CBPP: Managed care plans need to prep for major coordination with states on Medicaid redeterminations

Medicaid managed care plans need to prepare for “unprecedented coordination” with state officials to ensure beneficiaries continue to get care after the COVID-19 public health emergency (PHE) ends, experts said. 

Officials with the think tank Center on Budget and Policy Priorities outlined how state Medicaid agencies could be falling behind with potentially only five months to go before the PHE expires and with it a requirement to redetermine the eligibility of all beneficiaries. 

States can rely on Medicaid managed care plans to help with reaching out to beneficiaries on Medicaid and to relay key information on how to reapply for coverage.

Managed care plans “tend to be in closer contact with [the] beneficiary and have information fed to the state agency,” said Jennifer Wagner, director of Medicaid eligibility and enrollment for the center, in a call with reporters Wednesday. “MCOs can get lists from state agencies of all of their members due for renewal each month and they have the opportunity to do something that agency doesn’t have.”

The plans can use direct messages to these beneficiaries that make it easier to reach out to them. 

“We are seeing [the] potential for unprecedented coordination and leveraging [managed care organizations’] capacity to help those stay covered,” Wagner said. 

At stake is a potential major drop-off in Medicaid coverage that could start to occur later this year. In March 2020, states agreed to take on a 6.2% increase in federal matching Medicaid rates in exchange for not dropping anyone off Medicaid for the duration of the PHE. 

The Department of Health and Human Services has promised to give states a 60-day heads-up when the PHE will not be renewed, and that deadline came and went on Monday. That means the PHE will likely be extended again in July and run at least through October. 

Experts at the center said states need to use the extra five months to shore up their staff, infrastructure and processes to prepare for the massive task of redetermining its Medicaid population. The Centers for Medicare & Medicaid Services (CMS) is giving states 12 months to start redeterminations starting the month after the PHE ends and 14 months to finish the job. 

Recent estimates from the Kaiser Family Foundation show that between 5.3 million and 14.2 million people could lose coverage after the PHE. 

Wagner said there is a reasonable risk that state Medicaid agencies could fall behind answering calls and processing paperwork. 

“People who do everything right may still lose coverage,” she said. “Many states are facing dramatic workforce shortages and have IT systems that don’t turn on a dime.”

States can increase the rate of automatic renewal and options for people to renew such as online, experts said. 

“Agencies should ensure [they] have adequate staffing by hiring more workers and bringing back retirees temporarily,” said Farah Erzouki, a senior policy analyst with the center. “Improvements can go a long way to ensure people can navigate [the] enrollment process.”

A major way for states to reach out to beneficiaries is via text message, and states need to ensure they have the right information.

“Insurance companies can work with states and can have more updated contact information than the agency itself,” Erzouki said.

But it still remains unclear whether managed care plans will continue to face barriers from a more than 30-year-old telecommunications law that could prevent beneficiaries from getting texts from plans without their express permission. CMS wrote to the Federal Communications Commission last month calling for an exception for contractors and managed care plans to text beneficiaries and not violate the law.