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Looking Ahead: What Will the Aftermath of Medicaid Unwinding Look Like?

June 11, 2024
OA Editorial Team
June 11, 2024
Medicaid Unwinding - Man talking to woman

At the time of writing, we’re about four plus months into the unwinding, or redetermination, process, which officially began April 1, 2023. For most states, this process will stretch to 12 months, meaning we’re around one-quarter of the way through. Some key findings have started to emerge.

High numbers of Americans have lost Medicaid coverage

As of writing, at least 3,757,000 Americans have been disenrolled from Medicaid across 37 states and the District of Columbia. On average 38% of people who completed the enrollment renewal process lost coverage. 

Disenrollment rates vary greatly across states

Because each state was given the freedom to choose its approach to Medicaid redetermination, we’re seeing major differences in disenrollment rates by state. At the start of the process, in May 2023, 12 states had completed 500,000 disenrollments, with more than half in Florida alone. Now, around three months in, disenrollment rates continue to exhibit wide variation. Consider these four states alone:

Most Americans have had coverage terminated for procedural reasons

According to the Kaiser Family Foundation, “Across all states with available data, 73% of all people disenrolled had their coverage terminated for procedural reasons.” Procedural disenrollments occur when a person does not complete the renewal process, despite potentially still remaining eligible for coverage. 

CMS has paused redetermination in certain states

The redetermination process has seen its share of snags, most recently in July 2023 when CMS required some states to pause redetermination due to a rise in errors. While CMS did not name states or specify a number beyond “around a half dozen,” the organization did say it had found problems that violated federal laws and unwinding guidelines.

So far, Medicaid redetermination has lived up to its advanced billing as an unprecedented disruption in the healthcare landscape. But the story is still being written. States and providers still hold the power to lower procedural disenrollment rates, enhance communication with Medicaid populations and avoid errors in the process.

Looking ahead: What’s the aftermath?

Based on what we’ve learned so far and what industry experts anticipate, there are several things we can expect to see at the end of the redetermination process April 1, 2024. Specifically, we can expect to see significant changes in the Medicaid population and self-pay patient population. 

Medicaid population

In 2024, the Medicaid population overall will shrink after experiencing significant growth throughout the public health emergency (PHE). The population will also likely be a finer cut of those who are eligible following significant disenrollments for those no longer eligible and high rates of procedural disenrollments in many states. 

Notably, those who remain enrolled will differ from the current population because nearly all will have experienced the renewal process and will know what to expect in the future. Ideally, these patients will emerge from unwinding as a more educated consumer with a deeper understanding of the Medicaid process and what is required for them to continue coverage. 

Self-pay population

While the Medicaid population will shrink, the self-pay population, in turn, will grow. We can anticipate that growth in three distinct groups among self-pay patients.

  • Uninformed: These patients got lost in the unwinding process despite their best efforts. They may be transient, didn’t understand the process or didn’t realize they lost coverage as they tried to navigate procedural bureaucracy and deliver everything required of them to maintain coverage.
  • Passive: These patients are likely not proactive about their coverage. Despite being eligible and needing coverage, they may ignore communications or decline to engage in the renewal process. 
  • Newly eligible: These patients were not part of the unwinding process and did not enroll during the PHE, but have recently lost insurance without finding new coverage. It’s still a fluid time in our economy with inflation issues and big job layoffs. These patients may be eligible for Medicaid, but don’t know how to enroll or don’t realize they qualify. 

As healthcare finance professionals, it’s our goal to help all three of these groups get coverage. 

Three key takeaways for providers

Despite being a major disruption to the American healthcare system, Medicaid redetermination has also proven to be an excellent learning opportunity for providers. Hospitals and health systems that have been a resource for the re-enrollment process will inevitably strengthen their relationships with patient populations. 

Providers who have already taken an active role in redetermination, or still plan to take an active role, have the opportunity to gain experience in key areas that will enhance patient relationships in future after redetermination has ended. 

  • How to more effectively communicate with your patient population
    Many Medicaid patients will be disenrolled for procedural reasons, which can often be prevented provided they have received adequate communication from their health providers. Consider how you reached out to patients before and during redetermination.
    Did a large portion of patients respond well to text reminders or emails? Maybe you saw the highest success rate with direct engagement, like a phone call or one-on-one discussion with a financial counselor. Moving forward, consider whether you can rely more on electronic communication entirely or use it to enhance follow-ups after in-person discussions.
  • The importance of proactivity
    There are two possible approaches to address the unwinding process: active and passive.
    There’s absolutely nothing wrong with a passive approach, but in the context of 6.8 million Medicaid patients losing coverage, a hands-off approach may very well lead to thousands of new self-pay patients coming to that hospital for care, all of which will now require extensive investigation, time and resources and cost to settle their accounts if they lost Medicaid coverage.
    On the other hand, active providers who are reaching out to patients at risk of losing coverage and offering help immediately are able to act as a resource and a lifeline to help patients understand the need to re-enroll. With constant and persistent outreach and follow up, they are able to re-enroll patients as quickly as possible to avoid a future lapse in coverage.
    The overwhelm that comes with an influx of self-pay patients is preventable if you opt for an active approach that works to maintain coverage now rather than scramble to find it later. Passive providers are likely now learning the importance of a proactive approach for future operations.
  • How to leverage technology
    Understanding the way states are approaching unwinding has been a key action for providers throughout the process. Medicaid enrollment is moving away from manual county-based systems and into state- and consumer-based online tools. Knowing what the state is doing allows providers to stay on pace and take complementary activities on the same timeline.

As additional technology tools become available, some just for hospitals and certified application counselors and assisters, providers need to develop a solid understanding of the resources available to patients and staff.

  • External resources: Federal and state governments have started driving patients to online portals where they can upload and securely share information to streamline re-enrollment. Some states are also leveraging external sources of data, like IRS data, to help predict eligibility and prioritize patient outreach.
  • Internal resources: Hospitals have several technology tools available to improve the financial counseling process and find coverage for self-pay patients quickly by leveraging automation, AI and rules-based processing. Often, these tools can also access key sources of data to streamline the enrollment process. 

Data & technology tools available for use 

Hospitals nationwide are benefiting from internal resources that increase efficiency while reducing the need for human capital. 

At Office Ally, we provide access to comprehensive data to help you better better understand patient eligibility and coverage options, including credit scoring and comprehensive insurance discovery.

Office Ally also provides technology solutions to facilitate patient outreach and engagement via our MAPS-Clear patient portal. The MAPS-clear patient portal can serve as an outreach tool to draw patients into the financial counseling process and facilitate communication. 

No matter the outcome of Medicaid redetermination, the process will inevitably provide hospitals with valuable knowledge that will help improve patient relationships and manage any future disruptions. For best results now and after April 1, 2024, use this time as a learning opportunity to reevaluate your self-pay management and make changes for the better.

Simplify and improve your self-pay management with technology and data available from Office Ally. Contact us today and connect with one of our experts for more information.

OA Editorial Team


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