What Is Medicaid Redetermination?

If the COVID-19 Public Health Emergency (PHE) is not extended, the continuous enrollment requirement will end, along with the Medicaid coverage provided by the Family First Coronavirus Response Act. The impending need for state Medicaid agencies and plans to administer redeterminations for nearly 80 million Medicaid beneficiaries poses a risk of lost coverage for many eligible individuals in this vulnerable population. 

Those who are eligible must recertify their eligibility via their state Medicaid website when the state resumes redeterminations with the PHE expiration, or they will lose coverage. This can create and exacerbate gaps in care, and cause serious financial strain, especially for those beneficiaries in states that do not have retroactive coverage.  

The challenge with this redetermination process is many members are unfamiliar with the need to take action to maintain their coverage because this step has been waived since the PHE began in early 2020. Also those eligible for Medicaid coverage for the first time during the pandemic are unfamiliar with the process, and those more experienced with the system haven’t had to recertify for 18+ months. It’s simply not on their radar. 

Because of this, it’s up to states and health plans to drive members to the appropriate state websites and resources to recertify their eligibility.

The Stakes Are High for Both Plans and Vulnerable Populations

There are approximately 10 million more people now covered by Medicaid than there were before the pandemic. For health plans, this can create membership churn impacting their financial profile. Proactive outreach campaigns are necessary to engage and re-engage members in this process.

Medicaid members will be negatively impacted by gaps in coverage, and their health will no doubt suffer. The Association for Community Affiliated Plans (ACAP) and NORC at the University of Chicago recently issued an insightful report that explores the ramifications of eligibility churn and redetermination. The report includes 15 testimonials from Medicaid plan members that underscore the critical value of continuous coverage, including reduced financial stress, fewer canceled appointments, and better pre- and postnatal care for moms and babies.

5 Steps to Take in the Face of Uncertainty

It’s undeniably complex to create a clear, actionable message to members when no recertification deadline has been announced. Here’s a 5-step plan to help you get your ducks in a row. Achieving success will hinge upon your ability to communicate in an efficient, powerful way to reach your membership and educate them about the requirements ahead.

#1: Shore up Your Contact Database

A well-crafted message is useless if it doesn’t reach its intended audience. The member contact information Managed Care Organizations (MCOs) receive from the state is typically about 30% complete and accurate. Supplementing what the state supplies is an important step in the redetermination process if you’re going to reach all or even a high percentage of your members with essential communications.

Start by analyzing the state-supplied data you receive and then enrich it to achieve far greater levels of success. Data enrichment may be as rudimentary as the addition of a mobile phone number or email address or as complex as identifying social media use habits.

You have two key sources for enhancing this information: restricted and unrestricted databases. As health plans have financial relationships with members, unrestricted databases are the only options generally available, and their data is frequently spotty. By contrast, you can work with a partner like Icario, who has access to restricted databases and the highly accurate and complete contact information they contain.

#2: Start Educating Members Now—Don’t Wait to Build Trust

With a lack of clarity around when members will need to recertify via state websites, it can seem like a daunting task to begin communications now. But beginning outreach is critical to driving awareness and education around redetermination, as well as for building trust and ultimately motivating members to engage. Early outreach tactics also give you a method of confirming contact information, identifying preferred communication channels, and starting to understand the social determinants of health (SDoH) affecting each member. 

Begin the trust-building campaign by educating members on why they need to be prepared to recertify their eligibility when relevant dates become available. Assuming the PHE will be extended and the redetermination process won’t be required for a while, communicating with members 3-6 months in advance will make them more comfortable with hearing from you and help them understand the topic.

Remember: Enrollees new to Medicaid during the pandemic are completely unfamiliar with the process, and those familiar with the plan haven’t recertified in many months and need to know this task is imminent. Education is key on both fronts.

At some point you will need sensitive information from your members. But that can’t be in the first outreach attempt. You’ve got to build trust and familiarity. They need to like you. Then members will be much more apt to complete the recertification process when the time comes.

“We know from our collective experience implementing the ACA that early, tailored messaging to members is critical for maintaining coverage. The PHE covers an even broader and more diverse group. Reaching and engaging people well before the process begins will ensure that families, seniors, and people with disabilities will continue to get the care they need.”


Marie Zimmerman

Vice President, Medicaid Transformation & Financing at Aurrera Health Group and Icario Medicaid Advisory Council Member

#3: Establish a Regular Cadence of Multi-Channel Communications

Make hearing from your plan a normal occurrence, not an outlier. Historically, the challenge of relying on poor contact information has meant members often wouldn’t hear from their plan or realize how many programs they could access. If the first time members are hearing from you is for redetermination—a process many have never heard of—they may not trust you and probably won’t take action, even if it’s in their best interest. They may think it’s a scam if they receive a request to go to a website and enter their income and social security information.

Nudge members down the redetermination path through regular communication delivered in a variety of forms. For today’s audiences, using digital messages is an essential component of a successful multi-channel outreach strategy. This means leveraging text messaging and email in addition to live agent phone calls, IVR, and direct mail. 

This outreach can direct members to online resources or the state agency that administers the redetermination process. Icario also utilizes a reporting suite with program performance data that informs real-time adjustments to outreach, minimizing member abrasion while maintaining efficacy.

#4: Track Preferences to Hone Member Experience

Even though this is a state-required activity, the member experience is crucial, particularly when people have the option to stay with your plan or move to a competitive offering. It will pave the way for long-term success and quality ratings. If you haven’t started thinking about preferences, you’ve got some catching up to do! 

An Icario/Harris Poll Survey found that only 56% of members received helpful information about Medicaid redetermination or re-enrollment, meaning there is a clear opportunity for plans to increase their level of engagement with members.

Tracking who responds and how will become the foundation of your member preference database. The more you communicate, the more you’ll learn about your membership. Your goal is to figure out which messages members respond to and through which channels, as well as which days and times are most successful. Knowing each member’s preferred language is also critical. Sending communications in English to Spanish-only speakers isn’t going to get you anywhere.  

Likewise, understanding the social and economic barriers your members face goes a long way toward building health equity. As you’re interacting with members and gaining information, you’ll begin to understand not only their preferences, but also SDoH challenges such as food or housing insecurity and much more. Many plans are placing significant emphasis on this today. Kudos to those working toward NCQA health equity certifications!

#5: Set Expectations for Next Steps and Motivate Members to Take Action

With your communication engine up and running, you’ll slowly build and strengthen relationships with your members, enhancing trust and the overall experience along the way. Now you’re in a strong position to educate them specifically on what’s going to be asked of them regarding redetermination in the weeks or months ahead. 

When the time is right, guide members to the appropriate place to recertify. Once this process is complete you’ll have greater success when asking them to complete downstream health actions, such as Health Risk Assessments (HRAs), Annual Wellness Visits, and many other preventive steps and screenings that will help them improve their health over the long term.

Moving Forward

There are many challenges ahead regarding Medicaid redetermination. By partnering with Icario, you can prepare for the end of the PHE and future redetermination barriers with effective enrollee outreach, engagement, and health action strategies.