Medicaid Agency Workforce Challenges and Unwinding

For many Medicaid agencies, workforce shortages and agency vacancies are creating real challenges for accomplishing the significant lift that is the unwinding. States are facing the reality of Medicaid eligibility redeterminations for hundreds of thousands or millions of individuals.

Here’s a look at the realities states are facing as well as the efforts states are currently undertaking to try and overcome these issues in support of a comprehensive and fair unwinding process.

• Like many employers, state Medicaid agencies are struggling with workforce vacancies. The National Association of Medicaid Directors that represents all 50 states, DC and the territories found that the average Medicaid agency vacancy rate is 17 percent, although some states are as high as 30 to 40 percent.
• States are facing workforce shortages at the same time they are assessing Medicaid eligibility of 90 million individuals who have been continuously enrolled in Medicaid since February 2020.
• Challenges finding skilled workers and filling vacancies are exacerbated by a low national unemployment rate at 3.4 percent.
• The Medicaid agency staff most heavily involved in conducting redeterminations are eligibility staff who are analyzing Medicaid eligibility information, processing applications, and working directly with families, the elderly, and people with disabilities who are going through the redetermination process. This work is detailed-oriented, pressure-filled, and time-sensitive.
• States are taking many measures to address workforce challenges and boost productivity and capacity. States are:
  • Hiring temporary staff;
  • “Borrowing” staff who work within sister state agencies;
  • Leveraging existing contractors, like health plans;
  • Encouraging former state employees who have retired to come back to work;
  • Funding counties to enhance the county-based workforce;
  • Providing targeted training and professional development to enhance and strengthen state teams;
  • Strategically managing workload by giving more complex cases to more seasoned employees;
  • Using technological advances, like bots, for processing returned mail;
  • Integrating eligibility systems to increase the use of ex parte reviews, sometimes called “passive” reviews executed using existing data, which reduces eligibility workload; and
  • Supporting telework.
• State workforce shortages are another reason for states to “strike a balance” on the speed with which they do the unwinding, i.e., to process redeterminations in a way that avoids unintended administrative costs/burdens down the road by moving too quickly while adopting a timeline that is right for each state.