States of Unwinding: April 14, 2023
By State Health and Value Strategies
With the expiration of the Medicaid continuous coverage requirement as of March 31, states now have 14 months to complete redeterminations and renewals of all enrollees enrolled in coverage as of the expiration date. Below are recent examples of the work states are engaging in to prepare for and operationalize the unwinding of the continuous coverage requirement to minimize coverage losses. States continue to focus on outreach and communication efforts, creating web pages dedicated to unwinding, launching texting campaigns and partnering with stakeholders to reach consumers. A couple of states are investing additional resources to increase their workforce and support the operations of unwinding. In an effort to share information with the public about the roll out of unwinding, states are making public information about their unwinding plans and how many enrollees they have renewed to date. Other efforts states are working on include coordinating with their State-Based Marketplace and leveraging federal flexibilities to implement more efficient renewal processes. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding.
Communicating About Unwinding and Conducting Outreach
California released updated communications materials for community partners. The California Department of Health Care Services (DHCS) updated its Medi-Cal Continuous Coverage Toolkit to include a section focused on renewals. The toolkit is available in 19 languages and includes materials that can be customized to help ambassadors and partners assist Medi-Cal members with the redetermination process and content that encourages members to update their contact information. The toolkit includes interactive voice response call scripts, sample emails, and text messages. For more information, see Department of Health Care Services Coverage Ambassador Resources. DHCS also published communications materials to support coverage transitions for the COVID-19 Uninsured Group. DHCS released a toolkit in English and Spanish for Coverage Ambassadors and other partners to help encourage members of the COVID-19 Uninsured Group (UIG) program to enroll in ongoing health coverage through Medi-Cal (Medicaid) or Covered California (the state’s official health insurance Marketplace) after the UIG program ends. During the COVID-19 public health emergency (PHE), more than 500,000 Californians were able to obtain temporary health coverage for COVID testing and treatment through the UIG program, which will end with the end of the federal public health emergency.
Connecticut created a webpage for enrollees to update contact information. The Department of Social Services created a webpage “Update Us, so we can Update U” for enrollees in HUSKY Health, the state’s Medicaid program, cash and food assistance programs to update their contact information.
Louisiana is texting Medicaid enrollees to remind them about renewals. The Louisiana Department of Health (LDH) announced that it will start using text messages to send members important reminders about their health insurance coverage. These text messages may include reminders about renewals and reminders to update contact information. (Clonazepam) LDH is also hosting a series of webinars for providers on the end of Medicaid continuous coverage and the restart of Medicaid renewals.
Massachusetts’ Marketplace created a website dedicated to unwinding and is co-hosting a webinar with Medicaid on accessing coverage. The Massachusetts Health Connector created a website dedicated to unwinding the Medicaid continuous coverage requirement that includes resources for individuals and families to take action to stay covered, resources for employers and employees, and a toolkit from MassHealth (Medicaid) with member-facing materials for redeterminations. The Massachusetts Health Connector co-hosted a webinar “Keeping or Getting Coverage through MassHealth and the Health Connector” with MassHealth, the state’s Medicaid program, on April 12. This session covered how enrollees renew MassHealth coverage, report any changes, how to access an online account, and get help with completing renewal or enrolling in Health Connector coverage.
Montana is focusing on providers to disseminate information about unwinding. The Montana Department of Public Health and Human Services is hosting a series of webinars on unwinding for providers, with webinars targeted to specific types of providers, such as behavioral health providers. The state views providers as “a trusted source of information for Medicaid members” critical to letting members “know what they need to do to keep their coverage.”
Texas is sending renewal notices in yellow envelopes and texting enrollees. This month, The Texas Health and Human Services Commission (HHSC) will begin mailing all Medicaid renewal notices in a yellow envelope that says “Action Required” in red. In addition to mailed notices, HHSC is using social media posts, online banner messages, flyers, emails, and text messages to notify enrollees about renewing their benefits. HHSC has also supplied outreach tools to partner organizations or ambassadors to help spread the word about the end of continuous Medicaid coverage.
Investing Resources: Increasing the Unwinding Workforce and Allocating Additional Funding
Texas is offering merit pay and hiring temporary staff. The Texas Health and Human Services Commission (HHSC) announced that in order to handle the expected workload of Medicaid renewals, HHSC has increased its eligibility workforce through various recruitment and retention efforts, including hiring temporary staff to assist with the workload, implementing merit pay and salary adjustments, promoting flexible work schedules, and streamlining training requirements. Since April 2022, HHSC has added 1,000 eligibility staff to its workforce.
Minnesota passed a bill that funds operations related to implementing unwinding. Governor Tim Walz signed into law a bill that provides funding for the transition to regular eligibility verification procedures for the state’s Medicaid program, MinnesotaCare, and processes to support the retention of coverage. The legislation also provides $36 million to help county and tribal agencies process healthcare renewals.
Making Information About Unwinding Public
Arizona published data on changes in enrollment. Arizona is one of the five states that has started terminating individuals found to no longer be eligible as of April 1. The Arizona Health Care Cost Containment System published a report that provides a breakdown of disenrollment by eligibility category.
Connecticut shared its operational plan for redetermining eligibility. The Department of Social Services and Access Health CT, the state’s official health insurance Marketplace, shared a comprehensive 12-month operational and outreach plan to redetermine eligibility for HUSKY Health (Medicaid) enrollees and resume routine public program operations. Less than a quarter of the approximately 434,000 Connecticut residents being redetermined are expected to no longer be eligible.
Idaho announced the number of enrollees it has renewed to date. The Idaho Department of Health and Welfare (DHW) announced it has processed Medicaid renewals for 32,898 individuals since the beginning of February. Of the total 32,898 people processed, 13,647 have been found to still be eligible, and 19,251 have been found to no longer be eligible. Those who are no longer eligible will lose coverage starting April 1. Those determined to have too much income to qualify for Medicaid are being referred to the state-based health insurance Marketplace, Your Health Idaho.
Supporting Transitions to Marketplace Coverage
Nevada will help coordinate the transfer of individuals from Medicaid to the Marketplace. Nevada Health Link, the state’s official health insurance Marketplace, announced that it will help coordinate the transfer of the estimated 200,000 Nevadans who may be redetermined ineligible for Medicaid benefits over the next 14 months. For individuals who are not renewed for Medicaid coverage, Medicaid will contact individuals to advise them of their account transfer and Nevada Health Link representatives will do active outreach to those individuals to help them with next steps regarding their account.
Leveraging Federal Flexibilities
New York leverages waivers to improve renewal processes. New York received approval from CMS for two 1902(e)(14) waivers: 1) to accept contact information from managed care plans without additional verification; and 2) to conduct “zero-income” renewals. For more information on 1902(e)(14) waivers, see SHVS’ Leveraging Section 1902(e)(14) Waiver Authority Amid Unwinding expert perspective.