CMS Tools Suggest Key Roles for Managed Care Plans in Helping Enrollees Retain Coverage

While we were all unwinding from our Thanksgiving celebrations, CMS was busy putting out two new tools to assist state Medicaid eligibility and enrollment operations. The first is focused on preparing for the return to normal operations after the COVID-related continuous enrollment requirement is lifted while the second is a refresher on best practices and policies in outreach, enrollment, and retention.

The unwinding tool focuses on strategies that will help states keep eligible individuals enrolled when they begin the process of identifying enrollees who are no longer eligible. It includes operational tactics and policy options in seven topic areas: strengthening renewal processes; updating mailing addresses; improving consumer outreach, communication and assistance; promoting seamless coverage transitions; improving coverage retention; addressing the strain on workforce capacity; and boosting monitoring and oversight of eligibility and enrollment operations. This “punch list” echoes most of the tactics we’ve covered in our joint webinars with the Center on Budget and Policy Priorities and in our advocacy tips on the “unwinding.” But it’s important to note that these strategies represent best practices in normal times and are not limited to the return to normal operations when the continuous enrollment requirement is phased out.

The outreach, enrollment, and retention tool summarizes many of the best practices we’ve promoted in other publications over time, such as in our brief on ways to improve enrollment and retention following the decline in child enrollment in Medicaid and CHIP back a few years ago. It touches on the importance of strategic partnerships, providing consumer assistance, using effective communication strategies, harnessing technology to make enrollment and renewal easier, collecting and analyzing data, and taking a proactive approach to continually improving policy and operations. The brief includes state examples of innovative practices. For example, New Jersey recently added mental health and substance abuse providers as presumptive eligibility qualified entities and saw a corresponding increase in applications.

These new resources do not update previous CMS guidance on the return to normal operations, as the agency is likely waiting for the outcome of the Build Back Better plan, which would change how the continuous enrollment requirement is expected to be phased out. However, both tools help to clarify the important roles that Medicaid managed care plans can play both in the near term in unwinding the continuous enrollment requirement and on an ongoing basis to promote retention.

CMS is clear that states should look to managed care plans as essential partners. A critical role for managed care plans in preparing for the unwinding and beyond is to assist with updating mailing addresses. However, states should also make sure their systems are able to efficiently collect and integrate the new contact information received from MCOs. States are also encouraged to engage MCOs in supplementing communication, outreach, enrollee education, as well as providing support to enrollees during the renewal process. The agency goes as far as to suggest contracts require MCOs to assist with these activities.

While the strategies described in the tools aren’t new, it’s helpful for states to hear directly from CMS to reinforce the policy and administrative priorities that child health advocates continue to promote. In fact, the unwinding tool is an excellent checklist to review with your state as a way to encourage them to be as proactive as possible in enrolling and retaining all children and families who are eligible for Medicaid or CHIP.

Tricia Brooks is a Research Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.