As the calendar turns to April, states are officially restarting the Medicaid redetermination process.
Typically an annual process, redeterminations have been on pause to ensure continuity of care during the COVID-19 pandemic. During that time, access to Medicaid coverage also grew to a wider reach, meaning the backlog of redetermination decisions is massive.
Analysts have estimated that 18 million people could lose Medicaid coverage through the redetermination process, and many are unaware that it's set to even begin again.
States won't be on their own to navigate this process, however, as commercial insurers in the Medicaid space are gearing up to assist during "one of the most disruptive times in the Medicaid program," said Aimée Dailey, president of Medicaid at Elevance Health, in an interview with Fierce Healthcare.
"When you talk about the scope, it’s a little heady," she said. "State agencies in the past have methodically gone through based on an annual renewal, so it had some routine to it.
"When you think about all of the backup of applications and the people that will continue to become eligible … it’s a big darn deal for these states," Dailey said.
Medicaid managed care companies face several regulatory barriers that hinder how much they can do to assist members directly, Dailey said. There are limits on member data that insurers have access to, for example, and they can only offer broad guidance to direct them to other options.
Dailey said that in the lead-up to the redeterminations beginning again, Elevance Health and other payers have urged states and the federal government to loosen some of these restrictions to make it easier to gather accurate contact information on members and provide information that may "otherwise feel like sales," like whether they may be able to gain alternative coverage on the Affordable Care Act exchanges.
Within the confines of these regulatory policies, Elevance Health has launched two initiatives that aim to make the transition easier for members. The first is a web platform that asks members several basic questions, such as their ZIP code and annual income, and makes recommendations for the types of coverage they may qualify for.
Dailey said the tool was built to be easy for members to use. Elevance, much like any other health plan, benefits from keeping members within its ecosystem. However, the priority is to ensure people maintain coverage in general to avoid a crush of uninsured patients entering the health system.
"Our primary objective at Elevance Health is to find coverage somewhere for our members," she said. "Ultimately, it’s in the best interest of our members, it’s in the best interest of the healthcare system and it’s in the best interest of the country, quite frankly, that we get people covered where they need to be covered."
Dailey said that the member population who gained coverage during the public health emergency includes a number of people who have never experienced the redetermination process and people who may be transient or even homeless. That makes direct outreach to them that much more difficult, as flyers or phone calls may not reach them.
In addition, the process can be confusing to navigate and varies between states, so patients may struggle to understand their options, she said.
While the online tool arms members directly with information about their options, Elevance Health's second major program also leans on the influence of providers and community organizations to connect with people who could be impacted by the redetermination process.
"Ready, set, renew!" includes brochures and flyers that educate providers on how they can discuss redeterminations with Medicaid patients. Under this initiative, Elevance is also hosting health fairs and releasing ads that direct people to seek information about their coverage.
Direct member outreach through the program is personalized based on the data the insurer has available, such as the member's renewal date, and they can then send personalized texts or emails alerting them to the renewal window.
Though the stakes are high, the Medicaid redetermination process isn't going to be a quick one. A recent Kaiser Family Foundation analysis found that most states estimate getting through the full backlog of decisions will take a year, if not longer.
Dailey said that all the work put in to mitigate this wave of redeterminations will make state programs, Medicaid managed care plans and their interactions stronger for the future.
"I’d like to think that in the longer term, we’re going to be better going forward as a result of having to really come through what feels like a crisis," she said.