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It’s Time to Prepare for 2023 Medicaid Redeterminations

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Although COVID-19’s prevalence and lethality has dropped around the country, the winding down of the pandemic will have far-reaching repercussions for the healthcare industry. In 2020, Congress enacted measures in response to the pandemic that included a requirement that – in exchange for increased federal funding – Medicaid programs would maintain its members’ enrollments through the end of the month in which the public health emergency (PHE) was declared over.

With the continuous enrollment period now scheduled to end on March 31, 2023, the enhanced federal funding of Medicaid will phase down through December 2023.

Concerns for Medicaid Patients

The continuous enrollment period substantially increased the number of Medicaid recipients. Total enrollment grew to 90.9 million in September 2022, which was an increase of 19.8 million from February 2020. States were prevented from disenrolling people from coverage, so more people have maintained insurance through the pandemic.

What to know about disenrollment:

  • Beginning in April, states can reinitiate the Medicaid disenrollment process.
  • Between 5.3 million and 14.2 million people will lose Medicaid coverage during the unwinding period.
  • As many as 15 million beneficiaries could be disenrolled, but the Department of Health and Human Services (HHS) estimates 8 million people will still be eligible for coverage.
  • Along with people who moved during the pandemic, beneficiaries with limited English proficiency and people with disabilities are at a higher risk of losing coverage.

Beneficiaries in some states may not have had direct contact with Medicaid in the three years since their enrollment, and continuous coverage protections mean some states have lapsed in regular communication with enrollees.

Prior to COVID-19, temporary loss of Medicaid coverage was common, but the continuous enrollment mandate paused churn. The Affordable Care Act (ACA) requires states to complete administrative renewals by verifying continued eligibility – known as ex parte processes – through government data sources before sending renewal forms or requestion documentation from a beneficiary. This reduces the administrative burden on recipients to maintain their coverage. However, some states suspended renewals during the continuous enrollment period, and many are lagging in completing renewals with ex parte processes, according to KFF.

Priorities Ahead of Redetermination

After the PHE ends on May 11 and states begin the process of redetermining eligibility for Medicaid recipients, staffing capacity may be overwhelmed. Because of the daunting scope of the project ahead, state Medicaid agencies cannot expect to handle redetermination on their own. Communicating with beneficiaries will be a massive undertaking that will require additional Medicaid stakeholders, such as managed care plans, healthcare providers, and consumer advocates.

What to do before redetermination:

  • Monitor performance data: This will ensure agency goals are being met, to keep the process clear to enrollees, and to track the number of people disenrolled for reasons other than eligibility.
  • Update mailing addresses: The pandemic pushed many people out of urban areas. Address changes could cause Medicaid recipients to miss being notified of their upcoming disenrollment.
  • Contact beneficiaries: States are required to maintain up-to-date contact information for recipients and must attempt to contact enrollees before they lose coverage.

Due to the immense process of redetermination, call centers will be critical touchpoints for Medicaid beneficiaries. Carenet Health is well-positioned to assist during the disenrollment period through member engagement to ensure eligible enrollees maintain their coverage.

By utilizing multichannel support through outbound emails, texts, calls, and fielding inbound inquiries from disenrolled recipients who need to know how to reapply for coverage, Carenet’s wide range of solutions can help navigate the transition that lies ahead.

To talk to an expert about how Carenet Health can support your organization through its Medicaid redetermination, fill out the form below. 

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