MCOS/PHE- The Role of Medicaid Managed Care Organizations in the PHE Unwinding

MM Curator summary

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[MM Curator Summary]: A new survey of plans shows that most don’t have the up to date data CMS and states are hoping they have to help with the Return to Normal Operations.



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Medicaid managed care organizations can help mitigate the negative effects of the public health unwinding in a variety of ways.

Source: Getty Images


By Kelsey Waddill

February 14, 2023 – Medicaid managed care organizations have a key role to play in the public health unwinding, a Kaiser Family Foundation (KFF) brief found.

The brief’s findings are based on two study components: a survey of Medicaid managed care organizations fielded from October to November 2022 and a roundtable discussion in November 2022. Out of 65 Association for Community Affiliated Plans (ACAP) plans, 29 plans in 15 out of 26 states contributed to the survey and ten plans participated in the roundtable.

Medicaid managed care organizations will have to update beneficiary contact information, conduct outreach, support coverage transitions, and navigate the effects of the unwinding.

Only 31 percent of ACAP plan respondents said that they had verified or up-to-date contact information for 76 to 100 percent of their Medicaid beneficiaries and 28 percent said that 51 to 75 percent of their Medicaid beneficiaries’ contact information was verified or current.

Moreover, the data that plans do receive from their Medicaid agencies may not be accurate. Less than four out of ten of the respondents (38 percent) said the beneficiary contact data from Medicaid agencies was accurate most of the time. Another 45 percent reported that it was accurate half of the time or less and the remaining 17 percent did not know.

While most plans reported taking steps to connect with beneficiaries, health plans faced a few barriers to connecting with Medicaid beneficiaries and other challenges related to Medicaid beneficiary communication.

Almost all participating plans (90 percent) experienced challenges in reaching Medicaid beneficiaries. More than half of the respondents faced barriers to acquiring or updating beneficiary information due to state regulations or the Telephone Consumer Protection Act (TCPA). Four out of ten plans experienced challenges due to HIPAA and another 21 percent struggled working with third parties.

For most Medicaid managed care organization respondents, states planned to send a monthly file of the beneficiaries undergoing renewals and many will provide files on beneficiaries who have not yet submitted renewal forms and those who may lose their coverage.

Fifty-two percent of the survey respondents intended to target certain populations—such as individuals with chronic conditions, pregnant individuals, or those with substance use disorders—for renewal outreach.

“Plans indicated these targeted outreach strategies would include additional communication; customized messaging; call center and provider portal alerts for select members; leveraging care managers, transition teams, and life coaches; and partnering with CBOs to provide in-home application assistance for members with disabilities and homebound members,” the brief explained.

Over 50 percent of plans expected to receive termination files from their state’s Medicaid agency on a monthly basis. Managed care organizations that offer a qualified health plan on the Affordable Care Act marketplace can share qualified health plan information with disenrolled individuals, if their states allow such activities. Nearly all the respondents who could alert disenrolled beneficiaries to their qualified health plans intended to do so.

Health plans predicted significant coverage loss among their beneficiaries, with 75 percent of health plans expecting 10 to 25 percent of their enrollees to lose Medicaid coverage. These expectations align with separate predictions. A quarter of health plans expected that 10 to 25 percent of their beneficiaries would lose coverage due to procedural reasons.

“Responding plans most frequently reported decline in Medicaid enrollment and related revenue loss, enrollee churn, and disruptions in member care as significant challenges they are expecting related to unwinding,” the brief found.

These statistics reveal the influence that Medicaid managed care plans have over the impacts of the public health unwinding, including Medicaid redeterminations and renewals.