The DNA of Healthcare

Visit Corporate Site

Managed Care Plans Aid States in Return-to-Normal Medicaid Eligibility

Senior Director Healthcare Strategy

Medicaid coverage is in flux for many Americans. During the COVID public health emergency, Medicaid disenrollments were paused. The Consolidated Appropriations Act, 2023 called for the continuous coverage to end on March 31, 2023. States started disenrolling Medicaid members as of April 1, 2023.

During COVID, Medicaid enrollment grew substantially (27.9%). Potentially millions of Americans will lose coverage with the end of continuous enrollment. The Department of Health and Human Services estimates that ending the public health emergency will cause enrollment loss of 15M people, 6.8M of which will be disenrolled due to administrative “churn” but still eligible.

Medicaid redetermination is a normal process but the scope of the upcoming disenrollment is much larger and will be a substantial effort on the part of states and managed care plans to complete the process. States have a 12-month “unwinding” period following the end of continuous enrollment to initiate all post-enrollment verifications, redeterminations and renewals. Given the job ahead and being understaffed, some states taken advantage of a waiver to allow managed care plans to assist in the redetermination process.

Many of the current beneficiaries haven’t had to complete a Medicaid renewal in years and may have outdated contact information. As a result, many members are in danger of not receiving mailed notices or information requests, leading to inappropriate loss of eligibility for some. As states return to normal eligibility operations, individuals may need help with the processes and tasks such as submitting documentation, confirming eligibility or enrolling in Marketplace coverage. This is where a managed care plan can help.

Next Steps for Managed Care Plans
It’s inevitable that Managed care plans will lose members through the unwinding process. However, there are many members that are ineligible due to procedural issues. It makes sense for managed care plans to take action to help retain as many members as is possible.

Centers of Medicare & Medicaid Services (CMS) has provided a detailed description of how managed care plans are allowed to help with the unwinding process:

  1. Partner with the state and update beneficiary contact information, making establishing eligibility more efficient.
  2. Provide support to Medicaid members during their renewal period.
  3. Contact Medicaid members who have recently lost coverage for procedural reasons.
  4. Assist members to transition from Medicaid to the Marketplace if no longer eligible.

The steps that CMS has outlined ultimately will benefit Medicaid members, helping them look at all coverage options. These steps also allow managed care plans to participate in the process and retain members.

Why Updated Contact Information Is Critical
As managed care plans start outreach efforts, inaccurate contact data can be a barrier. Inaccurate data is inefficient and keeps members in the dark about their potential coverage options. Also, If you can’t reach a member because of inaccurate data, you are waiting on them to contact you, delaying action that can help them retain coverage.

The redetermination is going to be challenging for states, managed care plans and members. Managed care plans have a critical role as the link to care for members.

Contact us if you’d like to learn more about how you can get more updated member contact information.

Contact Us

The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

Related Articles

These blogs are published for information purposes only and can be statements of opinion. Although we LexisNexis rigorously check the accuracy of all information at the time of publishing the blogs, no representations or warranties are expressed or implied as to the blog, its contents and any accompanying materials and it should not be relied upon for acting in specific circumstances. Although links to external websites on any blog posts are tested and deemed accurate at the time of the blog posting, we LexisNexis accept no liability for such links to external websites and do not endorse or warrant in any way any materials available through such links or any privacy or other practices of such sites. In addition to this blog disclaimer, access and use of the blogs is governed by the LexisNexis website.