Eighty-four percent of health plan leaders believe Medicaid eligibility checks could cause, at minimum, moderate disruption in maternal care continuity, according to a May 5 report from healthcare consultancy Sage Growth Partners. Within that group, 14% expect major disruption.
The survey featured the perspectives of 50 health plan leaders who held director-level or more senior roles, as well as 300 pregnant or recently pregnant people and their caregivers.
Under HR 1, beginning in 2027, adults enrolled in expanded Medicaid will face more frequent eligibility checks every six months. Sixty-two percent of health plan leaders think Medicaid eligibility determinations will most affect pregnant women with intermittent income or coverage. Nearly three-quarters of surveyed leaders see delayed or avoided prenatal and postpartum care as the highest risk from these determinations.
While 2% of health plan leaders have not formally prepared for Medicaid maternity health risks, several plans have started making moves.
Here are the top five steps health plans are taking and the percentage of leaders that indicated each:
1. Boosting outreach and member education: 68%
2. Collaborating with community organizations and partners to mitigate churn: 58%
3. Building continuity-of-coverage pathways, connecting commercial coverage: 42%
4. Forecasting utilization differences: 42%
5. Altering case management programs: 38%
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
