States of Unwinding: April 28, 2023

By State Health and Value Strategies 

As of May 1, an additional 14 states will begin terminating individuals determined ineligible for Medicaid. To prepare Medicaid enrollees for this upcoming deadline, Medicaid agencies are doubling down on their outreach and communication efforts. States with their own Marketplaces are also conducting outreach and many are launching communication campaigns. As unwinding progresses, more states are putting out press releases warning enrollees about scams, which are being reported across the country. Beyond communications and outreach, states are also implementing safeguards for individuals who  missed the window to sign up for Medicare Supplement policies. Massachusetts is working on educating the employer community about unwinding to smooth transitions to employer-sponsored insurance, which estimates suggest will be the largest source of coverage for those losing Medicaid eligibility. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding.  

Medicaid Agencies Are Alerting Enrollees About Potential Scams

The Arizona Health Care Cost Containment System updated their unwinding frequently asked questions (FAQs) to include information about recent scams targeting Medicaid members. The Colorado Department of Health Care Policy and Financing (HCPF) issued a notice that scammers are targeting Health First Colorado and Child Health Plan Plus members through text messages and phone calls. The scammers are telling members they must pay to keep or renew their health coverage. The HCPF notice encourages enrollees to report any suspected scam activity to the Attorney General Consumer Protection Unit. HCPF is also developing communication resources for partners to help raise awareness about potential scams, to be announced in coming weeks.

Kansas’s Medicaid program, KanCare, posted a notice warning enrollees of possible scam texts and calls during the unwinding process. Louisiana is highlighting to members how they will reach out to them so they can identify scams. The Louisiana Department of Health is working with community organizations and others to reach members, and will never ask for money or charge members to update their information or renew coverage. Personal information will also never be requested over the phone, only through a form sent in the mail. 

Nevada issued a warning about how scammers are attempting to take advantage of Nevadans who may need to reapply for Medicaid or transition to other insurance. As members are trying to reapply or shop for insurance, text, email, and phone scams are offering fraudulent services that ask for payment to renew. Washington issued a press release highlighting reports of fake texts and phone calls to Medicaid enrollees. The Washington Health Care Authority is asking Medicaid enrollees to be aware of suspicious contact seeking money to maintain their health coverage. Wyoming Medicaid is alerting residents about current Medicaid renewal scams that are targeting program clients, following reports of fake texts and bogus calls seeking money.

Educating Employers About Transitions to Employer-Sponsored-Insurance

Massachusetts has created resources about unwinding for employers and employees. The Massachusetts Health Connector, the state’s official health insurance Marketplace, created a webpage featuring resources for employers and employees during the unwinding. The resources include a letter from the Massachusetts Executive Office of Health and Human Services directed to the employer community, a list of FAQs for employers on Medicaid redeterminations and employer coverage, a template newsletter and graphics for employer associations to share information with the employer community, and an employee flier available in multiple languages for employers to distribute within the workplace. MassHealth and the Massachusetts Health Connector also held a briefing for employer and broker leaders in Massachusetts on the upcoming transition to help ensure state residents continue to have access to health coverage.

Protecting Access to Medicare Supplement Policies 

Michigan issued an order allowing those eligible to purchase a Medicare Supplement policy. The Michigan Department of Insurance and Financial Services (DIFS) is taking action to help Michigan seniors who may lose Medicaid coverage during the unwinding by outlining Medicare enrollment opportunities. DIFS has issued an order enabling eligible Michiganders to purchase a Medicare Supplement policy. This will allow individuals who became eligible for Medicare during the continuous coverage requirement and missed the Medicare Supplement open enrollment window to access Medicare Supplement plans during the unwinding. Pennsylvania is guaranteeing enrollment periods for Medicare Supplement plans. The Pennsylvania Insurance Department announced it will be protecting consumers who had Medicaid continuous coverage through the COVID-19 public health emergency and missed their Medicare Supplement open enrollment period. As Medicaid redetermines eligibility, individuals who lose Medicaid coverage and transition to Medicare will have a guaranteed issue enrollment period for Medicare Supplement plans.

