A Closer Look at Medicaid Call Center Options as the Unwinding Kicks into High Gear

More than a year ago, we posted a blog warning that call center statistics would be the canary in the coalmine as states began the unprecedented challenge of renewing coverage for all 92 million Medicaid enrollees now that the COVID-related continuous enrollment requirement has ended. We all know how frustrating it can be when you need to access customer assistance and encounter unreasonable wait times or get caught in a multi-layered phone tree that doesn’t seem to route you to a live person. And that experience is alarming when your child or family’s health coverage is on the line. Like in Arkansas, where over the weekend coverage was terminated for some 25,000 children enrolled in ARKIDS, the state’s Medicaid and CHIP programs.

Automated phone systems, when well designed, can efficiently provide information or direct callers to a person who can help. But if a phone tree has too many options or tries to convey too much information, it makes it difficult for people to get the help they need. As the unwinding was starting, we made two rounds of calls to state Medicaid call centers to see what consumers encounter when they call the hotline. Specifically, we wanted to know if the call center offers a call back option or reports the approximate wait time or if there are options for non-English speakers or to report updated contact information. State level data can be viewed by hovering over a state on this map.

Here’s what we found in our calls to state Medicaid call centers. The call was answered without a wait in 14 states on at least one of the two occasions we contacted the hotline. Another 14 states required Medicaid identifying information before accessing the main menu. In these states, less information about the phone system options was assessable. But keep in mind that phone systems and processes evolve as states and state contractors monitor and respond to changing conditions during the unwinding. For example, Alaska added a call back option to its hotline between our first and second round of calls.

Call Back Option

A call back option eliminates the need for someone to wait on hold until a customer service representative is free. Instead, the system retains your place in the queue and calls you back when it’s your turn. A call back option also saves cell minutes for people with limited data plans. We found that about half of the states do not offer a call back option while the option was offered in 8 states. In the remaining one-third of states, either the call was answered promptly, or the system required identifying information to proceed to the main menu options.

Prompt for Non-English Speakers

Offering an option for non-English speakers following the initial greeting helps route people to where assistance in other language(s) is available. Almost all states, including those requiring identifying information upfront, offer a menu option for one or more languages.

Separate Option to Update Contact Information

Having a direct dial option for individuals to provide updated contact information can free call center and eligibility workers to answer enrollee questions and assist with renewals. However, only a handful of states offer a selection from the main menu to report updated contact information.

Call Wait Time or Place in Queue Provided

One major frustration for those seeking assistance is to have no idea of how long the wait may be before you are able to speak to a representative. People who have limited break time from work benefit knowing whether it makes sense to wait on hold or try at another time. Because our calls were fielded before disenrollments began in most states, it was not intended to give an estimate of average call wait times. We’ll have to wait until CMS posts official state data to get a better sense of call center performance.

Some State Toll-Free Numbers Are a Catch-all for Multiple Purposes and Stakeholders

Some states use their toll-free numbers to provide access to information for different Medicaid stakeholders. We heard provider-directed and other messages that had no relevance to enrollees. One state prominently featured a message about reporting enrollee or provider fraud but then provided useful information about the unwinding. Providing a recording explaining the unwinding and what to expect could be another way for states to share information that can be useful during this unprecedented time. However, using one number for purposes beyond giving applicants and enrollees with access to enrollment or coverage information may cause some callers to abandon the call thinking they don’t have the right number.

To the extent that we were able to fully access a state’s phone tree, no state offered all four options that we queried in our calls. This suggests that states can do more to create automated systems that more efficiently help individuals get the assistance they need. As the demand for enrollee assistance grows during the unwinding, states would be well served by assessing ways to make their hotlines and call centers more efficient.

[Editor’s Note: This is the 32nd blog in the Unwinding Wednesday series. For more information, visit our PHE Unwinding resource page where you’ll find other blogs in this series, reports, webinars and the 50-state tracker.]