Medicaid is a lifeline for more than 90 million U.S. adults and children. Laws enacted during the COVID-19 pandemic removed annual renewal requirements, making it easier for people to remain covered by their Medicaid plans. This continuous enrollment period also eliminated the need for plan administrators to conduct annual Medicaid redetermination. However, in early 2023, the continuous enrollment period for Medicaid ended. With states resuming routine Medicaid disenrollment processes, plan administrators are now scrambling to connect with beneficiaries and complete redetermination requirements. “Continuous enrollment ensured healthcare access for vulnerable populations, including children,” says Shawna Knight, director of client operations and clinical services for Carenet. “Without annual renewal requirements for the past few years, many Medicaid beneficiaries have moved or become difficult to reach. This means millions of people stand to lose coverage.” Knight says a loss of Medicaid coverage is about so much more than loss of health insurance. “When people lose Medicaid coverage,” says Knight, “they often lose other benefits, like transportation and access to meal programs.”Partnering with Carenet through the Medicaid redetermination process helps organizations streamline their administrative processes and ensures their members navigate the complexities of Medicaid reenrollment.
The Bottom Line for Medicaid RedeterminationHigh Medicaid turnover rates can be costly and disruptive for healthcare providers, payers and individuals. Medicaid redetermination:
- Prevents coverage gaps: Maintaining coverage prevents healthcare access issues, which can lead to delayed or skipped medical care.
- Preserves revenue: Re-enrolling Medicaid members guarantees payments for providers and associated premiums for health plans.
Carenet Can Help With Medicaid RedeterminationCarenet works with health plans and payers to conduct direct outreach and member engagement. By seeking help with redetermination, organizations can ensure eligible beneficiaries retain their coverage. Carenet offers:
- 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: The Carenet team helps reduce administrative burden, allowing organizations to focus on other essential tasks.
Medicaid Redetermination: Member Engagement Success StoriesWhen 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 tailor our support and quickly scale to meet their needs.”
Reaching Medicaid Enrollees in CaliforniaA California-based Medicaid plan administrator used text messages to initially reach out to its members. Through personalized live telephone interactions, Carenet followed up directly with members who left their texts unanswered. Our Engagement team successfully reached thousands of members, ensuring that the Medicaid redetermination process was completed accurately.
Success Snapshot11,228 contacts 87.37% success rate
Medicaid Redetermination Success in TexasOne Texas-based, women’s and children’s 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’s Engagement team connected with members, ensuring each understood the Medicaid re-enrollment requirements and, in many cases, walked them through packet completion.
Success Snapshot23,027 calls 80.76% success rate speaking with a member.
Overcoming Medicaid Redetermination ChallengesMedicaid 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.