Leveraging Federal Flexibilities 

Oregon received approval from CMS to implement a bridge program to preserve coverage. The Centers for Medicare & Medicaid Services approved an amendment to the Oregon Health Plan (OHP) demonstration that authorizes Medicaid coverage for individuals ages 19 through 64, with incomes from 133% to 200% of the federal poverty level, who are currently enrolled in OHP as a result of the Medicaid continuous coverage requirement. The amendment will streamline retention of coverage by not requiring people to move to the Marketplace.

Medicaid Communication and Outreach Efforts

Arizona launched a virtual assistant to answer common questions. The Arizona Health Care Cost Containment System (AHCCCS) recently launched SAM, a virtual assistant available 24 hours a day to answer more than 30 common questions related to Medicaid renewals. In the coming months, AHCCCS call center agents will be able to field members’ questions in a live chat. Members will also be able to submit contact information changes directly into the chat tool. Georgia is making information about renewal dates available online. The Georgia Department of Health Services announced that Medicaid members can find their individual redetermination month and information about the process in their Gateway account at gateway.ga.gov. Virginia is sharing information about renewal timelines. The Department of Medical Assistance Services published a renewal calendar that outlines when renewals will begin each month over the next year as well as an example of the letter it will send to enrollees when it is time to renew their coverage.

D.C. hosted a community meeting. The Department of Health Care Finance (DHCF) hosted a community meeting on restarting Medicaid renewals to educate stakeholders about the renewal process. The meeting included several updates, including the dates for upcoming renewal meetings and trainings and an announcement that automated calls and texts will start next month. Nebraska is hosting a listening tour. “Unpacking the Unwind: A Medicaid Listening Tour” will be held in eight cities this April and May, along with two virtual options. The tour will include a presentation from Nebraska Medicaid that will focus on important updates for both members and providers regarding the end of the public health emergency and continuous coverage requirement. After the presentation, Nebraska Medicaid will field questions and feedback from those in attendance.

Indiana is texting enrollees. The Indiana Family & Social Services Administration announced it is sending text messages to Medicaid members to alert them that they need to take action on redeterminations. Louisiana is calling members. The Louisiana Department of Health announced that Medicaid members should expect a recorded call from Louisiana Medicaid reminding them to make sure their contact information is up to date. The call will also ask about a pink letter that was mailed to every Medicaid household in late March. South Carolina is texting members and created an online portal for members to upload forms. The South Carolina Department of Health and Human Services (SCDHHS) announced that Medicaid members who have provided SCDHHS with a cell phone number will receive a series of text messages to remind the member to return their annual review form. SCDHHS also released a new document upload tool which will allow members to provide requested information, report a change in income, return an annual review form or submit other documents. The information received through the tool will allow SCDHHS to contact members if there are any questions about the documents. Members may also continue to return their annual review form in-person or via mail, email, or fax. 

Maine launched an outreach campaign to encourage Medicaid enrollees to update their contact information. The Maine Department of Health and Human Services (DHHS) launched a “Stay Connected to Stay Covered” outreach campaign, urging MaineCare members to update their contact information so DHHS can reach them about renewing their coverage and to be on the lookout for their renewal form, which must be filled out and returned to avoid a gap in coverage. The campaign includes multilingual communications and outreach materials for partners to download and a paid advertising campaign, which includes radio advertising, a social media campaign, and digital advertising.

Minnesota has created a webpage dedicated to unwinding. The Minnesota Department of Human Services created a webpage informing individuals enrolled in Medicaid or MinnesotaCare (the state’s Basic Health Program) to be prepared to renew their coverage during the unwinding. The webpage provides information about how to maintain coverage during the unwinding, the timeline for renewals, and communications toolkits. 

New Mexico is sending renewal notices in turquoise envelopes. The New Mexico Human Services Department (HSD) provided a briefing about the Medicaid continuous coverage requirement. HSD highlighted during the briefing that enrollees will receive their renewal application in a turquoise envelope by mail when it is time for them to renew. 

New York has created a communications toolkit with materials in over 14 languages. New York State of Health (NYSOH) created a communications toolkit to keep New Yorkers covered during the unwinding. The toolkit includes resources to encourage enrollees to update their contact information and communication tools and templates including videos, social media posts and infographics, and materials available for co-branding. NYSOH has also created educational materials, such as fact sheets, posters, and rack cards. All of these materials are available in at least 14 different languages.

