Stricter Medicaid eligibility checks look destined to be included in President Donald Trump-backed reconciliation legislation charging through Congress, dubbed the One Big Beautiful Bill.
New work requirements are likely to make it more difficult for current Medicaid enrollees to keep their insurance coverage, leading to a push aimed at exempting managed care plans from a 1991 law restricting their ability to text members.
The charge is led by Abner Mason, chief strategy and transformation officer at GroundGame.Health, who has worked with plans to change the law for the last decade but is viewing the situation with renewed vigor. He is beginning to speak with a coalition of stakeholders including America’s Health Insurance Plans and the Medicaid Health Plans of America, hoping to leverage their expertise and lobby senators for the policy's inclusion in the bill.
His plan could have motion among lawmakers hoping to reduce spending but minimize the disruptions brought about by work requirements.
“The need to modernize communication has increased tenfold,” he told Fierce Healthcare in an interview.
President H. W. Bush signed the Telephone Consumer Protection Act into law to stop intrusive robocalls and telemarketing practices. Part of that law says a person can’t be texted unless they give permission. Because Medicaid enrollees are assigned a health plan by a state or county, legal teams at health plans say implied consent is not present like it would be through another line of business, such as Medicare Advantage or the individual market.
Some insurers have sent members a text asking for permission to continue texting, but other health plans have refused since even an initial text could be considered a violation. Each infraction, or text, could result in a $500 to $1,500 fine. Multiplied over hundreds of thousands of members, those costs add up quick.
In Virginia, only about 3% of Medicaid enrollees agreed to opt into receiving messages from the state’s program, reported KFF.
An inability to text enrollees in 2025 is staggeringly inconvenient and unrealistic for health plans, said Mason. It’s important plans are able to text updates about an upcoming diabetes screening appointment, for example. If Republicans’ bill passes—requiring states to conduct eligibility checks every six months among the latest provisions—members should not face any additional complications in remaining enrolled.
The Medicaid and CHIP Payment and Access Commission expressed similar concerns in 2022 for members that do not receive mailed notices and are then subject to coverage loss.
Managed care plans have been able to text enrollees in two instances. During the COVID-19 public health emergency, plans were allowed to communicate strictly about the pandemic. That flexibility disappeared when the emergency ended.
The Centers for Medicare & Medicaid Services and the Federal Communications Commission, under the Biden administration, also issued guidance allowing plans to text about Medicaid redeterminations once the public health emergency was lifted, though that guidance could be easily revoked.
If texting is not an option, members are forced to communicate with their insurers through traditional mail or even fax. Some low-income members on Medicaid may have a phone but not have easy access to a computer.
Ideally, said Mason, texting a member would incentivize them to follow a care navigation plan, remember critical preventive screenings and get better educated on how to live a healthy life. He sees a path, if a narrow one, to convince Republicans the importance of exempting managed care plans of requirements he deems outdated.
Trump has repeatedly said he does not want Medicaid cut other than by rooting out waste, fraud and abuse. Some senators on the right are wary of touching the program, concerned at how constituents back home would react. Hardliners justify the changes, saying the program needs to be reined in to support Medicaid’s original intent. Meanwhile, leadership across the Department of Health and Human Services has shown a desire to modernize the department in the name of efficiency and effectiveness.
“We’ve got to thread that needle,” Mason said of the push to update the texting restrictions. “Why would you force people to use a horse and buggy when you know there are more modern ways of getting people from point A to point B?”
Republicans have steadily pushed the reconciliation bill out of the House, despite blowback from health systems, patient advocates and insurers over how reduced Medicaid spending could affect the healthcare ecosystem.
Today, the Congressional Budget Office projected the proposal’s work requirements would slash spending by $344 billion. Medicaid changes alone would result in 7.8 million fewer insured individuals—10.9 million people when factoring in other changes.
Overall, the reconciliation bill would reduce spending in healthcare by more than $1 trillion. The Trump administration hopes to sign the bill into law in July.