Recommended Terms for Direct-to-Consumer Unwinding Communications

Julie Bataille and Kevin Caudill, GMMB

This expert perspective has been updated to reflect the passage of the Consolidated Appropriations Act

Introduction

The unwinding of the Medicaid continuous coverage requirement will be one of the most significant health coverage events since the implementation of the Affordable Care Act, as state Medicaid agencies across the country will resume regular renewal processes for over 89 million people. Following the resumption of redeterminations, Medicaid enrollees will need to affirmatively renew their coverage and those who are no longer eligible for Medicaid will need to transition to other forms of coverage or go uninsured. To help states effectively communicate with enrollees, this expert perspective provides research-based recommendations regarding terminology that can be used in consumer education and outreach. Congress passed the Consolidated Appropriations Act on December 23, 2023, an omnibus funding package that separates the Medicaid continuous coverage provision from the COVID-19 public health emergency (PHE), provides a fixed end date for the Medicaid continuous coverage guarantee of March 31, 2023, a gradual phase down of the Families First Coronavirus Response Act (FFCRA) enhanced federal match rate, and new guardrails to prioritize coverage retention and smooth coverage transitions during the “unwinding.”

Consumer Research Insights

Over the past year qualitative consumer research has been conducted by the Centers for Medicare & Medicaid Services (CMS) and with Medicaid enrollees to gain insight into how to effectively communicate the unwinding. The takeaways are consistent and provide insight for communications efforts. The research included a combination of individual interviews as well as focus groups representing a mix of recent and longer-term enrollees from different racial and ethnic backgrounds. All had incomes between 100% and 200% of the federal poverty level and some had experienced recent changes in income and jobs. They were asked about the role Medicaid plays in their lives, the health services they use, their experiences with the renewal process, how they communicate with the Medicaid agency, and what it would mean if they lost their Medicaid coverage. Some key takeaways include:

Low Awareness of “Public Health Emergency” – With the legislation mentioned above, communicators should not use “public health emergency.” Prior to the legislative changes, research found that the phrase “public health emergency” is confusing to consumers. Only a handful had heard of the phrase and many just assume it refers to the pandemic, eliciting various points of view. Most find references to the public health emergency to be confusing and scary. If you must reference something, you can refer to “continuous enrollment requirements” but in consumer facing materials it’s best to simply acknowledge that rules will be changing now that the timeline is clear.

Terminology on “Renewals” – Enrollees use different terms when referring to the process they must go through to keep their Medicaid coverage. “Renewal” was the term used most often, and some called it “redetermination,” “recertification,” “re-apply,” or even “re-enroll.” Bottom line, there is no common terminology for this process but the fact that some action must be taken is understood. Additionally, almost no one seems to know that this next renewal period is particularly important and may put them at risk of losing their health coverage.

Using “Insurance” Instead of “Coverage” – It is recommended to use insurance as opposed to other terms such as health coverage when messaging to consumers. This is because insurance is more specific, and when translated, is easier to understand in other languages where there may not be common use of the term coverage for health insurance.

Enrollees Prefer Multiple Communications Channels – Enrollees want to receive important information about Medicaid renewal through email and other means beyond just mailed notices. Many also want Medicaid to use multiple communication methods to notify them about renewal, including mail, text, digital app, phone, and email. Most said they see information from state agencies as the most official source, but they also expect to get information from their health plan and/or provider.

Knowledge Gaps on Coverage Options for Non-Medicaid Eligible – General awareness of the marketplace exists and varies across states, but significant knowledge gaps remain about the availability of financial help to lower costs.

Communications Resources

SHVS has created resources to assist states in their communications planning based on these research findings. A message guide is available in English and 10 other languages, that provides a framework for states to build communications tactics that will educate Medicaid enrollees about what they need to do to keep their insurance coverage and raise awareness of options for individuals to get free or low-cost health insurance. The guide includes research insights and key messages states can customize and use in their own creative communications campaigns. A companion resource provides recommendations on specific terminology that can be applied to your efforts. What is most important is that entities conducting outreach with consumers collaborate and share the same information and language to minimize confusion.

Conclusion

Developing tested direct-to-consumer messaging as states prepare for the various stages of work needed to inform stakeholders and consumers about the upcoming end of the Medicaid continuous coverage requirement has been a priority of SHVS and of CMS. State Medicaid agencies and marketplaces should collaborate to ensure both entities are using consistent terminology to limit consumer confusion and ensure clarity. The end of the Medicaid continuous coverage requirement presents states with tremendous opportunities to keep individuals enrolled in Medicaid or transition to another form of health coverage, especially marketplace plans.