The difference in procedural disenrollment rates varies from state to state, but key differences lie in expanded or non-expanded Medicaid programs, redetermination pacing, outreach approaches, and variance in allowances states make for managed care organizations (MCOs) to help with the redetermination process.

The types of permissions allowed to MCOs by states continues to be one of the most impactful conversations to come out of the unwinding. Before redeterminations resumed, multiple MCOs were unable to update information in state databases that could have helped update member contact information or other important demographic factors. To help with the massive workload of the unwinding, these restrictions were loosened in several states, but at a variety of levels. Some states allowed MCOs to own outreach, while others just allowed MCOs to update member contact information directly. Now, plans are left wondering which allowances they will retain once their state privileges expire.

These differences are especially important to MCOs operating in multiple states. They found that the difference in capabilities and data sharing processes between states made it hard to understand how well they were performing. Consequently, the dozens of health plan Medicaid leaders Advisory Board spoke with rated their redeterminations performance as just six out of 10 on average.

Medicaid has changed significantly since the end of the public health emergency (PHE). While enrollment reached an all-time high during the PHE, the unwinding led to quick declines, making some plans worry about the viability of staying in Medicaid managed care in the long run.

Despite the highly visible nature of this decline, total Medicaid enrollment has increased by 22% since 2019.² States with projected growth in Medicaid are usually launching innovative programs or expanding Medicaid, while states that expect Medicaid enrollment rates to decline usually saw higher unemployment during the PHE. Despite these outliers, Medicaid managed care is still a viable business for health plans.

Moving forward, cost will become a big focus point for Medicaid at both federal and state levels. Federally, Medicaid spending is only projected to grow 3.4% in 2024, while states will be responsible for a 17.2% greater share of Medicaid spending. Because states are facing such drastic changes in their budgets, they are likely to reduce Medicaid spending through a greater push to value-based arrangements in upcoming requests for proposals (RFPs).

Simultaneously, Medicaid plans will be covering a riskier member pool after the dust settles from the unwinding. This is because the most at-risk members are also more likely to ensure that they maintain their coverage, and/or are exposed to more touchpoints in the care continuum that prompt them to submit their redetermination paperwork. Medicaid plans must also be aware that capitation rates for Medicaid won’t reflect this increased level of risk for at least another two years and should develop a strategy for how to cost effectively manage their members’ health.

While the unwinding pressure tested many MCO strategies, plans that had historically invested in member engagement, care quality, provider partnerships, health equity, and cost management fared well during the unwinding. Soon, these evergreen priorities will narrow into these focused priorities.

Membership churn is a recurring issue for plans in all lines of business (LOBs), but especially for Medicaid plans. Plans that retain their members can reduce their costs by preventing their high-cost populations from experiencing care interruption.

Action item

Use onboarding materials as a cost-management tool by building an updated set of FAQs that address members’ evolving concerns, and explains when and where members should seek care for common medical issues.

Health equity is an especially large concern in Medicaid with its unique blend of members. Plans must consider this when they look to close care gaps, as communities will all respond differently to plans’ tactics. One way to think about designing programs for communities that deal with racial and ethnic disparities is to ask: “does this help all our members to the same degree?”

Action item

Prioritize partnerships with CBOs that engage with populations who most closely resemble your membership and offer support to community members through a diverse workforce (peer support specialists, community health workers, therapists, etc.) to close outreach gaps and drive equitable health outcomes.

Marketing that reached members in unique places, such as the top of utility bills, was integral to informing members about redeterminations resuming at the end of the PHE. Plans should continue cooperating with state agencies on marketing strategies to reach large swaths of their member populations about ways to improve the quality of their care.

Action item

Partner with your state and other local agencies to utilize marketing materials that teach members how Medicaid covers preventative care and how that care can positively impact their health and wallets in the long run.

Provider partnerships proved useful for plans during the unwinding because they provided members with another reminder of their redetermination deadlines. Plans supported interested providers with monetary grants and by sharing data on patients whose coverage was about to lapse.

Action item

Offer providers the chance to apply for grants that expand their operations to improve members’ access to care. Providers who apply for these grants are committed to solving the same problems as plans, incentivizing strong partnerships between both parties.

Member engagement practices are potentially more important in Medicaid than other LOBs because Medicaid members are less likely to respond to plan communications, as compared to members in other LOBs.³ Plans must continue to build trust with their communities and members by being visible, available, and culturally integrated.

Action item

Engage in member communities through neighborhood centers, community-based organizations (CBO), and other channels to provide multiple opportunities for positive interactions so plans are seen as invested members of the community.