Marketplace Communication and Outreach Efforts

Idaho’s Exchange released resources on how to transition to Marketplace coverage.  Your Health Idaho, the state’s official health insurance Marketplace, released FAQs on the Medicaid continuous coverage unwinding that address topics such as what happens to someone who has lost coverage and what actions they need to take in order to maintain or transition to another source of coverage. The Marketplace also has step-by-step instructions for individuals referred from Medicaid to the Marketplace and instructions for individuals starting an application without a referral.

Kentucky’s Marketplace has created a webpage dedicated to unwinding and is hosting monthly calls with stakeholders. The Kentucky Health Benefit Exchange, the state’s official health insurance Marketplace, has created a webpage focused on the Medicaid unwinding which includes the state’s unwinding approach, a stakeholder FAQ document, and communications materials. The state is also hosting monthly stakeholder meetings to address questions individuals are encouraged to submit through a survey. New Mexico’s Marketplace created a webpage dedicated to unwinding. The webpage includes information on the steps individuals must complete to obtain coverage, resources for shopping for a health plan, an unwinding stakeholder toolkit, and media digital downloads.

New York is stationing assisters in pharmacies. New York State of Health, the state’s official health insurance Marketplace, is teaming up with retail pharmacies across the state to educate New Yorkers enrolled in public health insurance programs about the upcoming changes in their coverage. Certified enrollment assisters will be available on-site at pharmacies to answer current enrollees’ questions about renewals, as well as provide information to uninsured New Yorkers about enrolling in health insurance through NY State of Health.

Supporting Transitions to Marketplace Coverage

Maine will hold a special enrollment period. Maine’s official health insurance Marketplace, CoverME.gov, announced a special enrollment period (SEP) for Mainers transitioning from the state’s Medicaid program. The SEP, which began on April 15, 2023 and will continue through July 31, 2024, will align with the HealthCare.gov Unwinding SEP.

New York is training assisters on the unwinding. NY State of Health hosted a training for application assisters and facilitated enrollment staff on the unwinding and renewal processes. NY State of Health plans to host a second session on New York-specific tools to support individuals as they navigate their coverage options. Virginia created a dedicated line for assisters and Navigators to answer questions about unwinding. Cover Virginia, the state’s official health insurance Marketplace, launched a dedicated call center for assisters and Navigators to help improve customer service and answer questions about Medicaid renewals and applications, including questions assisters and Navigators may have about a consumer’s application status and existing coverage. 

New Mexico is paying the first month’s premium for individuals moving to the Exchange. New Mexico has created the Medicaid Transition Premium Relief Program intended to support coverage transitions during the unwinding. Through the program, the first month’s premium may be paid for most people moving from Medicaid to beWellnm, the state’s Marketplace. The program is meant to minimize coverage disruptions and lock-in consumer protections for qualifying individuals and families who need affordable coverage. Rhode Island is auto-enrolling eligible individuals in Marketplace plans and paying the first two months’ premiums. The state is implementing an auto-enrollment program with premium assistance during the unwinding to connect Rhode Islanders who are terminated from Medicaid with health coverage through HealthSource RI, the state’s Marketplace. Those eligible for auto-enrollment will be enrolled in a silver health plan with financial support to cover the first two months’ premiums. Individuals may also select and enroll in a dental plan and may be eligible for additional premium payments for their dental coverage.

Making Information About Unwinding Public

D.C. published an unwinding data dashboard. The Department of Health Care Finance launched an eligibility monitoring dashboard, which is posted on their Medicaid renewal information webpage. As a reminder, SHVS is tracking which states have created unwinding dashboards and will be updating our expert perspective as additional states launch dashboards.

Indiana released projections of changes in enrollment and spending as a result of unwinding. The Indiana Family and Social Services Administration released projections estimating that net Medicaid enrollment will decline by 400,000 through May 2024. Costs are expected to rise due to the phasing out of the enhanced federal Medicaid matching funds.

Streamlining Medicaid Eligibility and Enrollment Processes

Minnesota has created a new streamlined enrollment form. The Minnesota Department of Human Services released new renewal forms for Minnesota Healthcare Programs for families, children, and adults. The new renewal form was designed to streamline the renewal process by gathering only the information needed to redetermine eligibility.