Printed materials, educational question and answer sessions, and dedicated, live resources are all part of my employer-sponsored insurance (ESI) annual open enrollment experience. I take advantage of this enrollment assistance each year and would be lost without it. The same holds true for the hospital patients and health plan members Centauri Health Solutions (“Centauri”) assists with health coverage enrollment each day. Enrollment assistance is a difference maker–in outcomes and in people’s lives.

Enrollment assistance is needed NOW more than ever. There are five over-arching reasons why this is true:
1. Complexity
2. Redeterminations
3. Medicaid periodic eligibility checks
4. Continuous coverage requirement
5. Economic and employment conditions Complexity
With so many different options available (COBRA, Marketplace/Exchange, qualified health plans, commercial, high-deductible health plans, Medicare, Medicaid, Children’s Health Insurance Program),choosing medical coverage can be overwhelming. Once you take the eligibility and application processes into consideration, applying for coverage becomes even more complicated.

Eight in ten people who were uninsured said they would enroll in Medicaid if told they were eligible. According to estimates, 24% of people who are uninsured are eligible for Medicaid but are not enrolled.1

Consumer barriers to coverage can include a lack of:

  • Awareness of coverage options
  • Self-confidence
  • Timely response to requests
  • Literacy/language skills, leading to an inability to understand notices or forms
  • Stable housing arrangements
  • Communication vehicles (phone, computer, internet)

To help simplify a complex process, enrollment assisters can be utilized to help individuals in their native language, provide guidance on enrollment options, and offer expertise in completing forms.

Redeterminations
Consumers enrolled in coverage are subject to a redetermination or renewal on an annual or semiannual basis. This means a repeat of some, maybe all, of the complexities we just examined.

The Affordable Care Act mandated simplification of the process for Modified Adjusted Gross Income (MAGI) based Medicaid groups, including parents and caretakers, children, pregnant women, and the Group XVIII expansion population. While each state’s approach may differ, the idea is to passively renew consumers using automated processes when possible. Below are the percent of renewals for MAGI-based groups that are successfully completed via automated processes for the 50 states and D.C., without enrollee action, based on state rules in place as of January 1, 20202:

<25%                 8
25-50%            13
50-75%            13
75-90%             9
>90%                 0
Not Reported  8

These passive enrollment results illustrate that thousands of Medicaid renewals per state must undergo a more rigorous redetermination process.

The Kaiser Family Foundation recently conducted a national survey of individuals, ages 18-64, who had coverage through a qualified health plan, Medicaid, or who were uninsured at the time of the survey. Forty-one percent of uninsured consumers who had been covered by Medicaid themselves or had a child covered by Medicaid said that coverage had been terminated. Among those whose Medicaid coverage had been terminated at some time in the past two years, nearly three in ten (29%) said it was because they could not complete the redetermination process.. 3

Consumer assistance can help, minimizing the complexities and enhancing the opportunity for a successful experience and outcome. Maintaining eligibility reduces the uninsured, benefitting providers, and the churn experienced by health plans.

Medicaid Periodic Eligibility Checks
In addition to the required annual or semiannual redetermination, states have been encouraged to conduct periodic eligibility checks for Medicaid beneficiaries. Results from the Kaiser Family Foundation’s 18th annual survey of the 50 states and the District of Columbia (DC) found thirty states that conduct routine electronic data matches with one or more data sources between annual renewal periods to identify potential changes in circumstances that would affect financial or other eligibility.4 Changes can result in disenrollment, even if that change is temporary. Examples include overtime or seasonal work.

Beneficiaries are notified by the state, often by mail, and typically have ten days from the date of their notice to respond. Contrast those ten days to the 30 days allowed for a redetermination. Ten days is not much time. Again, the complexities discussed earlier come into play and enrollment assisters can help.

Continuous Coverage Requirement
The Families First Coronavirus Response Act (FFCRA) offers states the opportunity to increase their Federal Medical Assistance Percentage (FMAP) by 6.2 percentage points. One of the Centers for Medicare and Medicaid Services (CMS) requirements is continuous coverage, regardless of any changes in circumstances or redeterminations at scheduled renewals that otherwise would result in termination.5 To qualify for the temporary FMAP increase, states cannot disenroll a Medicaid beneficiary unless they die, move to another state, or ask for their Medicaid to be discontinued. The continuous coverage requirement became effective on March 18, 2020.

State and managed care Medicaid rosters have increased. Health Management Associates6 (HMA) estimates, “Medicaid enrollment could increase by 5 to 18 million by the end of the year, depending on the economy.” This estimate includes continuous coverage and newly enrolled.

According to Modern Healthcare7, “A handful of the largest Medicaid managed care insurers have reported Medicaid membership growth of 5% to 7% over the last few months, each attributing the bulk of the gains to the freeze on eligibility redeterminations, as required under the Families First Coronavirus Response Act.”

