With the expiration of the continuous coverage requirements, states have begun redetermining Medicaid and CHIP enrollee’s eligibility. Estimates from the Assistant Secretary for Planning and Evaluation (ASPE) show that more than 15 million people could lose their current coverage through the unwinding process. To help mitigate these potential coverage disruptions, the Connecting to Coverage Coalition (CCC) is working with stakeholders across the country to ensure a responsible transition in all 50 states.
CMS notes that while many people with Medicaid may not have gotten recent communications regarding coverage renewal or redetermination, some have received communications, and many have renewed coverage since March 2020 – this depends on the processes in place in each state. The need for renewal or redetermination may not be surprising to current enrollees, but they may need time to take action, as some find the activities associated with renewal to be time consuming.
CMS notes that while many people with Medicaid may not have gotten recent communications regarding coverage renewal or redetermination, some have received communications, and many have renewed coverage since March 2020 – this depends on the processes in place in each state. The need for renewal or redetermination may not be surprising to current enrollees, but they may need time to take action, as some find the activities associated with renewal to be time consuming.
CMS's full unwinding toolkit contains materials and messaging that states can use in communicating with Medicaid enrollees about the renewal process.
Reaching Beneficiaries
In addition to direct mail, email, and portal communications, CMS has identified several additional sources that may be useful levers for outreach to beneficiaries.
1. Health care providers and clinics, and state or local health department, including Indian health care providers operated by the Indian Health Service, Tribes and Tribal organizations, and urban Indian organizations.
2. Social services, such as HUD, WIC, SNAP, particularly for people who are eligible for Medicaid due to income.
3. Social Security Administration and disability benefits for individuals with disabilities.
4. Managed care health plan issuers, especially for people who are dually eligible for Medicare and Medicaid.
5. Community sources, like places of worship and schools, are also frequently mentioned touchpoints.
1. Health care providers and clinics, and state or local health department, including Indian health care providers operated by the Indian Health Service, Tribes and Tribal organizations, and urban Indian organizations.
2. Social services, such as HUD, WIC, SNAP, particularly for people who are eligible for Medicaid due to income.
3. Social Security Administration and disability benefits for individuals with disabilities.
4. Managed care health plan issuers, especially for people who are dually eligible for Medicare and Medicaid.
5. Community sources, like places of worship and schools, are also frequently mentioned touchpoints.
Key Messages for Medicaid Enrollees
CMS is encouraging states to focus their messaging on getting people ready to renew their Medicaid or CHIP coverage with simple, direct, and informative lines of communication. Key examples of enrollee messaging:
1. Update your contact information – Make sure [Name of State Medicaid or CHIP program] has your current mailing address, phone number, email, or other contact information. This way, they’ll be able to contact you about your Medicaid or CHIP coverage.
2. Check your mail – [Name of State Medicaid or CHIP program] will mail you a letter about your Medicaid or CHIP coverage. This letter will also let you know if you need to complete a renewal form to see if you still qualify for Medicaid or CHIP.
3. Complete your renewal form (if you get one) – Fill out the form and return it to [Name of State Medicaid or CHIP program] right away to help avoid a gap in your Medicaid or CHIP coverage.
1. Update your contact information – Make sure [Name of State Medicaid or CHIP program] has your current mailing address, phone number, email, or other contact information. This way, they’ll be able to contact you about your Medicaid or CHIP coverage.
2. Check your mail – [Name of State Medicaid or CHIP program] will mail you a letter about your Medicaid or CHIP coverage. This letter will also let you know if you need to complete a renewal form to see if you still qualify for Medicaid or CHIP.
3. Complete your renewal form (if you get one) – Fill out the form and return it to [Name of State Medicaid or CHIP program] right away to help avoid a gap in your Medicaid or CHIP coverage.
Outreach Strategy for Enrollees Transitioning to Marketplace Coverage
CMS has outlined several communications and outreach strategies related to individuals who are determined ineligible for Medicaid who may be eligible for Marketplace coverage.
