At the beginning of the pandemic, new legislation called the Families First Coronavirus Response Act (FFCRA) was enacted, requiring that Medicaid keep people continuously enrolled through the end of the Public Health Emergency (PHE). As a result, Medicaid enrollment grew, and the number of uninsured people dropped over the last three years.  

Congress ended this continuous enrollment provision on March 31, 2023, which means that states have now started the disenrollment process and many individuals stand to lose their Medicaid coverage. Considering that homecare providers primarily bill through Medicaid, this may have an impact on their census. Thankfully, managed care organizations (MCOs) can help prevent people who should be eligible for Medicaid from losing their coverage during the redetermination period. Here we explore the key role MCOs play during this process, and how they can help providers keep their valued clients. 

How Many People Will Lose Medicaid Coverage? 

According to KFF, enrollment in Medicaid/CHIP grew by 23.3 million from February 2020 to the end of March 2023, reaching nearly 95 million enrollees in March 2023. They estimate that between 5 million to 14 million people will lose their Medicaid coverage now that states are disenrolling people. They expect that the ACA (Affordable Care Act)expansion adults, other adults, and children will be among those most affected since they were the groups that saw the largest growth in enrollment during the pandemic. It will be important that outreach and education efforts are made to ensure that the people who remain eligible for Medicaid re-enroll and keep their coverage.  

How Managed Care Organizations Can Help Prevent Loss of Coverage 

CMS is working closely with states and other stakeholders to ensure, as states resume routine operations, that the renewal process happens in an organized manner and that it’s not too difficult for Medicaid beneficiaries to re-enroll. Continuity of coverage for eligible individuals is also a major priority. This includes those who no longer qualify for Medicaid and need to transition to a different form of coverage, such as through a Marketplace. To ensure this happens, they will need the help of MCOs.  According to CMS, MCOs can support states in the following ways: 

  • Help individuals enrolled in their MCO plan complete the renewal process 
  • Minimize churning due to loss of coverage for procedural reasons 
  • Facilitate transitions from Medicaid to the Marketplace where appropriate 

Let’s explore these in more detail. 

Update Beneficiary Contact Information 

Since many enrollees have not had to complete Medicaid enrollment in a few years, states may have outdated contact information. Considering MCOs may already be in communication with enrollees because they manage their care, they are a great resource. If MCOs send updated contact information to states, it will help them get the important renewal documents sent to the right place.  

Conduct Outreach and Provide Assistance 

It’s important to note that the federal Medicaid managed care marketing rules (42 CFR 438.104) do not prohibit plans from supplying information and conducting general outreach on behalf of states. In fact, in this instance, it’s encouraged. 

MCOs can contact the beneficiaries and instruct them to reach out to the state agency directly. They can assist them with this process by either giving them instructions on how to use an online portal, or by calling the state agency call center while the member is on the line with them. 

If the state agency provides the MCO with file information about beneficiaries who the state is starting the renewal process with, or information about individuals who are at risk of losing coverage, then the MCO should try and reach out to them through phone or text and encourage them to complete and return their documents. 

Reach Out to Individuals Who Lost Coverage for Procedural Reasons 

States can provide MCOs monthly termination files and the MCOs can reach out to people who were terminated from Medicaid for procedural reasons as long as they are compliant with federal marketing requirements. 

Help People Who Are No Longer Eligible for Medicaid Transition to Other Coverage 

If the MCO also offers a Qualified Health Plan (QHP) they can assist people in transitioning over to Marketplace coverage if that person is no longer eligible for Medicaid.  

How We Can All Help Ensure Minimal Disruptions to Homecare Services 

It is critical during this redetermination process that those who receive homecare services, especially older adults, many of whom are dually eligible for Medicare and Medicaid, keep their coverage. According to Justice for Aging, those who are dually eligible have higher rates of disability and poverty, need more help with ADLs, and are more likely to need communication assistance. This especially vulnerable population, who relies heavily on homecare services, may have a harder time navigating the renewal process. That is why those of us in the homecare space need to work together to ensure that this population is aware of the process, and that they have the help they need to complete their re-enrollment, including getting their information updated and their documentation completed. 

Learn more about how HHAeXchange can give MCOs more visibility and control over their operations and help them ensure members get the care they need.