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Medicaid leaders need your continued partnership on unwinding

NAMD Executive Director Kate McEvoy urges deeper understanding of unwinding data and help from partners in outreach.

Focus Areas

The Centers for Medicare and Medicaid Services released a call to action to governors across the country around the federally-mandated nationwide process for redetermining the eligibility of all people currently served by the program. In a nutshell, CMS is asking states to do more to ensure that Medicaid members who remain eligible for the program don’t lose coverage. This call comes on the heels of data releases from the initial states that have launched their redetermination processes, which show a range of experiences in coverage loss and retention.

On behalf of our membership – the 56 state and territory Medicaid programs – we honor and are completely aligned with the concern about retaining people who continue to qualify. Loss of the comprehensive protections of Medicaid coverage is significant and we all acknowledge that our continuum of health care insurance options remains fragmented.

The shared goals across the country are to maintain coverage for all people who remain eligible – with a particular emphasis on children, older adults and people with disabilities – and to support people who have become ineligible in accessing coverage on the marketplace or through their employers. To this end, throughout the redetermination process, all states are required to observe extensive procedural protections for members, including specific types and frequencies of outreach, fair hearing processes and a new 90-day reconsideration period during which people can be reinstated to coverage.

As we have said since unwinding began in earnest earlier this year, we cannot do this critical work without all interested parties – advocates, providers, managed care plans, hospitals, and community-based organizations – linking arms. Specifically, we have all known that overcoming more than two years of messages to Medicaid members telling them to disregard eligibility notices would be a steep hill to climb.

That’s why states have been conducting the most extensive outreach many of them have ever done. This continues to include mail, texting, call centers, navigators, outreach grants to community-based organizations, and large-scale digital campaigns. Some combination of these strategies – and for many states, all of these – are working to reach Medicaid members. That said, states remain in a constant posture of examining experience and layering on new ways to connect.

While we focus on additional actions that our agencies can take, as well as new and enhanced opportunities for partnership, we also want to help put the current unwinding data in context. Medicaid has always been a large and complex program, and unwinding is the largest and most complex effort we’ve ever undertaken. It is essential to understand the data more fully to continue to improve and evolve our mutual strategies.

Compellingly, there is clear evidence that many Medicaid members still don’t understand that unwinding is occurring, don’t know what action to take when they do become aware, or can’t complete the enrollment requests. But we also know that many folks have not responded to Medicaid agencies because they are no longer eligible or have moved on to employer-sponsored health insurance or coverage through state-based or federal marketplaces. It is too early in the process to know exactly how many, and we need data from the federal government about marketplace coverage to tell a more complete story.

A critical message that we need your help to deliver is that Medicaid is always open for new enrollment or reenrollment. Unlike private insurance which has open enrollment periods with limited exceptions for life events, Medicaid is always available to people who need it and qualify for the program. Even if a person loses eligibility because they have not been able to respond timely or only learn they have lost eligibility when they visit the doctor, they can be restored to eligibility at any time.

 This year of unwinding won’t be simple or static. Data will change month over month as people are redetermined, states make course corrections, and new people come onto the program. The bottom line is that states are and will continue to be in a constant cycle of evaluating experience and data, and pivoting their approach to address emerging issues of concern.

Without question, we all have shared goals: Keep all eligible people covered and do everything possible to help those who are no longer eligible to transition to marketplace or employer coverage. With your partnership, we can do just that.


Four important considerations for understanding initial unwinding data

Related resources

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