An influx of consumers may be looking for healthcare coverage. Exactly how do you prepare for that?

States across the country have begun redeterminations for Medicaid coverage eligibility. Over four million consumers have already been disenrolled, and that number is expected to climb. Let’s unpack the best way to handle the resulting surge in potential commercial health plan enrollees and how to navigate an ever-changing legislative landscape.

First, a word on the end of the federal COVID-19 Public Health Emergency (PHE). At a time when jobs were lost and loved ones faced severe health crisis during the pandemic, millions of consumers were wrapped in the safety net of mandatory continued Medicaid coverage. But, as of May 11, 2023, with the expiration of the PHE, and over the coming months, that safety net will be removed for an estimated 17 million consumers for medical coverage and an estimated 14 million consumers for dental coverage.

And the numbers don’t stop there: A third of those affected are children, based on the 14 states reporting age breakouts, and consumers with disabilities and those with limited English proficiency are also struggling to navigate the enrollment process.

How can we ease the stress and fear of shifting coverage amid such a chaotic transition?

For health plans in an ACA marketplace, the federal government has opened a special enrollment period to accommodate new members. And, for plans that are in an employer-sponsored space, the Centers for Medicare and Medicaid Services (CMS) notes that a large proportion of the group losing coverage will move to their employer-sponsored health plan. Either way, health plans need to prepare for an increase in members. Ensuring these members find quality care is key, and that starts with seamless operations to meet growing demand.

The good news!

The Department of Health and Human Services (HHS) is encouraging states to use all available resources to reduce abrasion. They have 23 strategies to help minimize terminations, and they’ve approved 188 waivers to date to help states and territories renew Medicaid coverage for eligible enrollees. They’re also adding Medicaid beneficiaries who were improperly removed back into the program.

The risk of losing coverage and finding a new provider in a new network can be daunting for members. Add to that the complexities of receiving care—from barriers like affording medications to understanding treatment and navigating a new policy—and disenrollment has the potential to expound on preexisting challenges, making for a uniquely frustrating experience.

You can help them through this by talking to them about their expansive network, the many provider choices available, and how to shop for and find the right provider. This could also be a good time to introduce care guidance solutions that assure members they’re doing the right thing at the right time. For example, instill confidence in receiving quality care by encouraging regular checkups and other preventative measures. Leverage a concierge team to remind members about important next steps or consider implementing a rewards system to help members stay motivated along their care journey.

These might seem simple, but they make a big difference to your members. Small touch points can have a tremendous influence as you help them navigate a new plan. Plus, the additional insight into the health of your members will help you accurately analyze their risk adjustment. A win-win all around.

Working together is key.

Most, if not all, areas of the healthcare industry will be impacted by the Medicaid disenrollment process. No one is immune. For example, let’s look at the effect on providers and their patient relationships.

When Medicaid members lose coverage, they’re far more likely to decline or delay care, leaving providers to face a loss in revenue. While we can expect patient relationships with safety-net providers (providers who provide care regardless of someone’s ability to pay) to continue, specialized care and/or mental healthcare treatments could decline. This is where health plans can lend a hand.

By working with providers to ease patient transitions from Medicaid to a new health plan, you can help prevent lapses in care. Providers might also want to reassess their collections strategy to mitigate revenue loss.

The more communication to members about their options, the better. Ensuring they are informed is crucial to avoid gaps in care. This requires empowering providers during transitions and prioritizing reduced abrasion and preparation for new enrollees.

So how do you do all that seamlessly?

Start by making sure the service providers and business partners you have in place can meet growing demand and support new members where they are with their health, whether they are getting on a preventative care schedule or shopping for a new doctor. Agility is important here. There is nothing simple or seamless about this type of complicated legislative change, but you can facilitate a positive transition by working within an adaptable solution that provides guidance for your members, confidence in coverage, easy access to care, and reduces abrasion wherever possible.

CMS is doing a lot to help make this transition easier too. They’ve worked with most states to improve their renewal process and urged them to spread out disenrollments over a 12-month period. More than 40 states are working with Medicaid Managed Care Organizations to ensure correct contact information is used to send renewal packets. Considering procedural disenrollments, like incorrect contact information, account for a large portion of consumers losing their Medicaid eligibility, that alone goes a long way toward minimizing terminated coverage.

Everyone is working hard to make redeterminations as seamless as possible. Still, it will take all of us working together to minimize disruptions and reduce abrasion, thereby keeping your member population confident, engaged, and ultimately heathier.

The healthcare consumers quickly becoming Medicaid outcasts are looking for new refuge. There’s no reason that can’t be you. And there’s certainly no reason you should be worried, unless you’re unprepared.

Now is the time to make sure your solution partners are poised to scale and guide members to the right care as redeterminations continue in the months ahead.

If you need assistance preparing for the influx of enrollees, we’re here for you. Connect with our team to talk about your options and learn different ways we can help.

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