At the end of the federal public health emergency, states will need to redetermine eligibility for nearly all Medicaid enrollees in the largest healthcare event since the Affordable Care Act. In order to avoid potential coverage losses, states will need to communicate with enrollees and other stakeholders about the actions they need to take to keep individuals enrolled in Medicaid or transition to another form of health coverage. One way that states are promoting transparency in their communications and planning efforts is through the public release of their unwinding operational plans. This expert perspective highlights several states that have made their unwinding operational plans publicly available as well as examples of states’ ongoing communication efforts, including outreach campaigns to Medicaid enrollees, strategies for collaborating with stakeholders, and collaborative initiatives within Marketplace states. This expert perspective has been updated as of November 17, 2022 to reflect recently released state unwinding operational plans.
Creating Seamless Coverage Transitions between Medicaid and the Exchanges
Center for Health Care Strategies – Carolyn Ingram, Shannon M. McMahon, and Veronica Guerra
Under health reform, Medicaid will expand in 2014 to cover an additional 16 to 20 million beneficiaries. This population will include a significant percentage of childless adults with urgent and complex health care needs, who are likely to shift between subsidy programs over time. This brief, prepared by the Center for Health Care Strategies, draws from current state programs that have dealt with this challenge successfully. The experiences described herein can help states develop policies and procedures that foster seamless coordination of care during coverage transitions between Medicaid managed care organizations and qualified health plans in the exchanges. A companion matrix includes excerpts of sample contract language related to coverage transitions in existing programs.