How states are preparing for Medicaid redeterminations

State Medicaid departments had been waiting for more than a year for certainty of when the unwinding of Medicaid's continuous coverage provision would begin, according to Kate McEvoy, executive director of the National Association of Medicaid Directors. 

States got that certainty in late December with President Joe Biden signing the 2023 Omnibus Appropriations bill. The provision expires March 31, and enhanced federal Medicaid matching funds will be phased down through December.  

"Now that we have clarity, states can move forward," Ms. McEvoy said in an interview with Becker's

She said states have put together their transition plans and submitted them to the federal government. Those plans include public education components, among other elements. Ms. McEvoy said the overwhelming focus is on ensuring that enrollees are aware the Medicaid redetermination process is upcoming and to connect with them to update their contact information. 

That work will involve state Medicaid programs as well as their managed care plan partners and community partners, such as hospitals and health centers, she said. 

"Medicaid members often change addresses midyear, so that's kind of a crucial first step is making sure that programs know where to contact them," Ms. McEvoy said. 

A recent Federal Communications Commission decision could make contacting Medicaid enrollees easier. The FCC said federal and state governments — as well as their partners — can make Medicaid enrollment calls and text messages without violating robocall and robotext prohibitions.  

Ms. McEvoy said it was a welcome decision, particularly allowing for text messages.  

"That's hugely important because everyone is using smartphones as our primary means of connecting in general," she said. "It's a way to get in contact with those who may have changed addresses midstream in the year, and it also helps states to fulfill the federal requirement of contacting people through multiple means." 

December estimates from the Urban Institute and Robert Wood Johnson Foundation show that up to 18 million people could lose Medicaid coverage when redeterminations begin. 

According to CMS, states can begin the unwinding process as early as Feb. 1 by initiating renewals that may result in eligibility terminations on or after April 1. States must begin their unwinding period no later than April. For states that start before April, terminations may not be effective earlier than April 1.   

Ms. McEvoy said although a few states may begin the process in February, most states have indicated they will not start at that time.   

"States have been preparing actively for quite some time," she said. "All of them are very alert to the need to really prioritize members in this process and they are proceeding carefully. All of them want to stage and pace this work over the full period that is permitted by the federal government so that they are able to ensure fair process for everybody. Because of the volume of work, that staging of the work is going to be incredibly important." 

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