Author: David Merritt
Our country is at a critical juncture when it comes to health care coverage. As we look to build on recent gains that have resulted in a record number of Americans who have health insurance, the ongoing Medicaid redetermination process has consequences for millions of Americans.
The partnership between the federal government and the states was instrumental in providing people with the coverage they need during the COVID-19 pandemic. Since April, all 50 states have been grappling with the task of reassessing the eligibility of millions of beneficiaries, determining if they still qualify for Medicaid, and transitioning their coverage to other health plans when necessary.
Nearly 7.5 million individuals were disenrolled from Medicaid between April and August — a number that will grow even larger since the redetermination process still has many months to go. To ensure the best processes are in place and the fewest number of people do not fall through the cracks, 14 states have voluntarily paused their redetermination efforts for a limited time.
While states have restarted their redetermination efforts, the Centers for Medicare & Medicaid Services (CMS) has taken unprecedented steps to protect access to coverage, including offering 23 waivers and other flexibilities to states to streamline and improve these processes. Of the available waivers and flexibilities, several best practices have come to light.
We conducted a comprehensive survey among Blue Cross and Blue Shield (BCBS) companies to identify the CMS flexibilities and other best practices that states can adopt that would be most impactful in addressing these challenges:
- Use health plans and all available outreach channels, such as phone calls, emails and texting — the latter of which has been particularly effective — to contact enrollees about renewal forms.
- Authorize health plans to assist enrollees in completing and submitting renewal forms.
- Permit an authorized representative, such as an assistor, navigator or health plan, to complete an application or renewal form during a phone call with the state and a beneficiary, who provides verbal authorization.
- Allow pharmacies, community-based organizations and other providers to use specified income guidelines to determine presumptive eligibility for those disenrolled for a procedural reason in at least the prior 90 days.
- Share a list of individuals that are up for renewal with health plans and care providers, including an indicator if people are being disenrolled for procedural reasons.
- Delay procedural terminations, as needed, for one month while the state conducts targeted renewal outreach.
At the Blue Cross Blue Shield Association, we recognize the valuable and important role Medicaid and the Children’s Health Insurance Plan (CHIP) play in providing vital health care coverage to the millions of Americans, including nearly 39 million children, who depend on it. It is a lifeline that ensures access to affordable, high-quality health care services, prescription drugs and preventive care for those who need it most.
We are committed to ensuring that no one loses their coverage as a result of this transition, and BCBS companies across the country have already been hard at work. Leveraging their local insights and close ties to provider and community partners, BCBS companies have been sharing their expertise with states, deploying numerous outreach efforts and facilitating a smoother transition to new coverage for those losing Medicaid. By doing so, we aim to assist with the operational challenges associated with redeterminations and ultimately help preserve the continuity of care for millions of Americans.
But more can be done. We strongly encourage all states to adopt relevant flexibilities, including the ones we have identified.
Together, we can navigate the complexities of the redetermination process and help ensure that every eligible individual and family maintains access to the health care they depend on now and in the future. We look forward to partnering with CMS and states to take the lessons we’re learning to improve the Medicaid program and renewal process for the members we serve.