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One year later: How payer communications can help consumers navigate Medicaid Redetermination

Leah Sheveland, Stephanie Counts

One year after the conclusion of the Public Health Emergency and return of Federal Medical Assistance Percentage (FMAP) to pre-pandemic levels, COVID-19 continues to impact Americans. Their ability to select appropriate health insurance is greatly influenced by their awareness of and access to well-matched plans for their families. Impacted consumers need supportive communications strategies and experiences to guide them to appropriate plans with as little friction as possible.

The COVID-19 Public Health Emergency and temporary increase in FMAP funds to states were key to ensuring access to healthcare would not be disrupted during this unprecedented crisis. Even still, 65% of the uninsured population in 2021 was eligible for but not enrolled in either Medicaid or non-Medicaid subsidized coverage.

There are an estimated 27 million people in the United States without health insurance. The Congressional Budget Office forecasts this number to grow by over 3 million in the next three years to more than 30 million by 2027. Disenrollment from Medicaid is forecasted to increase through 2025 before leveling off at participation rates below pre-pandemic levels.

In preparation for redetermination, states and their Health Plan partners deployed a range of strategies to prepare Medicaid members for resumption of eligibility verifications in 2023. While some states provided toolkits, dashboards, FAQs, and public plan summaries, others only distributed alerts to update contact information. These might seem like minor variances, but effective communication and facilitation around this transition is critical for current Medicaid members’ understanding and their ability to make informed decisions about their healthcare.

As payers navigate this time of transition, Customer Experience Transformation (CXT) is a flexible lens through which to evaluate their positioning in consumers’ consideration set. Payers should lean into CXT’s consumer-centric and proactive approach to strategically plan for the future they want, while remaining empathetic and agile relative to the situation confronting many Medicaid users. A post-pandemic, strengthening labor market increases potential access to employment-sponsored coverage and Exchange-based coverage, yet gaps remain in awareness of available subsidies for eligible Americans.

Digital CXT offers unique potential, particularly when navigating this cliff event. As of 2021, 97% of all Americans have a cell phone and 85% have a smartphone. That, coupled with the fact that one in five Americans is enrolled in a Medicaid plan, means leveraging digital solutions is the best opportunity for states and their payer partners to reach members with vital information about their coverage options.

Resumption of annual Medicaid verification has also introduced significant risk—for states and their payer partners to effectively communicate changes to impacted members, for healthcare providers to validate coverage at point of service, and, most importantly, for consumers to ensure they select the best plan for themselves and their families.

Payers and state Medicaid plans can close communication gaps that many states have left open leading up to redetermination by adopting a customer-centric approach—meeting consumers where they are with honest and clear communication. Payers that leverage digital-first solutions can ease the burden for consumers, helping them confidently make healthcare coverage decisions.

Organizations are increasingly relying on Customer Experience Transformation as an effective strategy to address their most pressing consumer-facing challenges, such as Medicaid redetermination. CXT creates opportunities for transparent communications that foster member loyalty by ensuring eligibility determination processes follow CMS guidelines, helping consumers stay engaged in the healthcare system, and allowing them to easily find and enroll in the best plan for them.