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Medicaid leaders gather to share unwinding lessons and gather insights

Continuous improvement is the goal for unprecedented effort

Focus Areas

On July 11-12, 139 state and territory Medicaid leaders from 43 states, the District of Columbia, and five U.S. territories convened in Denver, Colorado for the NAMD Unwinding Summit. The summit came at a vital time to support issue spotting and course correction on unwinding operations. Given the multidisciplinary effort of resuming normal eligibility operations after three years of continuous coverage, this was also an opportunity for internal team collaboration, including bringing together communication, eligibility, finance, IT/systems, and policy leaders. Coming out of the summit, Medicaid leaders learned from one another and identified areas to adjust in their internal operations as well as lifted up opportunities for long-term change in support of Medicaid members as it relates to the renewal process. Highlights from the summit include:

  • It’s vital to understand the data coming out of unwinding. The summit included several sessions to better understand the data from unwinding efforts. For instance, state/territory leaders are working to study why members may not be sending back their renewal forms and if that’s an indication of whether a Medicaid member does not intend to stay on the program because they have other coverage or if their messaging is not breaking through. Medicaid leaders are looking at third party liability data, change in unemployment rates, and claims data to better understand this question. Some states also conduct post-disenrollment surveys and incorporate special prompts into call center operations to understand the potential size of the group of Medicaid members who do not want to renew their coverage. Federal partners at the Centers for Medicare and Medicaid Services (CMS) shared their insights on how programs can use data to better identify challenges with coverage loss, particularly for children and across whole family groups.
  • Medicaid programs are leveraging the reconsideration period to prevent coverage gaps. Because of the nature of how people access the health care system and their health insurance, many people don’t realize they have lost coverage until they try to utilize health care services. Others may need multiple prompts to reconnect with their Medicaid program and submit their required paperwork. These are just two scenarios that highlight the importance of the reconsideration period as a vital time to get members connected back into coverage without causing gaps in care or out of pocket expenses. State Medicaid leaders are focused on effective strategies during this period including working with managed care organizations, community-based organizations, health care providers, and special communications to members. For instance, many states/territories are interested in extending the length of the reconsideration period, and many will restore coverage to the date of disenrollment (within the reconsideration period). States and territories are also interested in extending the reconsideration period to a broader set of their Medicaid members.
  • Member Panel Insights. Members and alumni from Colorado’s Member Experience Advisory Committee joined us for a panel to give on-the-ground insights around unwinding efforts. They provided meaningful feedback on unwinding operations from the Medicaid member perspective including: 1) Highlighting the fragmented system around eligibility that makes Medicaid member engagement challenging and sometimes impossible without assistance; and 2) The need for better translations for individuals with limited English proficiency and those who lack program understanding that hampers their ability to know where to turn for help. We know that Medicaid eligibility can live in different parts of government (e.g., counties, umbrella agencies, sister agencies) and it can be challenging for the Medicaid member to navigate across these systems. We know states have created journey maps and special trainings for eligibility workers to support warm transitions between systems. The member panelists also highlighted that direct translations do not always make sense for native speakers, and so, we know many states have notices and materials reviewed by members and community partners to ensure that they are informative to individuals who have limited English.
  • The workforce remains a major challenge. Given the greater national context, it is not surprising that workforce challenges continue to be a major issue across most states and territories as they work through a three-year backlog of renewals. Sessions related to building the capacity of the current workforce through recruitment and retention as well as system advances to increase the efficiency of the existing workforce were critical pieces in ongoing course corrections during the unwinding.

Support for this summit was provided by the State Health and Value Strategies program, a grantee of the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

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