Preparing for the upcoming Medicaid unwind

While few of us are ready to look back on the COVID-19 pandemic with any nostalgia, there were a few positives to that strange and tumultuous time period — at least from a public policy perspective. One silver lining: the rate of Americans not covered by health insurance fell to 8 percent, a previously unreached low.

One reason was the Families First Coronavirus Response Act (FFCRA), an emergency measure passed in January of 2020 that granted states additional federal funding for their Medicaid programs. To be eligible for these additional funds, states had to adhere to a list of requirements, including a requirement to keep people currently enrolled in Medicaid continuously enrolled through the end of the COVID-19 Public Health Emergency. This meant that Medicaid recipients did not have to reenroll or prove their eligibility to continue receiving coverage. If you qualified for Medicaid at any point during the pandemic, that coverage would extend until the end of the national emergency.

While the White House anticipates officially ending the public health emergency and national emergency in May of this year, FCCRA is wrapping up sooner than expected, with significant changes to the FFCRA going into effect on April 1, 2023. In a process that is being referred to as “unwinding,” states receiving additional funding for their Medicaid programs under the Federal Medical Assistance Percentage will be expected to return to their normal eligibility and enrollment operations over the next 14 months – including disenrolling recipients who are no longer eligible to receive Medicaid benefits.

What This Means

As the term “unwinding” suggests, this won’t happen overnight. As described by guidance released by the Centers for Medicare & Medicaid Services (CMS), states will have up to 12 months to initiate, and 14 months to complete a renewal for all individuals enrolled in Medicaid, Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP).

Most states’ systems were designed to handle enrollment communications on a rolling basis, not every member all at once within a short time frame. And with an historic number of people currently enrolled in Medicaid, even the additional time to ramp down services won’t make this an easy process. While this was never intended to be a permanent solution, the Medicaid Unwind has the potential to create a massive bottle neck in social services, a headache for government officials, and a situation that could disenfranchise vulnerable people.

Over the course of this “unwinding” process, around 15 million people – 1/6 of the Americans currently covered by Medicaid—may end up losing their healthcare coverage. This number includes citizens with additional hurdles like language barriers, disabilities, or simply not having an up-to-date address on file, who may end up losing their coverage despite still qualifying.

What Can States Do?

Preventing this loss of coverage will require states to invest in getting the word out to as many people as possible, as quickly as possible.

The federal government has issued guidance to help states reduce coverage disruptions, with new reporting requirements to ensure states stay on track in their unwinding processes. This includes providing operational plans for how they will prioritize renewals, how they plan on completing these renewals, and how they plan on reducing inappropriate disenrollment. How each state approaches their unwinding process will have a significant impact on whether citizens retain coverage or transition to other coverage seamlessly. While most states said they would take steps to update enrollee contact information and follow up before terminating Medicaid coverage, only 41 states had posted their plan summary by Feb 3.

Technical Challenges and Roadblocks

States are required to complete Medicaid renewals themselves by verifying ongoing eligibility from electronic data sources before requesting documentation from an enrollee. Despite this requirement, only 11 states reported completing more than half of their renewals themselves, and only six states reported completing more than 50% of renewals without requesting information from the enrollee.

Additionally, some states have skipped renewals over the past three years as they implemented the continuous enrollment position, which means they now have a lot of catching up to do. And many Medicaid offices are going to have to do it understaffed: according to the National Association of Medicaid directors, around 20% of the jobs posted at state Medicaid offices are currently unfilled.

For those who find they no longer qualify for Medicaid, there are options. ACA plans have enhanced subsidies through 2025, making it more affordable, and some recipients will now qualify for Medicare. Additionally, an increasing number of people currently enrolled in Medicaid also report being enrolled in private insurance.

For Medicaid recipients in this category, it will be key to quickly communicate this information to ensure the fewest number of people possible experience coverage disruption or gaps in coverage.

How TTEC Digital Can Help

Outcomes are going to differ, as each state faces a unique balancing act while they chart their path forward. But improving state eligibility systems, streamlining renewal processes, and communicating early and often with enrollees about the steps necessary to complete a renewal (or if no longer eligible, transitioning to the ACA marketplace) will go a long way in maintaining a positive citizen experience.

Increase Accessibility

While nearly every state accepts information by mail or in person, fewer offer other options: only 39 states allow individuals to submit information over the phone, while 41 allow information to be submitted through online accounts. A convenient online portal can allow people who might otherwise slip through the cracks to be contacted and submit information in a timely fashion.

Proactively Perform Outreach

For some states, it has been three years since they’ve done outreach on enrollment: the contact information and addresses on file may no longer be accurate. To solve this issue, agencies can reach out to members through SMS to confirm the address on file and have the member text back to confirm or update their contact information. Agencies can also use SMS to instruct members to look for their renewal notice in the mail and remind them when the renewal letter is due back.

Prepare for Unexpected Challenges

Many people have moved over the past few years, and qualified members should not lose coverage due to returned mail. Many state agencies don’t have the capacity to handle returned mail. Programs that use multichannel communications can extract data from forms and renewal documents to send customized messages over text and email to ensure contact with the recipient and give them time to renew their coverage.

Implement Strategic Automation

Strategic automation can help to avoid creating long hold times. As we’ve covered in our blog before, automation can be a great tool to strategically address bottlenecks, especially when employee attrition is a challenge. Automation can even help with reaching out preemptively, ensuring that citizens are getting the information they need in a timely manner. For example, agencies can handle increased call volumes by configuring a FAQBot to answer commonly asked questions, reducing the number of callers who need to speak to a live agent. By reserving live agents for more complex questions, FAQBots can help lessen the backlog.

Virtualize Contact Centers

The Alaska Department of Health and Social Services (DHSS) was able to streamline their citizen experience by creating a single, statewide Virtual Call Center that removed the need for long wait times on hold or in the lobby. This confidential and secure platform helped them streamline the eligibility process and made access to Medicaid, Supplemental Nutrition (SNAP), and other assistance programs easier.

Improve and Streamline Reporting

Starting April 1, CMS will require states to begin reporting on specific metrics on their Unwinding progress, adding yet another time-consuming process to agencies feeling stretched, and increasing the risk of error. Programs that can quickly import data from all of an agency’s data sources into a single source of truth through interactive dashboards can simplify and automate this process, freeing up agents to work on other tasks while remaining compliant with reporting requirements.

Build towards a Digital Front Door

We’ve written about the potential of the Digital Front Door in Public Sector before—the idea of pulling together all government services into an organized single pane of glass in order to make it more accessible—and that idea was built for this exact situation. By making it easier to access resources and using data to personalize experiences, state governments can improve and streamline citizen experience.

The stakes for experience in the public sector are slightly different than they are for private industry businesses. Over time, good experiences can help build trust in the government. Bad or frustrating experiences, on the other hand, can have severe consequences – like disruption in the health coverage designed to support them when they need it.

Regardless of what CSP you’re working with, we can work with you to find a solution that improves citizen experiences and ensures you remain compliant with all necessary security protocols. A little prevention and investment on the early side goes a long way in building support and protecting citizens.