Avoiding lapses in coverage: Sustainable solutions to encourage Medicaid renewal

With the right tools and resources, you can educate beneficiaries about Medicaid’s unwinding and support them in renewing their eligibility.
Value-Based Care

Medicaid is a critical safety net for more than 90 million Americans with limited income and resources. It’s the largest single source of health coverage in the U.S., and a growing body of research has demonstrated its ability to reduce poverty and out-of-pocket spending, increase access to care and improve health outcomes. 

But an estimated 15 million Americans are now at risk of losing Medicaid coverage as states begin unwinding the continuous enrollment provision that provided ongoing coverage to beneficiaries during the COVID-19 public health emergency. Half of those enrollees are likely still eligible for Medicaid, yet nearly two-thirds don’t realize that they need to redetermine their eligibility. With disenrollments underway since April 1, millions of Medicaid beneficiaries have already lost coverage—and that number is climbing by the day. 

Medicaid managed care plans and providers can help eligible beneficiaries renew their coverage—and suggest Affordable Care Act (ACA) Health Insurance Marketplace plan options to those who no longer qualify for Medicaid. But increasing eligibility-renewal rates isn’t about hiring more people to support the work. It’s about building a sustainable, replicable renewal strategy that supports and streamlines the process for enrollees and staff. 

With the right tools, technology and resources, payers and providers can work together to ensure that people don’t lose access to affordable care. By systematically engaging Medicaid beneficiaries at the point of care, payers and providers can educate them about the unwinding of Medicaid’s continuous enrollment provision, support them in renewing their eligibility and connect disenrolled members with coverage options that meet their needs. 

1. Educate Medicaid beneficiaries about the renewal period 

Between 2020 and 2023, total Medicaid and CHIP enrollment grew more than 30%, and the uninsured rate dropped to an all-time low. Millions of new members signed up for coverage—nearly half of whom have never been through renewal before. But despite providers’ and payers’ best efforts to educate members about the renewal process, the majority of beneficiaries are still unaware that states can remove people from Medicaid. 

Personalized digital messaging can help address that challenge, enabling healthcare leaders to more effectively engage key demographic groups—particularly young people who may prefer to receive renewal information via email. Digital communication complements traditional outreach channels like direct mail, giving organizations an additional touchpoint for reaching Medicaid beneficiaries and helping them understand the importance of renewing their eligibility. 

Better yet, personalized digital messaging generates measurable engagement—and the proof is in the numbers. More than half of beneficiaries open the personalized Medicaid renewal emails they receive from health plans and provider groups who use Phreesia, on average.1 By communicating with beneficiaries via the digital channels they already use, healthcare leaders can effectively scale their Medicaid outreach strategies across their membership.  

2. Support beneficiaries in completing their renewal forms 

The Medicaid renewal process is complex. Beneficiaries may struggle to interpret renewal notices because of confusing wording, language barriers or the volume of notices they receive. Not surprisingly, 85% of Medicaid beneficiaries say expert help would be useful in renewing their eligibility. 

The solution? Deploy staff to provide re-enrollment support—either by using existing representatives or by contracting with a third-party vendor or call center. With a dedicated team, Medicaid managed care plans can more easily help enrollees renew their coverage or select an ACA Marketplace plan. When possible, staff should work with beneficiaries beyond the renewal process to help them fully utilize their coverage and maintain it year-round. 

Given the high volume of beneficiaries who need to renew their eligibility, providers and payers should have a backup plan. If deploying additional staff isn’t an option, health plans should consider contacting beneficiaries through multiple channels—including mailed packets, emails, phone calls, text messages and via patient portals—with instructions to help them renew their coverage on their own.  

With digital channels specifically, Medicaid managed care plans can give members a step-by-step renewal guide—complete with detailed instructions that link to the right forms and resources. To date, organizations that use Phreesia have sent more than 1.5 million Medicaid renewal messages via text message and email across 75 unique campaigns.1 

3. Help ineligible enrollees transition to other coverage 

Not all Medicaid beneficiaries will remain eligible for coverage. If they lose eligibility, they’ll have to enroll in a Marketplace or employer-sponsored plan to avoid becoming uninsured. Yet more than 1 in 4 beneficiaries say they don’t know where to look for other coverage options. 

Point-of-care engagement can help providers and payers proactively address that uncertainty. By engaging newly and soon-to-be ineligible individuals during intake when their healthcare is top of mind, organizations can quickly reach those who are at imminent risk of losing coverage—and help them apply for a new plan. And by automating those point-of-care touchpoints, payers and providers can tailor those engagement to: 

  • Support members who need expert help by using rules-based logic to automatically follow up with beneficiaries who specify—during digital registration for a healthcare appointment—that they don’t know how to enroll in alternative coverage. 
  • Minimize lapses in coverage by sending tailored outreach to members who may become ineligible for Medicaid but have not yet secured new coverage. 
  • Localize efforts by stratifying beneficiaries by age, race, social needs and more. A health plan might geographically stratify members, for example, to inform those at risk of disenrollment about the specific Marketplace plans offered in their area. 


With 1 in 6 Medicaid beneficiaries projected to lose coverage, Medicaid managed care plans must act quickly to offset expected revenue shortfalls and elevated medical-loss ratios—not only in 2023, but in the years to come. That’s why it’s critical that health plans transition to an evergreen renewal strategy that puts member awareness, education and engagement at the forefront.  

By being proactive and effectively using technology, Medicaid plans can develop a replicable strategy to streamline annual renewals and better engage members. In doing so, they can support continuity of coverage, safeguard their profitability and position themselves to outperform as the annual renewal period resumes. 

Learn how Phreesia helps health plans support coverage continuity, generate leads for Marketplace plans and engage with members when their healthcare is top of mind.  

  1. Phreesia data from Jan. 1 to Aug. 2, 2023. ↩︎

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