HealthcareMedicaid redeterminations tech solutions aim to ease process

Medicaid redeterminations tech solutions aim to ease process


As states grapple with Medicaid redeterminations and high rates of disenrollments, states are teaming up with technology vendors to facilitate communications and outreach to affected enrollees.

States paused Medicaid eligibility checks for more than two years in exchange for a federal funding boost during the COVID-19 public health emergency but have begun reviewing the rolls again to remove people who no longer qualify. Scrutinizing eligibility for more than 90 million people is no easy task, and the Health and Human Services Department projects that 15 million people will lose Medicaid by the time redeterminations are complete.

A large number of people being disenrolled for procedural reasons, such as not responding to inquiries from states, already has triggered concern from the Centers for Medicare and Medicaid Services. According to the Kaiser Family Foundation, more than 500,000 people in 11 states lost coverage through May.

The three biggest challenges states face are staffing, underfunded or outdated technology and the lack of data interoperability between Medicaid agencies, health systems and health insurance companies, said Diana Zuskov, associate vice president for healthcare strategy at LexisNexis Risk Solutions.

That’s why states such as Arizona, Maryland and Massachusetts see technology solutions as critical to an orderly redeterminations process

For example, the Arizona Health Care Cost Containment System, which administers the state’s Medicaid program, deployed a web-based chatbot that can answer 30 commonly asked questions. Live agents will replace the automated system this summer, spokesperson Heidi Capriotti said.

The healthcare analytics consulting firm Socially Determined offers a tool for Medicaid insurers to create member rosters that enable them to identify enrollees at highest risk of losing coverage, said Ashley Perry, the company’s chief strategy and solutions officer. The app assesses factors such as educational attainment, language barriers, access to technology and frequency of moves, she said. Insurers then use this information to execute communications, outreach and support strategies, she said.

Challenges and opportunities

Despite the many challenges, a nationwide effort to review Medicaid eligibility presents an opportunity to improve how states communicate with beneficiaries, said Karen Shields, chief client engagement officer at Gainwell Technologies, which offers digital services to government agencies and healthcare providers. Gainwell Technologies provides call center workforce support and assists with provider enrollment, for example.

“You have to have a national view in order to meet a moment like this where everything is happening at the same time and the biggest gap is all those redeterminations that are a result of lack of communication,” said Shields, a former deputy director of CMS’ Center for Medicaid and Children’s Health Insurance Program Services. Medicaid, which is jointly managed by federal, state and territorial agencies, is more difficult for vendors to serve because there is so much variance, unlike the entirely federal Medicare program, she said.

Gainwell Technologies offers a mobile digital platform designed for Medicaid agencies. “The app includes several features to put the power literally in the hands of a Medicaid beneficiary. Features such as digital ID cards, electronic messages, essential provider data, detailed program benefits, multi-language options, ad hoc forms to complete and submit to the state agency, and claims fraud capture,” Shields said.

Arkansas and Nevada already use the app. Delaware and New York are implementing it, as is California, but only for dental coverage recipients, Shields said.

The patchwork of government agencies, health insurance companies, providers and community groups involved in the redeterminations process likewise complicates communications strategies, Zuskov said. Although the large number of procedural disenrollments suggests the message about Medicaid redeterminations isn’t reaching enrollees, too many messages from too many sources can be cause problems by breeding mistrust, she said.

Kaiser Permanente and eight other insurers have partnered with the Maryland Health Connection insurance exchange, providers and community-groups to ensure that messaging is consistent, said Shannon McMahon, executive director for Medicaid policy at the Oakland, California-based integrated health system. Kaiser Permanente also uses text messages, email and automated telephone calls to connect beneficiaries to its Medicaid assistance center, she said.

“As much rapid-cycle learning as we can do is really going to help drive success. Knowing how we’re reaching people and what’s connecting and what isn’t is going to be very critical here,” McMahon said.

Last summer, the Maryland insurance companies contracted with outreach firm GKV to create the Medicaid Check-In campaign, said Jennifer Briemann, executive director of the Maryland Managed Care Organization Association, a trade group for Medicaid insurers.

In addition to implementing technology solutions, such as including a QR code throughout campaign materials, the effort also seeks to meet enrollees where they are, Briemann said. That includes placing flyers and short videos in physician waiting rooms, buying advertising on billboards, bus shelters and laundromats, and including the QR codes on receipts at discount stores, she said.



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