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Carenet Can Streamline Your Medicaid Redetermination Program

medicaid redetermination blog

When the COVID-19-era continuous enrollment period for Medicaid ended in spring 2023, states resumed routine disenrollment processes.

This left many health plans and payers scrambling to connect with beneficiaries and complete redetermination requirements.

At Carenet, we help clients keep their Medicaid enrollees covered and engaged. Through our healthcare call center outreach, we also help health plans improve their members’ experience while helping to achieve their business goals of driving revenue and managing costs.

The Significance of Successful Medicaid Redetermination

Medicaid is a lifeline for more than 90 million U.S. adults and children. The continuous enrollment offered during the pandemic ensured healthcare access for vulnerable populations.

“Without annual renewal requirements for the past few years, many Medicaid beneficiaries have moved or become difficult to reach,” says Shawna Knight, director of client operations and clinical services for Carenet. “This means millions of people stand to lose coverage.”

And, Knight adds, loss of Medicaid coverage is about so much more than loss of health insurance.

“When people lose Medicaid coverage, they often lose other benefits, like transportation and access to meal programs.”

The bottom line is that Medicaid turnover rates are costly in many ways.

Carenet’s Medicaid redetermination support services can:

  • Prevent coverage gaps: Maintaining coverage prevents healthcare access issues, which can lead to delayed or skipped medical care.
  • Preserve revenue: Re-enrolling Medicaid members guarantees payments for providers and associated premiums for health plans.

Carenet Can Help with Medicaid Redetermination

Even though the big post-Pandemic redetermination process may have subsided, this is still a critically important process for Medicaid plans. To help in this effort, Carenet collaborates with health plans to conduct direct outreach and member engagement. Our engagement solutions team drives individual changes that lead to big impacts.

By seeking Carenet’s help with redetermination, organizations can ensure their eligible beneficiaries take necessary steps to retain coverage. Carenet offers:

  • Experience: Our engagement solutions team has more than 370k member interactions daily.
  • Expertise: Our enrollment and eligibility experts understand the Medicaid redetermination process. They work with beneficiaries to ensure all necessary documentation is gathered and submitted correctly.
  • Compliance: Carenet experts ensure your organization stays in compliance with all relevant Medicaid rules and regulations.
  • Efficiency: Our Carenet team can reduce administrative burdens, allowing organizations to focus on other essential tasks.

Medicaid Redetermination: Member Engagement Success Stories

When it comes to Medicaid redetermination, each state is doing things differently — and each has a different redetermination deadline.

“Each Carenet client has unique timing needs and a sense of urgency,” says Knight. “We can tailor our support and quickly scale to meet their needs.”

Reaching Medicaid Enrollees in California

A California-based Medicaid plan administrator used text messages to initially reach out to its members. Carenet used its medical call center to follow up directly with the members who left their texts unanswered.

The Carenet team reached thousands of members and successfully guided them through the Medicaid redetermination process.

Success Snapshot

11,228 contacts

95% success rate

Medicaid Redetermination Success in Texas

One Texas-based, child-focused health maintenance organization (HMO) called on Carenet to assist with their Medicaid redetermination process. They mailed redetermination packets to members and relied on Carenet’s medical call center to make follow-up calls.

Carenet client services connected with thousands of members, ensuring each understood the Medicaid re-enrollment requirements and, in many cases, walked them through packet completion.

320,471 dialed calls

97.2% success rate

Overcoming Medicaid Redetermination Challenges

Medicaid redetermination is a complex process for beneficiaries and the organizations administering Medicaid programs. Challenges include:

  • Documentation burden: Beneficiaries may struggle to gather the required documentation, such as proof of income, citizenship or residency, leading to delays in the redetermination process.
  • Eligibility changes: Life circumstances change quickly, making it difficult for individuals to accurately report changes in income, family size or employment status.
  • Administrative complexity: Organizations responsible for managing Medicaid benefits may have limited resources and face administrative burdens in processing redetermination applications for their members.

Partnering with Carenet through the Medicaid redetermination process can help organizations streamline their administrative processes and ensure their members can navigate the complexities of Medicaid reenrollment.

Carenet Health can manage your Medicaid redetermination program. Contact our team today to learn more.