PHE- Medicaid disenrollment is happening faster than anyone thought, says former Medicaid deputy director

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Its almost as if some states don’t want to pay billions of dollars for ineligible members. Cue outrage and pearl-clutching. But a large technology company wants you to care.



Clipped from:

“If I were a hospital administrator right now, I’d have a tent outside of every entrance, (asking) do you know if you’re still covered?” 


Karen Shields is chief client engagement officer at Gainwell Technologies.

Photo: Courtesy Gainwell Technologies

The loss of coverage for Medicaid recipients is happening faster than anyone believed it would, according to Karen Shields, chief client engagement officer at Gainwell Technologies, a large payer of Medicaid claims.

“It’s faster than we thought,” said Shields, a former deputy director for the Center for Medicaid and CHIP Services. “The call for action indicates everything thinks it’s faster.” 

The call to action is in the form of a letter sent earlier this month by Health and Human Services Secretary Xavier Becerra to governors urging them to adopt new flexibilities to minimize avoidable Medicaid coverage losses.

“The lessons learned that I took with me from my time (at CMS), being responsible for enrollment and predicting human behavior, … is that it’s hard to get people to pay attention to pay health insurance,” Shields said. “It’s because it’s not their top priority if they’re not currently sick or in pain. Insurance in general is a negative buy.” 

Not all states publicly release numbers on coverage losses. Since states began Medicaid redeterminations on April 1, over one million people in the 21 states that have reported had been disenrolled from Medicaid as of June 14, according to KFF.

The entire health and social services community must be involved in raising awareness for those who have lost coverage, to reapply within a 90-day window of opportunity to see if they still qualify for Medicaid, Shields said.

Many Medicaid recipients may not have broadband access, but most have cell phone service. A recent change in Federal Communications Commission policy allows health plans to reach out to them by text. In January, the FCC’s Consumer and Governmental Affair Bureau issued a Declaratory Ruling responding to a letter from HHS Secretary Becerra regarding government Medicaid enrollment calls and text messages.

“We can’t rely on CMS or Medicaid to do it alone,” Shields said. “The bottom line is, the level of community public awareness has to be at an all-time high. If I were a hospital administrator right now, I’d have a tent outside of every entrance, (asking) do you know if you’re still covered?”

Twitter: @SusanJMorse
Email the writer: