This week on Unwinding Wednesday, we are digging into the communications materials and toolkits found on our 50-state Unwinding Tracker – arguably one of the most critical elements of the tracker for ensuring individuals with Medicaid coverage are adequately prepared for the unwinding. The development of comprehensive communications materials by state Medicaid agencies is vital for enrollees to understand what changes are coming and what actions they may need to take to maintain coverage. Widespread distribution of these materials will not only help ease the unwinding process for both enrollees and the state, but it will also assist in minimizing coverage loss of eligible individuals by making sure that enrollees are aware of what they need to do to stay covered.

So far, around half of the states have posted some type of communications materials. Graphics urging members to update their addresses are the most common; these are available in many different formats, such as social media posts, fliers, posters, and mailers. Other elements found across state communications toolkits include e-mail and text message templates, as well as “on-hold” scripts for providers and health plans to use that provide details about the unwinding. Some states’ toolkits, like California’s, also include “call scripts” for stakeholders that provides specific information or answers to key questions that enrollees might ask. Materials target a range of stakeholders (providers, health plans, advocacy organizations) and often include key resources these groups can direct beneficiaries to for help, like assistors or navigators.

Here are some examples of graphics created in Arkansas and Georgia – these have a clear, actionable message and include information on how to take those actions:

In addition to the actual communications materials that have been posted, some states are incorporating attention-capturing elements into their direct mail materials to help prevent beneficiaries from losing coverage for procedural reasons. For example, Louisiana conducted a “Pink Letter Campaign” where beneficiaries received a pink-colored letter reminding them to update their address. The state’s message ­– “make sure you got your pink letter in the mail” – is simple and clearly indicates that if an individual who has Medicaid coverage has not received their pink letter, then they need to update their contact information using one of the methods included in the outreach materials. (New Hampshire also did a similar campaign early last year).

Many states split their communications plans into phases so that partners are clear on what messages to disseminate during each step of the unwinding process. The first phase of the communications plans often prepares members for the unwinding by encouraging them to update their contact information. Phases II and III largely occur after the announcement that the PHE will end. Messages during phase II urge members to check their mail and return renewal forms (if they get one – remember that enrollees whose coverage is successfully renewed via ex parte processes will only get a notice of continuing eligibility). Phase III messages provide information about transitioning to marketplace insurance plans for members who are determined to no longer be eligible for Medicaid. A phased communication plan is important to ensure beneficiaries are receiving consistent messages before and during the unwinding period at the appropriate time.

As with all of the elements of our tracker, some states have much more robust communications materials than others. A few states’ toolkits only consist of a graphic or two related to updating contact information and/or general information about the unwinding. While having any communications materials posted is an important first step, states must also do the work to ensure that these materials are effectively reaching Medicaid members. Alabama and North Carolina provide examples of excellent toolkits – both not only include graphics and template messages to share, but also information on the purpose of the toolkit and how stakeholders can best use the materials.

States that have limited or no communications materials posted should be encouraged to use these comprehensive toolkits, as well as those of other states, as models for creating or improving their communication strategy. There’s no shortage of good examples and research-driven messaging from which states can draw. In addition to state examples found on our 50-state tracker, the State Health & Values Strategies has posted a number of resources here.

Finally, a critical element in state communications materials that should not be overlooked is accessibility. While more than half of the states with toolkits posted have materials in both English and Spanish, there are still a few states with materials only available in English. It is reassuring though to see four states with their toolkits available in more than 8 languages, while California has materials in 19 different languages! And CMS has posted a communications toolkit in seven languages (English, Spanish, Chinese, Hindi, Korean, Tagalog, and Vietnamese) which can be found if you scroll down to communications tools on the CMS Unwinding landing page.

Other accessibility features should also be incorporated into states’ toolkits; for example, Alabama’s unwinding toolkit includes phone numbers for assistance to those who are deaf or visually impaired. It is imperative that states prioritize all of their members in their outreach efforts, especially given marginalized communities will likely be disproportionately impacted by the unwinding.

The fact that half of states still do not have communications materials posted is concerning. Now is the time to spread awareness about the unwinding, notify members about the need to update their contact information, and prepare them for what is to come. With the PHE almost certainly continuing until at least January, there is still time for your state to take action and start outreach if it has not already done so.

[Editor’s Note: For more information, visit our PHE Unwinding resource page where you’ll find other blogs in this series, reports, and the 50-state tracker.]