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The Drive to Activate Medicaid Members


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It’s time to recognize the vital importance of Medicaid programs and push to expand them for those in need. As beneficiaries prepare for Medicaid’s redetermination process following the official end of the public health emergency (PHE) in May, they will need help from their plan administrators to understand and navigate the complexities the transition will present.

Even before the PHE, connecting and engaging with Medicaid enrollees and prompting them to action presented challenges due to issues such as inaccurate contact information, language barriers, childcare and transportation difficulties, lack of reliable internet access, and other social determinants of health.

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Pandemic-related measures enacted by Congress in 2020 required Medicaid programs to maintain member enrollments through the end of the PHE in exchange for increased valuable federal funding. As a result, total Medicaid enrollment during this time grew to more than 90 million. But as many as 14 million people could lose Medicaid coverage, according to a study by the Kaiser Family Foundation, threatening the health and wellbeing of the country’s most vulnerable populations.

To retain Medicaid members, state Medicaid programs and Medicaid managed care organizations (MCOs) must have the resources to elevate member engagement and optimize health outcomes.

Delivering Better Outcomes for the Medicaid Population

Supportive Medicaid programs can deliver better health outcomes by taking a specialized approach to member engagement and activation that focuses on overcoming the barriers that block members from getting the care they need. Although the passage of the Affordable Care Act in 2010 helped address many of the challenges related to serving the Medicaid patient population, there is still more work to be done to ensure that everyone has access to quality healthcare.

For example, Medicaid engagement programs should include behavioral health crisis support that helps stabilize mental health episodes by providing people with immediate assistance to reduce potentially unnecessary ED visits. In 2021, Carenet designed a 24-hour specialty support hotline for a 15-state health plan that wanted to offer its Medicaid and Medicare Advantage members an improved behavioral health support experience. Following implementation, the crisis support solution helped 95% of participating members avoid expensive behavioral health-related ED care and gave all participants immediate access to de-escalation resources.

Additional approaches to effectively serve and engage the Medicaid population include addressing challenges such as fluctuations in membership growth, a shortage of providers and access to clinics, healthcare literacy issues, non-urgent emergency department (ED) visits, limited member support, continual regulatory changes, and financial constraints. Carenet, which supports over 22 million Medicaid lives through more than 1,000 programs, delivers a specialized engagement approach to serve the complexities of the Medicaid population. This includes designing a comprehensive contact plan, increasing proactive outreach, promoting access to on-demand telehealth care, providing around-the-clock member support, and leveraging progressive technology and actionable data.

By using the Carenet Health approach, you can:

  • Can more easily identify and engage with high-cost, high-need members with chronic and under-treated conditions
  • Ensure routine patient-physician interaction and relationship-building by overcoming barriers to care
  • Drive appropriate resource use to reduce unnecessary and or duplicate care
  • Control costs by reducing avoidable readmissions
  • Support care compliance by empowering members to become active participants in their care
  • Elevate member retention to reduce gaps in care and coverage

Other ways to serve the Medicaid population and promote health equity are through health advocacy services and disease management support. These services, which provide individuals with information on care options, scheduling, follow-up support, education, and outreach for high-risk, high-cost members, help ensure members get the treatment they need to achieve the best outcomes possible. For those who have or are at risk for developing chronic conditions like hypertension, disease management support has been found to play an important role in helping patients control their blood pressure.

Additionally, services such as telehealth nurse triage/advice lines and virtual clinics provide individuals with support options that are less expensive than in-person doctor appointments or ED visits. It’s important that Medicaid programs promote the existence of available virtual care options, as studies have shown that a high percentage of healthcare consumers are not aware of these resources.

Support for Challenges that Lie Ahead

Customized strategies allow state Medicaid programs and Medicaid MCOs to better serve their current members and create new paths to expand affordable healthcare to the nation’s most vulnerable individuals. At this critical moment, nearly six decades after the Social Security Act was signed into law, the unwinding of the PHE and the complexities of redetermination will present many challenges for Medicaid members, the workforce that supports them, and healthcare providers throughout the country. Don’t let your members get lost in the shuffle.

Learn more about how Carenet Health can support your organization through the Medicaid redetermination process and beyond, and contact us today. Also stay tuned for additional blogs on this important and timely topic.