Unwinding the continuous coverage requirement is an unprecedented undertaking for Medicaid programs that requires new and strengthened partnerships. Much like the Medicaid programs we serve, the National Association of Medicaid Directors is working to strengthen our partnerships at the national level, including with other organizations that support various agencies and branches of government in the states and territories. We are regularly convening these partners to ensure coordination across the branches of state and territory government and share insight from the Medicaid Directors.
The following is a list of questions, which will be regularly updated, that our partner organizations are asking about unwinding:
How is unwinding impacting different eligibility groups, especially older adults and individuals with disabilities?
Medicaid programs are intently focused on ensuring all eligible individuals across groups retain their Medicaid coverage, especially given evidence that awareness remains low among older adults and individuals with disabilities. However, federal unwinding data does not disaggregate the outcome of renewals by age or eligibility group, such as those who qualify based on disability. This makes it difficult to determine, at a national level, how renewals might be impacting those with the most complex health care needs. Nevertheless, many Medicaid programs are reporting data by eligibility group on their own dashboards. They are also deploying strategies to support older adults and individuals with disabilities through renewals, such as partnering with nursing facilities to help residents complete the required steps. Many Medicaid programs are also sequencing renewals to be able to provide extra time to these individuals and minimize potential disruptions in active treatment.
What are states doing to enhance call center capacity?
Unsurprisingly, the huge push of messaging about the unwinding process has resulted in many people reaching out to their Medicaid programs, typically by contacting their call centers. Despite planning in advance, making systems improvements and contracting for additional call center staff, states and territories are experiencing extraordinarily high call volume related to unwinding. Inquiries are often complicated and require research to resolve – these calls are often not cookie cutter, script-based encounters. Many states are also choosing to prioritize ensuring that the individual on the phone stays on the phone until their issue is resolved. That kind of prioritization does not lead to quick call times. In addition, many of these call centers handle multiple functions, not just for Medicaid but for a range of programs such as SNAP (food stamps) and other financial assistance for families. Calls for these other programs can often require more time than calls related to Medicaid.
States and territories continue to innovate and adapt new strategies to reduce wait times and improve the customer experience, such as:
- Automated tools to support members in updating their addresses (e.g., Nevada) and help members look up when their renewals will occur (e.g., Minnesota, Rhode Island);
- Sharing rosters of renewal rates with health care providers such as primary care physicians and health centers (e.g., Indiana), so that clinicians can remind patients about their renewal;
- Partnerships with their state-based marketplaces (e.g., New York and Pennsylvania) to ensure that eligibility platforms that integrate Medicaid and marketplace eligibility determinations are working smoothly and well;
- Use of staff, integrated voice response systems or chatbots (e.g., Colorado and Oregon) to triage calls as they come in, so that people can be appropriately directed;
- Use of a “pizza tracker”-type apps (under development) to help people understand the status of their application and redetermination without needing to contact a call center; and
- Call-back functions (e.g., Idaho) that ensure that people don’t have to wait for lengthy periods on the phone, but rather get an incoming call when a staffer is ready to help them.
How are Medicaid programs budgeting to serve people after the unwinding?
Medicaid programs serve two broad groups of individuals: Those who qualify based on their financial status and those who qualify based on their significant health care needs or disability. During the pandemic, families and adults with low incomes retained their Medicaid despite financial changes, which often fluctuate for Medicaid members. As we return to normal eligibility operations, Medicaid programs are budgeting for a more typical distribution of individuals with complex needs and those who qualify based on income. Families and adults who qualify based on income tend to need less health care services and are less costly per person for the Medicaid program to serve. Medicaid programs are building their budgets to account for this change in distribution and the fact that the per person costs of providing services to Medicaid members will increase on average.
Which are Medicaid leaders doing to get members to respond to their renewal notice? What strategies are working best?
States and territories have increased the volume of their outreach to members and the means they are using to engage, including texting and email as well as partnerships with community organizations that are trusted sources of information and support. But the challenging reality is that many people are not responding to notices or other contacts, which is a longstanding, historical challenge in Medicaid. People served by Medicaid often have very complex life circumstances. One or multiple jobs, caregiving obligations for kids and aging parents, health conditions, and financial stress hamper their ability to respond. In the best case, some people are not responding because they are aware they no longer qualify and already have alternate health insurance coverage through a marketplace plan or an employer. But undoubtedly there remain people who do not respond yet remain eligible. Often those individuals do not fully realize they have lost coverage until they seek medical help or try to fill a prescription.
There is no quick fix to this challenge. Medicaid programs continue to innovate and deploy an array of strategies to increase the number of members who are responding to their renewal notice:
- Reinforcing early-stage contacts with child care centers, pediatricians, clergy and others;
- Partnering with private sector partners such as Family Dollar stores and large chain pharmacies to raise awareness about the renewal process;
- Meeting regularly with a broad range of members, health care providers, stakeholders and advocates to learn from the lived experience of all involved;
- Making proactive outreach calls to prompt members who haven’t responded; and
- Using surveys, outbound calls, and other sources of data to understand why individuals may not be responding and whether they have other sources of coverage.