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The Coming Medicaid Fracture, and How to Ease the Pain

Millions of Americans could lose essential health-care benefits — despite remaining eligible — as pandemic-related policies end. There are practical strategies to sustain enrollment.

Doctor visit
As the federal public health emergency declaration that helped Americans weather the pandemic comes to an end, the work is getting tougher for state and local governments charged with managing Medicaid. News organizations are sounding alarms about benefits loss and the need for action as social services systems move away from pandemic protocols and return to normal enrollment procedures.

From governors to program leads, everyone in charge of state Medicaid programs understands the crisis well. As many as 15 million people could lose Medicaid coverage when it comes time for them to recertify their eligibility, even though almost half of them — 7 million — will remain eligible.

On the ground, this presents a frightening picture. Re-enrollment can be hard: It can require Medicaid participants to fill out forms correctly, provide supporting documents and return them, all within a specified time window. At the same time, states are facing an unprecedented shortage of staffing, as retirements and post-pandemic workforce shifts drain their offices; there is a lot of work and not enough people to keep pace with it. This could result in millions of low-income Americans becoming uninsured. Some will stop seeing doctors. Others will rely more on emergency services or roll up large amounts of medical debt. Add to that the rising cost of food and the reductions in SNAP assistance taking place right now, and it becomes a hammer blow to millions of families.

But we do not have to sit still and allow the nation’s largest health insurance program to fracture under the weight of bureaucratic problems. What we need now is action in the form of practical strategies to sustain Medicaid enrollment. Thankfully, there is much we can do.

At our organization, Benefits Data Trust (BDT), we established a grant-funded learning collaborative that invited states to begin regular discussions about practical solutions to help people stay covered as pandemic-era policies begin expiring in April. Working with Medicaid offices in six states — California, Kentucky, North Dakota, Rhode Island, South Carolina and Washington — we have identified many proven strategies to maintain and increase dignified access to Medicaid benefits.

For example, data sharing between programs such as Medicaid and SNAP just makes sense. States are deeply invested in helping people, and few see residents as simply a SNAP client or a Medicaid client. They serve the whole person. When we share data between programs, we can reduce the amount of time it takes to apply, ease the administrative burden on participants and government workers alike, and ensure that those who are eligible get enrolled. This strategy is already operating in dozens of states and municipalities, and it works.

Text messaging is another solution proving to be an effective technological tool. It allows for the collecting of information, giving deadline notifications and being extremely proactive with outreach. The ability to “nudge” people and answer questions can have a magical impact on enrollment. In addition, having the low-touch ability to have two-way communication with enrollees wherever they go is powerful. Last year alone, BDT worked with states and others to send people more than 3 million text messages about benefits programs.

As we bring pandemic-related emergency measures to an end, there’s no doubt that we face serious challenges. But there’s also no doubt that we have tools that can help, both immediately and in the long term. Governments can embrace modern digital strategies that act as a force multiplier for the resources we have to address our problems. There is much we can do to improve processes and secure dignified assistance for people in need. A practical approach will see us through.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
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