Finding members where they're at: How Aetna is approaching Medicaid redeterminations

States can begin disenrolling members from Medicaid April 1, the first time states have redetermined who is eligible for the program since 2020. 

Up to 18 million people nationwide could lose their coverage during redeterminations, according to estimates from the Robert Wood Johnson Foundation. Some Medicaid members will lose coverage because they make too much income to qualify for the program, while others may be dropped for administrative reasons. 

Kelly Munson is president of Aetna Medicaid, a CVS Health company. Ms. Munson has been with CVS Health since 2021 and has almost two decades of experience in managed care. 

Ms. Munson sat down with Becker's to explain how the company is working to contact members about redeterminations and partnering with Medicaid programs in the 14 states where it manages plans.

Editor's note: This conversation has been edited for length and clarity. 

Question: How is Aetna preparing for redeterminations, and how is this unwinding similar and different from redeterminations in the past? 

Kelly Munson: Redeterminations are something that every single managed care plan is used to handling prior to COVID.

There was a pattern every month. In the past you would see a member who would not understand that redetermination was coming because they would be hard to contact or didn't go to the mail. We weren't allowed to have robust redetermination campaigns that would alert them, and therefore they would fall off coverage for a period of time. It wasn't until they needed care or had an event that they would show up and realize they suddenly had no coverage that they would go through the process. In some instances they would get re-enrolled, and in some instances they would have a break in coverage. What that really means is that people who are on a medication regimen would lose two to three months, or they lose touch with their care manager. 

That absolutely drives up prices. Members tend to use the [emergency department] more during that time if they have a need. It was always a concern to try to keep members continuously enrolled. 

Now with the redetermination process, it's really the sheer volume that is driving the change, and because members haven't had to go through this process. 

You have a lot of states that have to bring in a lot more staff to accommodate the volume issue. With the change from the FCC allowing a managed care plan to text [members] and not have that considered marketing — that's really important because many Medicaid members are young and they're used to texting and digital. So, we're going to be able to contact them in different ways than we had before. 

But it really is just the state and us sitting down and sharing data, or the most updated contact information. Medicaid members, by and large, are harder sometimes to contact because they move or change phone numbers frequently, so we're making sure that the state has that. 

In every single state we have a campaign that is omnichannel and it's according to all state guidelines. We are reaching out to members through social media, text, digital, websites, mailing, phone calls, to remind them [about redeterminations.] 

We happen to have something extra special in our CVS ownership in that we've been able to work with our CVS partners and the way they can support Medicaid on the whole. Regardless of payer, CVS can be supportive of all the Medicaid members that are walking in the door. We have messaging in the stores that plays over the sound system, videos that remind members they need to be looking for redeterminations, and we have QR codes they can scan so they can know and understand what their next move is.

Then there's the provider partnership that's really important. The providers are worried about this too, because suddenly a member comes in and they're not covered, and what does that mean for them in terms of cost and administration. We are making sure we're partnering with our providers, and this is all payer agnostic.

Even after all that, there may be members that drop off — that will not be eligible. Hopefully they can find eligibility on the exchange. There will also be a group of members that do not have coverage after this. 

Q: Aetna manages Medicaid programs in several different states. Is it a challenge to coordinate across many different programs? 

KM: They are very different in their approaches. Most states have let us know the time frame in which they plan on beginning the redetermination process. The states can begin disenrolling members from Medicaid beginning April 1, which means some of them are redetermining members and going through those processes now. Some of them will not start going through those processes until April 1, because they need to make sure that they have the staff.

About half our states are requiring us to use the communication that they themselves have created. Half of them are approving our communications or the plan's communications specifically. Most of them are fairly prescriptive. We have a few that haven't indicated a way yet that they're planning to approach this.

There's something else exciting that's a little different than before. Many states are allowing us either 90 to 120 days, depending on the state, after a member has disenrolled for procedural reasons — because the member just didn't follow through or complete the paperwork, meaning they weren't deemed ineligible — in order to contact them and work with them to get them to complete the needed paperwork. That has not been allowed in the past.

Q: How many Medicaid members who are no longer eligible will be able to find other coverage on the ACA exchange, and are there barriers to getting them there? 

KM: It's estimated that about 30 percent of the members who are deemed ineligible for Medicaid will be eligible for some other coverage, including the exchange. I think the challenge is the same challenge that has always existed, which is that the majority of Medicaid members work. Sometimes they're working two jobs. The paperwork and going through the process or even being able to contact people who are living pretty busy and complicated lives — that's the risk. 

That's why so much of the time, energy, money and focus has been on how we can connect with members in a way that either they indicated they want us to communicate with them, or in the way that we think is most likely going to [reach] them. The worst scenario to me, and this will happen, is there will be people who are not going to know that they were disenrolled from coverage. It's going to create a stressful event for them later when they go to utilize services. That's still the biggest risk. 

Then it's just simply explaining options to members so that they know and understand what it means to be eligible for the exchange, and how they can do that. We are of course set up to do that for our members with our footprint on the exchange. But it's another area of complication that could be a stressful event for our Medicaid population.

 Q: What can state and federal partners do to make the redeterminations process as smooth as possible? 

KM: Transparency and data sharing to allow us to do whatever we can to get reach that member is most important.

Even in this process today, in not all states do we know the designation when a member is disenrolled from the program. We don't always know the reason why. We're working really hard with all our states to find out the mechanism by which they can send us the reason why [a member is disenrolled.] There will be members who are disenrolled simply because they're not eligible anymore, and there will be members who are disenrolled because they didn't do what they needed to do. 

Those are very different outreaches. One is an outreach to say, 'Hey, you may be eligible for the exchange,' and one is an outreach to say, 'I don't know that you know this is coming,' or, 'How can we help you fill out that paperwork?'

Another really good example is there are members who will be enrolled through the ex parte or passive enrollment, meaning the state can already determine without having to do an income check that those members will be eligible. If we can identify that, we can make sure that we're not sending notices to those members that they could be disenrolled, because that would be confusing to them. It will also allow us to not waste time and resources and money on sending things to members who otherwise would not be disenrolled. 

Some of our states can do this [data sharing.] In some of our states, we don't quite know how we can get that information yet. We're still working through it with them. The ability to streamline this process and make sure that we can customize what the members need at this time will make this much smoother.

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