State Best Practices Can Help Reduce Coverage Losses During Unwinding

The Medicaid continuous coverage protection ended on March 31, 2023, and states have begun the unwinding process and resumed Medicaid coverage terminations. The early months of unwinding have shown significant coverage loss, including among those who still meet eligibility criteria but lose coverage for procedural reasons. Such coverage losses lead to unnecessary coverage gaps and additional burden on individuals and Medicaid agencies when people must reapply for coverage. States should do all they can to avoid these losses.

Eligible enrollees may lose Medicaid coverage if they don’t receive a renewal form, don’t understand what they’re required to do to maintain coverage, don’t return the form in time, or if a Medicaid agency falls behind in processing paperwork. Fortunately, some states are using innovative strategies to streamline renewals and to more effectively communicate with enrollees to reduce the risk of eligible people losing coverage.

• Communication and outreach. To increase awareness among enrollees and help stakeholders understand the steps they need to take to renew their coverage, states should communicate unwinding plans and information to enrollees and community members via user-friendly webpages. For example, Colorado and Pennsylvania have created unwinding homepages with toolkits, messaging information, detailed instructions for enrollees, and frequently asked questions. Some states are also communicating directly with enrollees through text messages.
• Displaying the renewal date. Many people are hearing unwinding messages now, but most states are conducting renewals over the course of 12 months. If enrollees don’t know when their renewal is due, they may be concerned that they haven’t received a renewal notice and call eligibility workers, which increases traffic at call centers. To reduce confusion and increase enrollees’ awareness, some states are providing a user-friendly avenue for enrollees (and providers, in some cases) to check the month of their scheduled renewal. Several states, including Kentucky, allow users to view their renewal month through their online portal.
• Call center best practices. As call center volume and wait times increase during unwinding, states can take steps to improve the experience of callers seeking assistance and make it easier for them to take action to renew their coverage. For example, New Mexico informs callers of the expected wait time and offers a callback option. Along with the callback option, Kansas offers a separate dial option to update contact information, simplifying a key step for people in the renewal process. Massachusetts offers the option to schedule an appointment with the call center, including with an interpreter if needed. Adopting such practices also helps agencies better manage incoming inquiries, helping to alleviate workload challenges.
• Waiving asset tests for elderly and disabled enrollees. States have a lot of policy flexibility for their elderly and disabled enrollees. These enrollees are often referred to as non-MAGI populations because their eligibility is not determined based on the “modified adjusted gross income” standard used for other enrollees. They often face cumbersome Medicaid renewals because federal rules do not currently require states to simplify procedures for non-MAGI enrollees in ways that are mandated for other groups. But states can and should streamline these processes, and some are doing so. For example, California and Minnesota have waived asset tests for most of their non-MAGI populations during unwinding to significantly reduce administrative burden on enrollees and eligibility workers.
• Data transparency. Transparency in unwinding outcomes allows the agency, consumer advocates, and other stakeholders to address issues that arise during unwinding. Because unwinding will last about a year, publishing and analyzing early results can allow for course correction to improve the process in subsequent months. For example, data showing that a large number of people aren’t returning their renewal forms should lead to redoubled outreach and communication efforts by states, community organizations, and providers. In addition, data that can be disaggregated by race and ethnicity, eligibility category, and ZIP code can help states more effectively target their efforts. Arizona, Iowa and Oregon offer examples of data disaggregation and operational activities. Operational data, such as call center wait times, renewal volumes, and determination outcomes (for example, in Utah) are also helpful in understanding states’ unwinding progress.