Millions of Medicaid beneficiaries are at risk of losing coverage at the end of the quarter in which the public health emergency ends, currently December 31, 2020. Enrollment assistance is a necessity to help Medicaid beneficiaries keep coverage or to find them new coverage should they lose their Medicaid due to ineligibility.

Economic and Employment Conditions
The COVID-19 pandemic changed our world, almost overnight. Our economic and employment conditions changed with it. Employees were furloughed, meaning they temporarily lost their jobs but kept their ESI. The immediate needs of furloughed workers were food and rent.

There was not a rush to Medicaid. Some who lost their job may not have known Medicaid was an option. “There is often a lag between changes in unemployment and Medicaid enrollment,” according to the Kaiser Family Foundation.8 “Nearly all states with early projections anticipated that enrollment growth would accelerate in state fiscal year 2021.”

A Medicaid rush is still expected. HMA’s estimate of a 5- to 18-million-member increase in Medicaid by the end of the year includes continuous coverage and newly enrolled. Additionally, HMA9 forecasts, “Individual Marketplace enrollment could see significant turnover. Some newly unemployed who lose their ESI will have family income that is above the Medicaid limit, and therefore could choose to purchase subsidized coverage from the Marketplace. Other newly unemployed may have previously been purchasing individual insurance from the Marketplace, and with the loss of a job and associated income these people will qualify for Medicaid coverage. In addition, in a slower economic recovery, some individuals who choose individual Marketplace coverage upon job loss may become eligible for Medicaid at the end of the year.”

Enrollment assistance can help.

Summary
Let’s revisit the Kaiser Family Foundation survey10 of individuals ages 18-64 who had coverage through a qualified health plan, Medicaid, or who were uninsured at the time of the survey. Results indicate that:

  • Overall, 18% of respondents reported getting help from someone other than a friend or family member, an estimated seven million people over the past 12 months
  • Among consumers who received help, 62% said they did not understand their coverage options and 52% said the process of applying was too complicated to complete on their own
  • Consumers sought help because they did not have internet access at home (18%), they had problems with the marketplace website (18%), or they needed assistance in Spanish (15%)
  • Sixty-one percent of consumers who enrolled in the Marketplace and 40% of Medicaid enrollees experienced difficulties
  • Of consumers who actively looked for coverage, 12%, or nearly 5 million consumers, tried to find enrollment assistance without success

Consumer assistance in health coverage matters. How can Centauri Health Solutions help you?

Shanna Hanson, FHFMA, ACB
Manager, Business Knowledge
Centauri Health Solutions, Inc.

[1, 3, 10] Consumer Assistance in Health Insurance: Evidence of Impact and Unmet Need, Karen Pollitz, Jennifer Tolbert, Liz Hamel, Audrey Kearney, Kaiser Family Foundation, August 07, 2020, https://www.kff.org/report-section/consumer-assistance-in-health-insurance-evidence-of-impact-and-unmet-need-issue-brief/
[2] Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey, Kaiser Family Foundation, https://www.kff.org/coronavirus-covid-19/report/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies-as-of-january-2020-findings-from-a-50-state-survey/, Table 10: Medicaid Renewal Processes and Use of Periodic Data Matches Between Renewals for Children, Pregnant Women, Parents, and Expansion Adults, January 2020, March 26, 2020, http://files.kff.org/attachment/Table-10-Medicaid-and-CHIP-Eligibility-as-of-Jan-2020.pdf
[4] Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey, Kaiser Family Foundation, https://www.kff.org/coronavirus-covid-19/report/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies-as-of-january-2020-findings-from-a-50-state-survey/, Table 10: Medicaid Renewal Processes and Use of Periodic Data Matches Between Renewals for Children, Pregnant Women, Parents, and Expansion Adults, January 2020, March 26, 2020, http://files.kff.org/attachment/Table-10-Medicaid-and-CHIP-Eligibility-as-of-Jan-2020.pdf
[5] Families First Coronavirus Response Act – Increased FMAP FAQs, Centers for Medicare and Medicaid Services, April 13, 2020, https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-faqs.pdf
[6,9] COVID-19 Impact on Medicaid, Marketplace, and the Uninsured, Health Management Associates, May 2020, https://www.healthmanagement.com/wp-content/uploads/HMA-Updated-Estimates-of-COVID-Impact-on-Health-Insurance-Coverage-May-2020.pdf
[7] Medicaid enrollment is climbing, but not because of newly uninsured, Shelby Livingston, Modern Healthcare, August 4, 2020, https://www.modernhealthcare.com/medicaid/medicaid-enrollment-climbing-not-because-newly-uninsured
[8] Data Note: Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic, Elizabeth Hinton, Robin Rudowitz, Natalie Singer, Lina Stolyar, Kaiser Family Foundation, Jul 27, 2020, https://www.kff.org/coronavirus-covid-19/issue-brief/data-note-growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/