Individuals who currently participate in Medicaid waiver programs are getting an additional year of benefits. CMS made this decision in an effort to boost retention for eligible Medicaid recipients. As a result, the waiver program will now end in June 2025 instead of December 2024.
Last spring, many states started the eligibility redetermination process for their Medicaid members. Since this hadn’t occurred in over three years–the last time being mid-pandemic–it was a lengthy undertaking. However, research shows that true ineligibility was far from the leading cause of Medicaid members losing their benefits. Nearly 70% of Medicaid recipients who lost coverage experienced this termination as a result of missed deadlines, failure to fill out related paperwork, and other logistical reasons.
To address these concerns, CMS has approved almost 400 waivers over the past few months. This involved kickstarting renewals for members who were disenrolled and encouraging automatic enrollment to prevent future concerns from recurring. From their own research, CMS has found states that completed eligibility redetermination in under one year had higher disenrollment rates than those that took longer than 12 months.
This information offers some guidance for health plans wanting to take steps to smooth the transition for their existing Medicaid members.
How can health plans help?
- The high number of logistics-related member disenrollments creates a large opportunity for health plans to assist with such requirements. Improving and expanding member-centered processes can not only increase retention rates and satisfaction but also prevent unnecessary benefit lapses and minimize added effort for both parties.
- Health plans can collaborate more closely with case managers, patient advocates, social workers, and other clinicians within their provider network to avoid coverage changes. These professionals can help members meet deadlines and fulfill requirements needed to maintain ongoing coverage.
- Fleshing out the eligibility redetermination and unwinding processes allows plans to determine the root cause of member disenrollment. From there, they can make action plans to address each cause and keep retention rates high.