Best Practices for States Navigating the Unwinding of the Public Health Emergency




Now that the federal Covid-19 public health emergency (PHE) has officially ended, the great unwinding has begun. As of last month, states are once again tasked with determining Medicaid eligibility for all enrollees — a daunting project that will require the recertification of millions of Americans for healthcare coverage, and by some estimates may result in as many as 7 million people losing coverage despite still being eligible.


It’s all but impossible for states to manage the unwinding process perfectly, but many state leaders are taking action to ensure that eligible Medicaid recipients don’t fall through the cracks. To help identify best practices, we’ve explored some of the most effective approaches that states are taking as they prepare to grapple with the challenge of recertification.


Communicate: Early and Often


In states like Oregon, Medicaid and healthcare agencies are getting the word out to Medicaid-eligible citizens as quickly as they can. Since some states automatically terminate coverage after receiving a single piece of returned mail, this means everything from triple-checking addresses to embracing digital strategies to reach recipients. According to a spokesperson for the Oregon Health Authority, “We’re doing everything we can to prevent people from falling through the cracks.”


Last fall, Oregon sent a test mailing to every household with medical benefits (more than 850,000 homes), which revealed that about one in 10 households had the wrong address. This allowed the state agency to collect updated information for 17,000 families. At the same time, the state has partnered with a contractor to add about 150 staff to its call center, boosting the ability to take questions and support people as they navigate the redetermination process. Neither solution is a silver bullet – there are many addresses left to confirm, and wait times for the call center are still too long – but both reflect the critical importance of communication to streamline the recertification process.


Innovation to Support At-Risk Populations


Of course, some Medicaid enrollees face greater risk than others of losing coverage. Immigrants, people with limited English proficiency (LEP), individuals with disabilities, and non-standard workers (e.g., gig or 1099 workers) are likely to encounter the greatest barriers in the recertification process. 


To address these challenges, some states are revamping their home pages to ensure that they’re available in languages other than English. Others are making modifications to ensure that their applications are easily accessible for individuals with disabilities. For the non-standard worker population, a growing number of state leaders are tapping emerging technology that enables 1099 and gig workers to verify their income in near-real time instead of relying on the cumbersome and paperwork-intensive process that’s usually required. This approach, called the Income Passport, has already helped states reduce the time to complete verifications for unemployment insurance from days to hours, enabling more workers and families to access benefits faster.


In the coming months, states will continue to face one of the most complex challenges in the history of public benefits as they continue to navigate the PHE unwinding. The states with the greatest chance of success will be those that prioritize timely and proactive communication, partnership strategies, and the potential of new technologies to support the workers who stand to gain the most from healthcare coverage.

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