Strategies for Minimizing Loss of Medicaid Coverage When the Public Health Emergency Ends
In July, the U.S. Department of Health and Human Services renewed its declaration of the COVID-19 public health emergency (PHE). When the PHE ends, so too will one of the most important temporary policies adopted in connection with the PHE — the Medicaid “continuous enrollment condition” (CEC). Medicaid serves more than 80 million Americans and provides critical access to health care services for lower-income populations, many of whom were affected by job losses due to the pandemic. Under the CEC, as a condition for receiving increased federal Medicaid funds, states are largely prohibited from disenrolling Medicaid enrollees.When the PHE ends, it is expected that the CEC policy will be discontinued and states will begin to resume normal Medicaid eligibility and enrollment operations, including processing eligibility renewals and disenrolling individuals who are no longer eligible. This transition has come to be known as “unwinding.” With millions of Medicaid enrollees at risk of losing coverage as the PHE ends and “unwinding” begins, it will be critical for states to invest in communication strategies to help Medicaid enrollees understand the process and the steps they will need to take to keep their health coverage. In doing this, states should consider testing different communications strategies using randomized controlled trials (RCTs) — the gold standard in clinical and social science research.In a new Health Affairs Forefront piece titled “As Medicaid Continuous Coverage Requirement Ends, Randomized Controlled Trials Can Minimize Churn” with co-authors Jacob Wallace and Atheendar Venkataramani, professors at the Yale School of Public Health and the Perelman School of Medicine at the University of Pennsylvania, respectively, we discuss the opportunity to use RCTs to identify strategies for communicating with Medicaid enrollees that will help minimize coverage loss.In the article, we argue that the cessation of the CEC necessitates the use not just of RCTs, but adaptive RCT designs. These designs assign a larger proportion of the participants to RCT groups that are performing well and reduce the number of participants in groups that are performing poorly over time. In the case of Medicaid enrollee communication, the state would use interim RCT data to rapidly shift beneficiaries to the communication strategies found to be most effective. This would mean that states could use what they learn from the experiences of enrollees with earlier redetermination dates—about, for example, the effectiveness of outreach through text messages— for enrollees with later renewal dates (and beyond). Importantly, because adaptive RCT designs do not compromise the underlying validity of the RCT, an adaptive RCT in connection with the unwinding would still support the development of evidence about how best to communicate with enrollees to enlist their effective participation in the renewal and redetermination process. This evidence is critical to state efforts to promote continuity of coverage and minimize inappropriate terminations. To learn more, visit Health Affairs.Aurrera Health Group is proud to support states and the federal government on all matters related to promoting access to affordable, high quality health coverage and care through Medicaid, including eligibility and enrollment issues, addressing the social drivers of health, modernizing access to and delivery of behavioral health services, supporting the design of alternative payment models, and more.