Preparing for the unwinding of the Continuous Enrollment Provision
Challenges and solutions for health plans to help Medicaid members retain coverage
For nearly a year, states, health plans, and other healthcare stakeholders have been thinking about the unwinding of policy provisions that allowed millions of Americans to stay on Medicaid without redetermination and what the implications might be once they end. Conversely, Medicaid members remain largely unaware of the impending Medicaid redeterminations according to a poll from the Urban Institute and Robert Wood Johnson Foundation. The Medicaid renewal process will begin on April 1, 2023, and millions of individuals are at risk of losing their health coverage if they don't follow the correct processes and timelines to complete their redeterminations.
For health plan leaders, it's essential to have an effective outreach strategy in place to engage Medicaid members, make them aware of the impending redetermination process, and help guide them so they can retain health benefits coverage either through Medicaid if they remain eligible, or if they're not, through a Marketplace or other option.
As part of our ongoing discussion series Under the Same Sky, Abner Mason, founder and CEO of SameSky Health, discussed this important topic and the role that technology plays in helping Medicaid members retain coverage with Samantha Murphy, Industry Advisor – Health Plans/Payers in the Healthcare and Life Sciences division at Salesforce. View the recording below.
Although “payviders” is not a new term, it provides a good definition around the way we need to work and collaborate within the healthcare system to help us think differently about who our healthcare system is serving. There is a growing demand for patients to be treated as healthcare consumers, and the vertical integration between providers and payers is necessary to benefit the consumer. With Medicaid redetermination on the horizon for 18 million Americans, Samantha notes that it is imperative for health plans and providers to switch their mindset and be consumer focused to remain competitive.
Redetermination challenges that health plans are facing:
There are 50+ different Medicaid programs to abide by because each state and territory has different qualifications.
There is not a true number of how many people will lose coverage because we haven’t had complete data coming in over the last three years.
The member data we have isn’t fully accurate or reliable, especially among hard-to-reach demographics.
Medicaid qualification is inefficient, there are too many details needed from members, and the process is updating all the time.
The ability to scale the outreach that is needed is huge and the timeframe is limited.
“This process will require you to pull out your biggest, hardest tricks quickly AND at the individual level AND share it quickly.””
All of these challenges have created a daunting task for health plans to reach out and engage with Medicaid members to prevent them from losing coverage. They are staring down the barrel of a crisis without being able to access and share data quickly. Without the use of technology, the task will simply be impossible.
Solutions:
Create an outreach strategy with an omnichannel approach. It is the only way you will be able to reach members, especially since you will need multiple attempts. This will pull in multiple sources of data to allow you to reach out to people in a way that engages them.
Use texting as part of your approach. The FCC has granted permission for plans to use texting to reach Medicaid members during this time. It is still unclear what content will be allowed during this process, but health plans are advocating for clarity so that the outreach can be useful.
Take the time and use the necessary resources now to collect member data in a streamlined way so that it can be leveraged long-term. Efficient and beneficial member engagement brings more access to care, which can create better long-term solutions.
Collaborate! Communication and collaboration are essential and will be needed across the healthcare industry to pull off this redetermination crisis.
Learn more about how SameSky Health engages Medicaid members to help guide them through the renewal process.
“It would be a shame if we created a man-made emergency for people that lose their health insurance… Think about if you woke up tomorrow and lost your health insurance. It would be frightening.””
Salesforce has recently joined 39 organizations in signing a first-in-kind global health equity pledge. The “Zero Health Gaps” pledge is on a mission to create a healthier and fairer world by countering growing global disparities. Learn more about their mission.
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