How Will Medicaid Work Requirements Impact Churn and Member Retention?

January 23, 2018 Jennifer Forster

CMS' recent guidance to State Medicaid Directors on work requirements for non-disabled, non-pregnant adults was anticipated to those of us who serve Medicaid programs. Even so, this policy change has many Medicaid plans and advocates concerned that additional requirements will add to Medicaid churn or the administrative disenrollment and re-enrollment of Medicaid beneficiaries.

For Medicaid work requirements to both succeed and further the goals of the program, there will need to be an enormous amount of communication and coordination among state agencies, health plans, and Medicaid beneficiaries. Proactive, supportive outreach to members will be instrumental in this new era of work requirements to minimize churn and ensure members receive the care they need. 

HMS' Eliza health plan member engagement experts work with Medicaid MCOs to ensure continuity of coverage, thereby improving health, and reducing costs and attrition. Eliza's Medicaid retention programs have traditionally focused on proactively reminding members of an upcoming renewal date and explaining the steps they need to take to keep their Medicaid coverage.

Members can fall off of a plan and lose Medicaid coverage simply because they didn't receive their renewal notice in the mail (as was the case for 60% of one client's population), or because they didn't understand the process. When otherwise eligible members miss their renewal date for whatever reason, they lose coverage and access to necessary services for a period of time, only to come back onto the plan several months later, often with more expensive and complex conditions to manage.

We help Medicaid plans to minimize churn to increase member retention, with measurable results. For example, one of our MCO plan partners experienced a 25% greater rate of Medicaid renewal for those reached by Eliza, resulting in annual bottom-line savings of over $2 million. 

A decrease in member retention due to Medicaid churn is likely to increase with new work requirements. The addition of Medicaid work requirements, premium payments and lockout provisions for noncompliance will augment the need for retention efforts throughout the year to prevent any lapse of coverage, but steps can be taken to minimize the impact. Eliza is currently partnering with a plan in a state that recently enacted work requirements for a portion of its Medicaid population. We've developed a multi-touch, multi-channel approach to notify affected members about the new requirements and will provide education on how to maintain coverage by going through the state attestation process.

We're hopeful that this proactive, supportive outreach will keep members on the rolls, reduce Medicaid churn, and improve member retention. Because it's more than just health insurance. It's life-saving prescriptions for people with chronic conditions, it's preventive care, it’s immunizations for children, prenatal care for expectant parents, and thousands of other necessary healthcare services for over 70 million Americans.

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