On April 1, the regular renewal process for Medicaid will return. But after about three years of not having to renew coverage, 64.3% of Americans are unaware that redeterminations will start up again, a recent Robert Wood Johnson Foundation report found.
The risk is that if the message is not delivered loudly and often, millions of people will simply lose coverage. So the key to improving this stat is constant outreach and repetition.
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“This is not something that you say once,” said John Baackes, CEO of L.A. Care Health Plan, in an interview. “You’ve got to say it over and over and over again to the point that people will tell you to shut up — which would be fine, because that means the message got through. So it’s repetition and using every available communication channel at your disposal.”
When the Families First Coronavirus Response Act was passed at the start of Covid-19, it required a continuous enrollment provision that barred states from disenrolling members from Medicaid and CHIP during the public health emergency. But the Consolidated Appropriations Act, signed in December, separated the continuous enrollment provision from the public health emergency, and required it to end March 31. This means people will have to begin renewing for Medicaid coverage again (a process called redetermination). About 15 million people nationwide could lose coverage when this happens, the U.S. Department of Health and Human Services predicted.
The reason people are so unaware about the return to the renewal process is likely due to the fact that it hasn’t been required for so long, said Anthony Lopez, vice president of individual and family plan sales at eHealth, a private marketplace for health insurance.
“It’s possible that the multiple extensions of the federal Covid emergency declaration over the past year or so have eroded the sense of urgency some people might otherwise feel on this issue,” Lopez said in an email. “A lot of people were added to the Medicaid rolls since the emergency order began. Some of them may not even be aware of the typical renewal process.”
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Katherine Hempstead, senior policy adviser of Robert Wood Johnson Foundation, added that state Medicaid agencies need to step up to keep enrollees informed and avoid them from unnecessarily losing coverage.
“Most people are busy with the day to day responsibilities of their lives and people generally really avoid thinking about insurance unless it is absolutely necessary, so unfortunately, but not surprisingly, this is not on the radar of many people who will be affected,” Hempstead said in an email. “State Medicaid agencies need to get advocates, providers, and plans to help spread the word so that people are aware of the need to provide contact information. That way we can hopefully minimize administrative churn, when people lose eligibility because of failure to comply with enrollment processes, rather than due to a true loss of eligibility.”
L.A. Care could lose up to 350,000 members in the redetermination process, Baackes said. However, this won’t happen all at once, but throughout the year depending on when people enrolled.
Baackes said the members who will likely lose coverage fall into three buckets — people who moved out of the county and are no longer eligible; people whose income may have gone up, making them ineligible; and those who fail to return their renewal information. The latter is the bucket that’s especially worrisome for Baackes.
“That’s the one we’re really concerned about because they probably won’t realize they’ve lost coverage until they show up at their pharmacy to pick up a prescription,” Baackes said. “They can go back to social services and start over again, but that could lead to a lapse of coverage of up to 90 days.”
Baackes’ comment tracks with recent research. Before the pandemic, 65% of people who were disenrolled from Medicaid or CHIP had a period of uninsurance, with 17% being uninsured for a full year, according to the Kaiser Family Foundation (KFF). Another KFF report found that only one-third of managed care plans have verified or current contact information for between 76% and 100% of their Medicaid members. Current contact information is needed to renew coverage, and this is a problem L.A. Care is struggling with as well. To tackle this, the insurer has started asking each person who calls customer service to verify their contact information.
The insurer is working with its providers to get the word out so they can talk to patients during appointments, Baackes added. L.A. Care also has a network of community resource centers, which are storefront facilities spread across L.A. County in California that will provide health education and customer service. If members are overwhelmed with the renewal process, they can go to the center to receive help. In addition, the payer will have a marketing campaign that includes bus shelter ads, TV and radio ads and text messaging.
Another player that is working to keep members informed is Health Net, a subsidiary of Centene. The insurer recently launched its “Review to Renew” campaign, which leverages print and digital media to make Medi-Cal members aware of the deadline and the need to renew coverage.
Although eHealth serves people who are jointly eligible for Medicare and Medicaid, it doesn’t directly serve Medicaid members. But it does offer a range of individual and family health insurance plans, which members can move to if they’re no longer eligible for Medicaid.
“We’re preparing ourselves to serve new customers coming off Medicaid into the individual and family market,” Lopez said. “Our expert advisors are ready to help educate them about their coverage options, help them select the right plans for their needs and budget, and help them apply for advanced premium tax credits.”
Whether these outreach efforts will be enough remains to be seen, however.
“Each state is approaching this process somewhat differently, and we will have a chance to see what methods are most successful,” Hempstead said.
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