Medicaid is an essential part of America’s health care system covering about 1 in 4 Americans – estimated to reach 95 million people in March 2023. As the country returns to normal operations after the COVID-19 pandemic, states are required to review whether Medicaid enrollees are still eligible for the program. Many of these Americans have been enrolled in Medicaid since the onset of the COVID-19 public health emergency (PHE) in 2020.
States may begin this redetermination process beginning February 1, 2023, and may terminate coverage for individuals no longer eligible for Medicaid as early as April 1. As many as 18 million people may lose access to Medicaid coverage over the next year as a result. Some may lose coverage because their income is too high to qualify for the program, while others could face challenges in demonstrating they are still eligible. Health insurance providers are committed to ensuring Americans are able to enroll in coverage that is right for them, whether it is Medicaid or some other form of coverage.
Health insurance providers are taking important steps to mitigate gaps in coverage and ensure Americans maintain continuous access
to health care during redeterminations and coverage transitions:
- Building Awareness of the Medicaid Redetermination Process. Health insurance providers are working with federal and state agencies to raise awareness about Medicaid redeterminations. They are urging Medicaid enrollees to engage with and respond to important communications from their state Medicaid agencies about whether they are still eligible for the program. They are also providing information about other coverage options if enrollees are no longer eligible for Medicaid. Health insurance providers are conducting public service announcements and partnering with providers, hospitals, and other state programs (e.g., SNAP1) to meet Americans where they are. Medicaid managed care organizations (MCOs) are using visual aids like their logos to get enrollees’ attention, since Medicaid enrollees are not always aware they are enrolled in Medicaid but know their MCO’s logo. MCOs are also making efforts to reach enrollees with particular health needs, including pregnant or postpartum women, patients with chronic health conditions, and patients receiving behavioral health treatment.
- Convening Stakeholders to Support Seamless Transitions. A diverse group of organizations led by AHIP and collectively representing millions of Americans with Medicaid, people with disabilities, care providers, employer-related groups, and health insurance providers came together to form the Connecting to Coverage Coalition (CCC). The CCC aims to support information sharing, build on best practices, and develop solutions to ensure Americans are able to connect to coverage and enroll in a plan that is right for themselves and their families.
- Using Data to Support Policymakers and Stakeholders. AHIP funded a NORC Medicaid Coverage Transitions Report including state-by-state modeling of expected coverage transitions. Health insurance providers and other stakeholders are using these data to support and inform efforts on the ground and support smooth transitions to other coverage. Health insurance providers are using data from a variety of sources, including this report, data shared by their state Medicaid agency and federal government, and their own data to tailor their efforts to identify and connect with consumers.
- Conducting Marketing and Outreach. While states have different rules regarding direct outreach to enrollees, states with Medicaid managed care are working with their MCO partners to conduct outreach and assist members with Medicaid renewals. Many people moved their primary residence during the COVID pandemic. Where allowed, MCOs are providing state Medicaid agencies with up-to-date enrollee contact information. MCOs are also conducting specialized outreach to enrollees who are unresponsive to state requests and need to submit more information to complete their renewal application. Health insurance providers are continuously working with states to identify new outreach strategies, so no one is left behind during this process.
- Connecting Consumers with Enrollment Assistance. Where authorized, health insurance providers are connecting those no longer eligible for Medicaid with enrollment experts like agents and brokers, navigators, and assisters to enroll in other coverage such as employer-provided coverage and coverage through the individual health insurance Marketplaces. Health insurance providers are working to educate and engage a range of partners on these efforts, including providers, hospitals, federally qualified health centers, employers, and community partners like faith-based organizations.
- Educating Employers, HR Benefit Administrators, and Agents and Brokers. Health insurance providers are partnering with plan sponsors, representatives of the employer community, agents and brokers, and the CCC to build awareness of upcoming redeterminations and coverage transitions. Actions include encouraging employers to reach out to employees who may be dually enrolled in Medicaid and employer-provided coverage so they can update their Medicaid information, and to ensure employees are aware of the benefits in their employer-provided coverage. Health insurance providers and employers are also working together to let employees know that if they lose Medicaid coverage, they qualify for a special enrollment period. Together, they are also developing targeted resources to help people seamlessly transition to employer-provided coverage.
- Helping New Enrollees Maximize their Individual or Employer-Provided Coverage Benefits. Health insurance providers are committed to educating new enrollees on the differences between Medicaid, individual market, and employer-provided coverage. They want enrollees to understand their benefits and maximize the value they get from their health coverage. Special outreach includes education (e.g., through Welcome kits) on potential premium payments and differences in cost-sharing, provider networks, benefits and prescription drug coverage, and continuity of coverage, among other important features of commercial coverage.
Every American deserves access to affordable, high quality health coverage that protects their health and financial stability. Health insurance providers are taking decisive action now to help ensure that consumers across the nation enroll in coverage that is right for themselves and their families.