How payers can support members through Medicaid Redetermination 

How payers can support members through Medicaid Redetermination 
The unlinking of the temporary increase in Federal Medical Assistance Percentage (FMAP) from the COVID-19 Public Health Emergency could mean a loss in coverage for millions of Americans. Supportive communications strategies and experiences are needed to guide impacted consumers to appropriate plans with as little friction as possible.

On April 1, 2020, the Families First Coronavirus Response Act (FFCRA) established a continuous enrollment condition for both Medicaid and Children’s Health Insurance Programs (CHIP), as well as a temporary increase in states’ Federal Medical Assistance Percentage (FMAP) to 6.2%, for the duration of the COVID-19 Public Health Emergency. The continuous enrollment permitted Medicaid and CHIP users to stay enrolled without having to reconfirm eligibility for this period, while the increased FMAP raised the federal matching funds for these state medical insurance programs. The combination of these solutions enacted by the Families First Coronavirus Response Act (FFCRA) created a temporary system to ensure that access to healthcare would not be disrupted during this unprecedented crisis.

In December 2022, the Consolidated Appropriations Act, 2023 (CAA, 2023) took the first steps to resume normal eligibility and enrollment operations. Under CAA, continuous enrollment for Medicaid* and the increased FMAP percentage are no longer linked to the COVID-19 Public Health Emergency period, which ends May 11, 2023. The continuous enrollment requirement will end on March 31, 2023, and the temporary FMAP increase will be removed beginning April 1, 2023. As a result, states will lack the needed funding to support continuous enrollment for Medicaid and CHIP. States will begin the process of redetermining eligibility for enrollees to align with FMAP qualifications for the first time in three years, which is anticipated to result in millions of people at risk of losing coverage—creating what many refer to as a cliff event.

While some states provide toolkits, dashboards, FAQs, and public plan summaries, others only distribute an alert to update contact information. Though these may seem like minor variances, how this transition is communicated and facilitated is critical for individuals currently on Medicaid to understand and make informed decisions about their healthcare.

As payers navigate this time of transition, Customer Experience Transformation (CXT) is poised as a flexible lens through which they can evaluate their positioning within the consideration set for consumers. By leaning into CXT’s consumer-centric and proactive approach, payers can strategically plan for the future they want while remaining empathetic and agile relative to the situation many Medicaid users are likely to confront.

Digital CXT is a particularly promising lens when approaching the Medicaid cliff. As of 2021, 97% of all Americans have a cell phone and 85% have a smartphone. With one in five Americans enrolled in a Medicaid plan, leveraging digital solutions presents the best opportunity for states and their payer partners to reach their members with vital information.

Redetermination introduces significant risk—not only for states to effectively identify and communicate changes to impacted members, but for healthcare providers to validate coverage at point of service and, most importantly, for consumers to ensure they select the best plan for themselves and their families. State Medicaid plans and payers have an obligation and opportunity to close the communication gaps that many states leave unfilled. To succeed, they must put consumers first—meeting them where they are with honest and clear communication. By leveraging digital-first solutions, payers can ease the burden for consumers to confidently make healthcare decisions.

Consumer experience transformation can be an effective strategy to address this challenge, creating opportunities for transparent communications that foster loyalty, ensuring eligibility determination processes follow CMS guidelines, and taking care to ensure that citizens do not disengage from the healthcare system during this pivotal time.

* CHIP will be impacted differently than Medicaid. States will be required to implement 12-month continuous coverage for children under 19 by January, 2024; but may choose to do so sooner (Consolidated Appropriations Act, 2023: Medicaid and CHIP Provisions Explained – Center For Children and Families (

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Meet the authors
  1. Stephanie Counts, Partner, Healthcare

    Stephanie is an expert in strategy execution with more than 10 years of experience. View bio

  2. Leah Sheveland, Partner, Healthcare

    Healthcare Leader with over 15 years of management experience. Specialized in leading cross-functional teams in the areas of payer operations, Medicare Advantage, retail health expansion, and strategy definition. View bio

  3. Danielle Morton, Senior Business Consultant
  4. Sydney Spicer, Management Strategy Consultant

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