coverage. Other challenges will emerge that have not been predicted, or impacts will occur in parts of state government operations that were not anticipated.

Given the road ahead, partners can play several roles in accompanying states on the unwinding journey, and may offer valuable assistance in the following areas:

Analytics: Partners should have the ability to work with data to understand the population dynamics. This might include understanding which beneficiaries are currently in an active course of treatment. It could also include analysis of the unreachable population to provide more definition around population demographics and potential locations for more targeted outreach.

Community Outreach: Partners can scale up targeted community outreach activities to find and educate the unreachable population. In a few months, we will understand the impact of national and state level campaigns around redetermination efforts.

Helping people access new forms of coverage: For those no longer eligible for Medicaid, providing assistance in finding new coverage as well as making sure their needs are met through the transition is key. Care coordination support may be needed to assist them with services they were receiving through Medicaid such as transportation to medical appointments, transitioning doctors and pharmacies, and identifying any other social determinant factors they may need assistance.

By fall, we will have insights into the process of reinstating redeterminations. Through this experience, we will get an understanding of how difficult it is to find beneficiaries, what the unanticipated challenges may be, and what the states will be facing over the course of the next year.

The Value of Partnership in the Redeterminations Process

In evaluating their redeterminations strategies, states are seeking to overcome the challenges presented by aligning with partners who:

  • Understand their Medicaid programs and the intelligence that can be derived from claims data to assist with prioritization of redeterminations
  • Focus on the well-being of their beneficiaries
  • Work with the provider community
  • Have clinical review expertise
  • Regularly interact with their stakeholders
  • Have a vested interest in each state’s success in the unwinding

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