Medicaid Redetermination: How to Tackle the Largest Enrollment Challenge in Medicaid’s History

Medicaid Redetermination: How to Tackle the Largest Enrollment Challenge in Medicaid’s History

Published on: Tue, 05 Sep 2023

As MCOs are transitioning coverage for their beneficiaries, it’s no surprise that children and families are being heavily impacted by the Medicaid unwinding. For the eleven states reporting age breakouts for Medicaid disenrollment, children account for approximately three in ten (30%), according to KFF (formerly known as Kaiser Family Foundation).  

KFF finds that more than 5.3 million enrollees across all age groups have been disenrolled as of August 23; the research organization considers this number to be an undercount. In all, more than 15 million people are expected to lose Medicaid coverage during the redetermination process and more than 6 million individuals could end up without insurance coverage. 

In California, as of June, there were more than 15.5 million Medicaid enrollees, according to the Department of Health Care Services; that's down from more than 15.7 million in January. Just shy of 200,000 individuals were disenrolled due to procedural reasons, which can occur when paperwork isn’t completed appropriately or when letters about disenrollment are mailed to old addresses. Individuals who lose coverage for procedural reasons can have their coverage reinstated as long as they provide updated information to regulators within 90 days.  

Here are 4 additional findings about the loss of Medicaid coverage: 

  1. CMS has paused disenrollments in 12 states; this is intended to address issues related to procedural disenrollments, reports Healthcare Dive.  

  1. Loss of Medicaid coverage will have a significant impact on access to care for low-income individuals, in particular those with chronic conditions, reports STAT

  1. More than 100,000 Coloradans have lost Medicaid coverage; approximately half of these individuals lost coverage in June, reports CBS Colorado. Many lost coverage due to procedural reasons or because they don’t currently meet eligibility requirements.  

  1. When individuals call for help with the Medicaid redetermination process, they’re experiencing long hold times. For example, Montanans calling the state’s Medicaid helpline wait on hold for an average of 37 minutes, reports Montana Public Radio; that’s the third-longest wait time in the country. More than a third of calls to the helpline are abandoned, reports the media outlet. 

What can MCOs do? MCOs that are tasked with outreach to enrollees to capture updated information and determine their Medicaid eligibility can automatically connect with individuals and support them in the renewal process. 

EmpowerHealth can help. 

Our technology helps support human capacity for health insurers. EmpowerHealth increases reach without increasing costs. What health insurers get in return: Personalized, conversational engagement with beneficiaries. 

Contact us today to learn more.