How to Succeed at Redetermination: “It’s an integral part of how we care for members”
By: Enrique Balaguer, Chief Growth Officer
As the unwinding of Medicaid’s Continuous Enrollment Provision passes the six-month mark, it is clear that redetermination processes have been beset by significant challenges. Since April, more than seven million Medicaid members, or thirty-seven percent of individuals with a completed renewal, have been disenrolled, and of those, nearly three-quarters had their coverage terminated for procedural reasons.1
This can happen for any number of reasons, from an enrollee not receiving a renewal packet because of outdated contact information, to not filling them out correctly or completely because of lack of understanding or simply submitting too late. Differences in state policy also contribute. The number of disenrollments due to administrative problems is deeply troubling, as many of these current Medicaid enrollees may well still be eligible for coverage but are in danger of losing access to much-needed services because of unfortunate—and often avoidable—circumstances.
At MedZed, we are paying close attention to this problem, because the members we serve—high-risk with extensive social needs—are the least likely to lose eligibility, but most likely to struggle with fulfilling all the renewal requirements. Helping our members overcome barriers in their redetermination process is an integral part of how we care for the whole person. We developed a rigorous, targeted program grounded in education, tracking, and trust that we have interwoven into the care relationships we have with our members. In California we began working closely with our members in April of this year and have consistently achieved 98% reenrollment rates.
Educate Early and Often
Because the process is brand new to many MedZed members, and our staff as well, our goal was to get out in front of problems and prepare our teams with knowledge and tools before the process began. Since early this year, education sessions, scenarios and role plays addressing redetermination are part of new employee and bimonthly ongoing training. Our employees practice explaining what it is, why it matters, and how we can help at every stage—from educating members about updating their information and looking out for the renewal packet, to completing forms, gathering missing documentation, and even filing an appeal.
Detail and Track Every Single Step
It’s almost impossible to overstate the importance of documenting every step of the process. There are many places where something can fall through the cracks. We mapped out a detailed workflow, and our teams track each step, and with it, every requirement, every interaction, and the outcome of each to identify where, when, and how often to follow up. The teams review this regularly with managers to monitor performance and redesign strategies and interventions as needed.
Embed in Trusted Relationships
The entire process can be pretty overwhelming for enrollees. Even if they are unsure about what they need to do, they may also be wary of offers of “help” that require them to share personal and health information. “A big reason this is working so well, is that they trust enough to let us help them with all the paperwork,” emphasized Torey Neumann, Director of CalAIM Programs, Northern California. “They believe us when we tell them this is important. They know us and trust us to take good care of them and protect their health information.”
Medicaid redetermination is neither simple nor a “one and done;” it requires getting both enrollees and staff up to speed on all the considerations and keeping them aware and attentive at every stage. But with the right education and processes integrated into a broader program—and relationship—of caring and trust, MedZed employees are successfully working together to ensure their members’ continued coverage and access to the services they need to support their health.