Outreach Campaigns
CMS is conducting two outreach campaigns to raise awareness about the upcoming Medicaid unwinding and promote coverage continuity: (1) Awareness Campaign: Aims to raise awareness among current Medicaid and CHIP enrollees regarding the upcoming redeterminations proces; and (2) Transitioning to the Marketplace & Promoting Coverage Continuity: Targeted towards consumers that have lost Medicaid or CHIP and encourages them to transition to Marketplace coverage.
Direct Outreach
CMS will conduct direct outreach to consumers who are redetermined from their Medicaid coverage to encourage them to transition to Marketplace coverage. Once an enrollee is redetermined from Medicaid, CMS will send them a letter with information about how to enroll in Marketplace coverage, including information about HealthCare.gov and where consumers can receive additional enrollment assistance. CMS will also provide these consumers with enrollment reminders via e-mail, text messages, and autodial calls on a regular basis.
If a consumer does not initiate a HealthCare.gov application after a certain period of time, CMS will send select consumers an additional reminder letter via mail with further information about enrolling in Marketplace coverage. The Navigator and assister community may also conduct direct outreach to those consumers and offer personalized assistance to help them with the Marketplace application and enrollment process. Once a consumer has initiated the Marketplace application process, CMS will send them a separate set of reminder communications to help them finish their application.
Outreach Campaigns
CMS is conducting two outreach campaigns to raise awareness about the upcoming Medicaid unwinding and promote coverage continuity: (1) Awareness Campaign: Aims to raise awareness among current Medicaid and CHIP enrollees regarding the upcoming redeterminations proces; and (2) Transitioning to the Marketplace & Promoting Coverage Continuity: Targeted towards consumers that have lost Medicaid or CHIP and encourages them to transition to Marketplace coverage.
Direct Outreach
CMS will conduct direct outreach to consumers who are redetermined from their Medicaid coverage to encourage them to transition to Marketplace coverage. Once an enrollee is redetermined from Medicaid, CMS will send them a letter with information about how to enroll in Marketplace coverage, including information about HealthCare.gov and where consumers can receive additional enrollment assistance. CMS will also provide these consumers with enrollment reminders via e-mail, text messages, and autodial calls on a regular basis.
If a consumer does not initiate a HealthCare.gov application after a certain period of time, CMS will send select consumers an additional reminder letter via mail with further information about enrolling in Marketplace coverage. The Navigator and assister community may also conduct direct outreach to those consumers and offer personalized assistance to help them with the Marketplace application and enrollment process. Once a consumer has initiated the Marketplace application process, CMS will send them a separate set of reminder communications to help them finish their application.
Other important messages for Medicaid Enrollees:
- If you no longer qualify for Medicaid or CHIP, you may be able to get health coverage through the Health Insurance Marketplace. Marketplace plans are:
- Affordable. 4 out of 5 enrollees can find plans that cost less than $10 a month.
- Comprehensive. All plans cover things like prescription drugs, doctor visits, urgent care, hospital visits, and more.
- Losing Medicaid or CHIP coverage is a Qualifying Life Event (QLE), which allows you to enroll in a Marketplace plan outside of the Open Enrollment Period.
- Visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to get details about Marketplace coverage.
- If your child no longer qualifies for Medicaid, you may be able to get them health coverage through your state’s Children Health Insurance Program (CHIP).
- For more information about Medicaid renewal or CHIP coverage, contact your state Medicaid office or visit Medicaid.gov.
A note from CMS: Any messaging about Medicaid/CHIP renewal may prompt calls to State Medicaid offices for clarification and additional information. A few things to consider:
- Include specific dates and timeframes wherever possible. For example, “You need to renew your Medicaid coverage by March 31, 2022.”
- Include specific, relevant information so that people don’t need to fill in missing gaps or guess where they fit in. In states where individuals have had opportunities to renew their coverage or re-apply, ensure that messaging takes this into account.
- Avoid vague language that could confuse people, like “you may be automatically renewed or “most people must complete a form, but some will not.”
- Reference state-based exchange (SBE) contact information as an alternative to the Health Insurance Marketplace and HealthCare.gov, if your state has an SBE.
- People who lose Medicaid, but have Medicare coverage won’t need letters or other communications encouraging them to enroll in a Marketplace plan.
