Just months into the Medicaid redetermination process, state agencies are reporting a staggering number of beneficiaries being removed from these programs. More than 1.3 million Americans, including tens of thousands of children, have lost coverage through Medicaid and CHIP following the end of pandemic protections on April 1, which triggered redeterminations across those programs.  

In response to these alarming statistics, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra sent a letter to state governors on June 12 imploring them to take steps to ensure that eligible beneficiaries do not lose their healthcare coverage. “Nobody who is eligible for Medicaid or the Children’s Health Insurance Program should lose coverage simply because they changed addresses, didn’t receive a form, or didn’t have enough information about the renewal process,” said Secretary Becerra in the letter.  

The letter from HHS also included the announcement of new flexibilities for states as they continue the redetermination process. These new flexibilities include: 

  • Allowing managed care plans to assist people with Medicaid with completing their renewal forms, including completing certain parts of the renewal forms on their behalf. 
  • Allowing states to delay an administrative termination for one month while the state conducts additional targeted outreach, giving people more time to be reminded to fill out and return their renewal forms. 
  • Allowing pharmacies and community-based organizations to facilitate reinstatement of coverage for those who were recently disenrolled for procedural reasons based on presumptive eligibility criteria. 

In his letter, Secretary Becerra also encouraged governors to work more directly with families at risk of losing coverage, suggesting that state agencies work with schools, faith-based groups and other community organizations to conduct outreach to enrollees about the redetermination process. While it is true that individuals can reapply for these programs if they still qualify, many people are not aware of these appeal rights. There is also the issue that the grace period for reapplication doesn’t apply to all beneficiaries in several of the states with the largest numbers of cuts. 

In addition to Secretary Becerra’s recommendations, there are a number of IT solutions that state agencies can use to increase capacity and ensure that eligible beneficiaries aren’t losing access to health care coverage. Change & Innovation Agency’s (C!A) Insights Engine and Current™ are just two examples of SaaS software tools that can be integrated to help manage service delivery of vital social safety net programs like Medicaid and CHIP.  

Current offers visibility into an agency’s operation and provides insights needed by managers and supervisors to manage work and staff capacity in real time, optimizing the performance of the agency and worker productivity. Insights Engine uses the most up-to-date data sources to ensure that faster decisions are made with fewer human touches, improving the accuracy and efficiency of the Medicaid redetermination process, as well as other functions of human service agencies.   

By integrating GetInsured and C!A’s innovative capacity solutions with the actions outlined by HHS and the Biden Administration, state agencies can have a more efficient Medicaid redetermination process that will result in less coverage loss for millions of eligible beneficiaries. It is critical that states use these technology solutions to streamline their processes and increase capacity to ensure that no one slips through the cracks over the coming year.