Call Center Statistics: The Canary in the Coalmine When the Medicaid Continuous Coverage Protection is Lifted

As consumers, we all know how frustrating it can be to try to get help for some issue only to find that there is a lengthy wait just to talk to someone. Now consider how much more frustrating it would be if you work in a frontline position in service, retail, or hospitality industries and can’t multi-task at your desk while on hold. Or, perhaps, as a low-income Medicaid enrollee, you cannot afford a wireless plan with unlimited cell minutes.

When call wait times increase, so do call abandonment rates when callers are unable to remain on hold or the system gets overwhelmed and drops the call inadvertently. This means that people who have questions or don’t understand what they need to do to retain coverage will be left without answers if states are unable to handle the increased demand for consumer assistance when the unwinding begins. That’s why call center metrics are the canary in the coalmine when the continuous coverage protection is lifted.

There is another reason that monitoring call center statistics is important. States have indicated they are finding it difficult to recruit and retain eligibility and call center staff. With an insufficient capacity to handle demand, staff can burn out quickly. Monitoring call center data and taking mitigation steps if the workload becomes unmanageable can help avoid exacerbating the staffing shortage.

Although we can expect a spike in call volume when states began processing renewals during the unwinding, there is no reason to believe that unreasonable call wait times are unavoidable. We know that in the initial year of the ACA Medicaid expansion some states did not adequately expand call center capacity, which contributed to long wait time as noted in this Kaiser Family Foundation (KFF) brief. But states do have time to adequately prepare for the increase in calls during the unwinding. There are many options to do so, including hiring and training more staff; contracting for more vendor services; extending call center hours; programming their automated systems to triage calls based on the type of assistance needed or provide answers to frequently asked questions; and/or providing an option for a return call when it’s the caller’s turn in line.

I noted in this blog that I was disappointed that CMS did not include call center statistics in the data reporting template that states will use to provide baseline and monthly data at the end of the PHE (or whenever states otherwise begin processing disenrollments). But federal officials have provided assurances that they will be monitoring call center data that states are required to report monthly as part of the performance indicator project. But it would be helpful to have all the monitoring data in a single report, so stakeholders can urge their states to be transparent and accountable by sharing their monthly reports.

And let’s be clear, reporting and monitoring call center data is not rocket science. Call center metrics have been a key management tool in assuring quality consumer assistance in the business world for decades. No call center system, whether managed in-house or contracted to a vendor, would be complete without the ability to report a number of performance indicators that go well beyond the basics, including first-call resolution, customer satisfaction, and supervisor escalation rates. And, all but one state indicated that they are able to report basic call center data when asked on the 2022 50-State Survey on Medicaid and CHIP Eligibility and Enrollment conducted earlier this year by KFF and CCF.

Unreasonable call wait times should be a trigger for the state to pause or slow down the number of renewals it initiates each month and to take additional steps to boost consumer assistance. But if there is no public reporting of data, there will be a lack of transparency that is needed for stakeholders to push the state to respond appropriately if enrollees are having difficulty getting help. We’ve heard that the quality of the call center statistics and other performance indicator data are unreliable, although states have been required to report the data since 2013, which is why CMS routinely posts only limited application and enrollment data! But there is no urgency for addressing data quality issues if states know that the data will never see the light of day.

Publicly reporting call center statistics and other performance indicators and monitoring data is a critical way to increase transparency and accountability, whether at the federal or state level. States have an opportunity to kick it up a notch by sharing the planning process and collaborating with the many stakeholders who want to help make sure that millions of families and children do not experience a gap or loss of coverage. A big jump in the uninsured rate doesn’t have to happen if states approach the unwinding thoughtfully and take the time to get it right. Being transparent and accountable by sharing and monitoring key performance metrics, including call center statistics, is a good place to start.

Tricia Brooks is a Research Professor at the Center for Children and Families (CCF), part of the McCourt School of Public Policy at Georgetown University.