Using Medicaid Managed Care Organizations to assist with The Great Unwinding

States are finding innovative ways to partner with and leverage their Managed Care Organizations to ensure that their Medicaid redetermination processes are as effective as possible, according to an AHIP issue brief.

In February 2023, states began the process of redetermining whether each of the more than 90 million Americans currently enrolled in Medicaid are still eligible for the program, with eligibility coverage decisions starting April 1. A recent analysis from the Urban Institute and the Robert Wood Johnson Foundation concluded that 18 million people could lose access to Medicaid coverage.

A new issue brief from AHIP describes some ways the states are supporting people through the Medicaid redetermination. Here are some examples of how states are working with MCOs.

Arkansas: Leveraging the trust enrollees have with their MCOs, Arkansas is working closely with MCOs to share messages about the importance of updating contact information. While many states are prioritizing efforts to update enrollee addresses, Arkansas has implemented an
innovative strategy with their MCOs who hold drawings for incentives of nominal value for enrollees who update their contact information.

Maryland: Maryland’s 9 MCOs are supporting and complementing the statewide redetermination campaign in a variety of ways including:

• Analyzing monthly data reports to identify members at highest risk for losing coverage and conducting intensive outreach plans to those members.

• Conducting outreach and engaging with providers by using medical providers on staff at MCOs to speak within the medical community about the importance and impact of redeterminations and engaging with specialty provider groups in the state.

• Hosting Community Advisory Committee Meetings with stakeholders including providers and community-based organizations.

Maryland Medicaid has conducted focus groups with Medicaid members and many of the participants reported that they had received communications from MCOs about redeterminations
and that they found the information useful.

Nebraska: Nebraska reports implementing their MCO collaboration in the following ways:

• Medicaid has established processes for MCOs to provide them with updated enrollee contact information by submitting an eligibility change report to the agency.

• MCOs are supporting outreach efforts around updating contact information and preparing for redeterminations including reaching enrollees through mail, phone, text, email and direct contact.

• Medicaid is also coordinating with MCOs to have them follow up with their members when their Medicaid coverage has ended to help them to identify and connect with other potential coverage options.

Rhode Island: Rhode Island is partnering with MCOs to reach enrollees and ensure their redeterminations are completed accurately while providing needed support. Rhode Island has been working with their MCOs during the past year to obtain updated enrollee information (based on most recent returned mail). Once redeterminations begin, Rhode Island will continue
communicating with MCOs about which redetermination cases will require action so they can be prepared to provide additional enrollee support.