Sep, 22, 2023

States of Unwinding: How State Officials Are Innovating to Support Coverage

Heather Howard, State Health and Value Strategies

Through nearly six months of unwinding the Medicaid continuous coverage requirement, states have been working hard to implement strategies to reach enrollees, assist them with renewal processes, and if necessary, connect enrollees to new sources of coverage. While unwinding has not been without challenges–the recent revelation that some states need to correct complex systems algorithms to align with federal regulations will require significant effort in affected states–Medicaid officials across the country have been working diligently to support renewals. Whether states are providing grants to community partner organizations, modernizing connectivity to update account information, or using colorful mailers to ensure important mailings aren’t missed, the creativity and innovation states are employing to connect with enrollees speaks to the level of effort required to support coverage.

State Health and Value Strategies has been collecting examples of these efforts in our regular States of Unwinding series. These may be of interest as states redouble their efforts to process renewals.

Preserving Coverage for Medically-Fragile Enrollees or Groups at Higher Risk of Losing Coverage

Several states have implemented strategies to postpone renewals or terminations of coverage until the end of the unwinding period for certain medically-fragile populations or populations at higher risk of losing coverage. 

Postponing Procedural Terminations

  • Michigan: The Michigan Department of Health and Human Services (MDHHS) is extending the renewal of enrollees undergoing life-saving treatment through May 2024 to ensure these enrollees can keep their healthcare coverage and complete their treatment. The extension for those receiving life-saving treatment applies to enrollees undergoing chemotherapy, radiation, immunotherapy infusions or dialysis who are not able to be renewed through ex parte and do not have other comprehensive health insurance coverage, like Medicare.

Delaying Eligibility Redeterminations 

  • Rhode Island: The state is delaying the redetermination of families with children and will not start their Medicaid renewal process until December, 2023.

Connecting With Families Through Schools

Given the importance of continued Medicaid coverage for children, a number of states have leveraged back-to-school to remind families about the importance of completing renewal forms.

  • Kentucky: Kynect Benefits, the state’s single stop website for state benefit programs, created a back-to-school flier to inform families who are enrolled in Medicaid or CHIP coverage that their renewal letter will be coming soon and the actions they need to take to remain covered. The flier, which is also available in Spanish, includes contact information and a QR code directing individuals to more information about the unwinding.
  • Maine: A flier from the Department of Health and Human Services is being included in the back to school “virtual backpack” created by the Department of Education. The flier highlights for parents that even if they themselves are no longer eligible for MaineCare, their children might be, given Maine’s expanded coverage of children.
  • New Hampshire: The Department of Health and Human Services is using back to school to remind parents about completing their yellow renewal forms to avoid a gap in their children’s coverage. The flier also highlights the availability of Navigators to help families enroll in another source of coverage if they are no longer eligible. 
  • Virginia: The Department of Medical Assistance Services is continuing its annual back to school campaign. The 2023 back to school fliers are available to all public schools across the Commonwealth. Schools will decide the best way to distribute the flyers to parents and guardians. Schools may opt to share the flyers with students in person, via mail or digitally.

Connecting Enrollees With Assisters

The complexity of Medicaid forms leads many enrollees to seek assistance from trusted sources. Sometimes, those trusted sources can be hard to find and states are working to make those connections easier.

  • West Virginia: The state’s Medicaid enrollment website now allows individuals to search for community partners to help them enroll. The West Virginia Department of Health and Human Resources has upgraded search features on WV Path, the enrollment and eligibility website for Medicaid, SNAP, and cash assistance applicants and enrollees. Now users can search for “Community Partners,” organizations and individuals who help West Virginians enroll in benefit programs, by county.
  • New Mexico: The state’s health insurance Marketplace is hosting events where consumers can connect with assisters. BeWellNM has created an enrollment events calendar for individuals who have recently lost Medicaid coverage. The state is hosting various enrollment events across the state with certified assisters available to help individuals enroll in Marketplace coverage.

Connecting Directly with Enrollees

Reminding enrollees about the importance of returning renewal forms is a proven activity to avoid loss of coverage due to missing paperwork. States are leveraging a variety of communication modes to reach enrollees.

Outbound Calls 

  • Maine: The state is calling MaineCare member households who did not return their renewal paperwork in a given month. As a result of such calls, over 1,200 households initiated or completed their June renewal, and over 500 requested to close their MaineCare coverage for reasons such as having other insurance or no longer being a resident of Maine. 

Text Messaging

  • New York: is piloting a one question survey/nudge sent via text message to members who did not return their renewal forms. The text asks the member to reply by selecting one of four reasons for why they did not return their form, with one of the options being “I haven’t yet, but still want help.” Of those who received a text in July, 13% responded, and 7% of accounts who received it came back and completed their renewal even if they did not respond. 

Leveraging Technology

  • Arizona: The Arizona Health Care Cost Containment System (AHCCCS) added a live chat feature to its website, which call center agents can use to field enrollee questions, reducing the number of calls to the call center. 


State Health and Value Strategies will continue to track and share state efforts to support coverage through the unwinding period. If your state is implementing a new effort to reach enrollees, or if you have questions about how you can implement an example you have seen, please contact the team at SHVS.