Inside MetroPlusHealth's Medicaid renewal playbook

Education is the biggest challenge to overcome in ensuring Medicaid members keep their insurance as continuous coverage requirements end, MetroPlusHealth COO Lila Benayoun says. 

Ms. Benayoun, who was named COO in 2022, sat down with Becker's to explain how the New York City-based nonprofit payer is navigating the Medicaid redetermination process. 

April 1 marked the end of continuous Medicaid enrollment requirements in place during the COVID-19 public health emergency. Over the next months, state Medicaid agencies and managed care organizations will need to recertify the eligibility requirements of members for the first time in three years. 

MetroPlusHealth needs to recertify eligibility for around 340,000 members in the next six months, Ms. Benayoun said, tackling around 45,000 to 50,000 recertifications each month. 

"We developed a playbook for the organization," Ms. Benayoun said. "We've been preparing for the end of the PHE for quite some time and really trying to be proactive." 

Community outreach is key to the playbook, Ms. Benayoun said. 

MetroPlusHealth is collaborating with community organizations in each of New York City's boroughs and took a deep dive into its membership data, determining the boroughs, then zip codes, where it has high numbers of members. 

"We drill it down to the zip code area, and then within the zip code area, ethnicity, because each ethnicity or culture reacts differently to communication," Ms. Benayoun said. "So we want to make sure that communication caters to that population." 

As the weather warms, MetroPlusHealth staff are also working to be visible in the community and educating members about re-enrollments, Ms. Benayoun said.  

Provider town halls are another key part of the strategy. 

"We really try to make sure our providers understand that we want to make sure that there is minimal disruption in care, and that our members have continued coverage, and they can have continued care from their providers," she said. 

The most challenging piece in reaching hundreds of thousands of members is education, Ms. Benayoun said. 

A study published in February by the Robert Wood Johnson Foundation found that 64 percent of Medicaid members or those with family enrolled said they have heard nothing about upcoming redeterminations. 

"I am not sure if the general public understands that the PHE is ending. I'm not sure if the general public understands what recertification means to them. It's really the education piece," Ms. Benayoun said. 

"Among all New Yorkers, there are 9 million people that receive Medicaid, so it's a huge, monumental effort from both the state and the payer side to ensure that Medicaid recipients renew on time so they remain covered." 

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