HCD International Supports Medicaid Redetermination Post-Pandemic and the Mitigation of Procedural Disenrollments
By HCDI Communications
Since the end of the PHE on May 11, 2023, the country has been unwinding to return Medicaid enrollment to a state of normalcy through the process of redetermination to first verify enrollee eligibility before renewing coverage as required by the Consolidated Appropriations Act until June 30, 2024.
Today, as of December 1, 2023, at least 11,762,000 Medicaid enrollees have been disenrolled and 22,190,000 have had their coverage renewed. Moreover, of those whose coverage was renewed, 59% were renewed on an ex parte basis, by verifying eligibility through available data sources, while 41% were renewed through a renewal form.
Procedural Disenrollments Issue
Kaiser Family Foundation (KFF) estimates that close to 17 million Americans are at risk of losing Medicaid coverage or experiencing a gap in coverage by May 2024 due to barriers completing the renewal process. As of December 1, 2023, 71% have been terminated for procedural reasons. Erroneous procedural disenrollments have been occurring because enrollees:
- Are not receiving renewal notices
- Are no longer eligible due to an increase in income or other reason and did not respond to renewal requests
- Face barriers, such as not understanding how to complete the redetermination process
People losing Medicaid coverage because of procedural disenrollments include those who have moved, immigrants, people with limited English proficiency, people that are disabled, children, and older adults.
The Centers for Medicare & Medicaid Services (CMS) guidance advocates that states collaborate with health plans and community organizations to conduct redetermination outreach to Medicaid enrollees. The outreach supports Medicaid reenrollment or the transition to Affordable Care Act (ACA) marketplace healthcare plans through HealthCare.gov and state-based marketplaces, or employer-based plans.
HCD International Conducts Redetermination Outreach
Healthcare Dynamics International works with well-known managed care organizations (MCOs) and state health departments to ensure vulnerable, at-risk populations are enrolled in healthcare coverage. HCDI’s talented, diverse staff of over 150 full-time professionals from 20 different countries provides culturally intelligent outreach to members. We also apply our trademarked data analytic tools to offer our clients the latest metrics with one goal in mind, to improve health outcomes for all, especially those most vulnerable.
We have a proven track record of successfully reaching the most difficult to reach members to assist them with maintaining, or in some instances, regaining their healthcare coverage. Over the past year, HCDI engagement specialists have made over 60,000 calls to health plan members to support redetermination efforts for Medicaid plans. Common barriers to redetermination we see as we conduct our outreach include unawareness of the renewal process, incorrect contact information on file, long wait times when calling health plan, and trouble navigating website/app to complete the Medicaid renewal process.
What sets HCDI apart is that we prioritize relationships over transaction. Not only do we work with members to ensure they are covered, but we can screen for Social Determinants of Health (SDoH) needs and connect them with the services they need to get and remain healthy.
Even before the pandemic, HDCI managed outreach efforts for MCOs to process annual renewals. Like CMS, HCDI wants to make sure everyone, including our most vulnerable, has access to affordable, quality health coverage to live longer, healthier lives.
To learn more about our redetermination services, visit hcdi.com or contact us directly at info@hcdi.com.
