As the 41 states that expanded Medicaid to low-income adults under the Affordable Care Act, approach the implementation of H.R. 1’s federally mandated semi-annual renewals, we thought it would be helpful to review how states handled the daunting task of outreach during the unwinding of the pandemic-era Medicaid continuous coverage provision. During the unwinding, we conducted a scan of state resources and found a proliferation of outreach activities directed toward people enrolled in Medicaid focused on raising awareness that renewals were restarting and self-help tools to assist individuals in completing the renewal process. Self-help resources, like video tutorials, are important sources of consumer assistance that reduce administrative burden on states and individuals.
Georgetown University Center for Children and Families (CCF) researchers reviewed state Medicaid agency websites, social media accounts (e.g. Instagram and Facebook), and affiliated video sharing accounts (e.g. YouTube and Vimeo), from all 50 states and DC to examine renewal instructions and videos. (Resources posted by non-state entities are not included in the scan.)
Renewal Video Tutorials
The review, conducted in the fall of 2025, shows that most states (39) post video tutorials on how to renew Medicaid; ten of those have two or more videos. However, in 34 states, the renewal videos are specific to the unwinding. These videos were intended to assist enrollees needing to renew coverage for the first time in three years and could be easily refreshed by removing references to the unwinding to create a generic, evergreen resource.
Ten states have both generic and unwinding renewal videos whereas 5 states have generic renewal videos only. We could find no renewal video content online in a dozen states. Seven of those are Medicaid expansion states (AZ, ID, IL, MD, SD, UT, WV) where individuals in the adult expansion group will be subject to semi-annual renewals starting no later than January 2027.
States and individuals benefit from video tutorials on Medicaid eligibility and enrollment actions that are available online, generally through the use of an individual’s multi-function online account. Video tutorials are highly useful for filling out online forms because they combine visual and auditory learning and boost comprehension and retention, especially for complex or multi-step processes. By creating and maintaining video self-help tools, states can increase the share of enrollees who renew online which in turn increases state efficiency, timeliness, and accuracy. All states should maintain a series of video tutorials covering the varied actions Medicaid applicants and enrollees can accomplish online and in their accounts.
Notable examples of renewal videos include this short-form Nebraska video (<3 minutes) and a lengthy version from California (<10 minutes). Both do a good job of utilizing video effects, step-by-step visuals, and voiceovers to convey the renewal process. The California video also includes closed captioning for 18 commonly spoken languages in the state, accounting for the state’s wide linguistic diversity.
Website Content
State agencies post a range of informational resources; some intended for Medicaid applicants and enrollees and others for community partners to post and share to amplify the state’s messaging. Content is often embedded in the website with outreach materials such as flyers, toolkits, and FAQ’s available as downloads.
Most states (41) post Medicaid renewal information and/or instructions on the state agency website About half of those states (29) post general information while one third (17 states) post step-by-step instructions; some states post both. A few of these resources are specific to the unwinding and should be updated. The North Carolina Medicaid recertification page starts with a clear explanation of what to do if someone receives a letter from Medicaid or doesn’t receive one when they should. The standouts are the website’s large, easy-to-understand display of six ways enrollees can renew coverage as well as images of what official notices look like. The use of plain English and large type make the website accessible for those with visual impairments, older adults and people with limited-English proficiency helping to protect users from scams or misinformation.
Almost all states (44) have at least one flyer for renewals created and shared by the state agency for posting in doctors’ offices and other public places. Georgia’s one-page renewal flyer uses clear visuals to show deadlines and includes a call to action urging enrollees to check their self-service portal for accurate contact information and renewal date. Rather than providing vague guidance, the flyer explains the process step-by-step, encourages action, and works as a printable reminder.
During the unwinding, more than half of states posted a communications toolkit with usable content for groups, agencies, or organizations to disseminate while nine states posted an agency communications plan detailing how renewals will be communicated. Those resources remain posted in 38 states and provide examples of state outreach efforts that can be replicated as states implement H.R. 1 policy changes.
About one third of states have other renewal tools/resources provided by state agencies, including but not limited to FAQs, manuals, graphics, brochures, and videos. California’s FAQ page uses a clean, user-friendly design with four options based on an enrollee’s renewal or coverage status, helping people quickly find information that applies to them. This focus on user experience, from search to final resource, can support Medicaid retention by making guidance more accessible. Louisiana provides renewal information on its website as well as a print-ready manual with step-by-step written and visual instructions for using its self-service portal and any potential follow-up. Providing both web and print formats shows thoughtful attention to diverse age groups, digital literacy, and access to technology.
Adopting Lessons Learned from the Unwinding
The unwinding yielded many lessons regarding communications and providing consumer assistance directly or through self-help tools. In the range of evaluation and analysis of the unwinding conducted by various researchers, the involvement of providers, health plans, and community-based organizations and clear, frequent communications with enrollees reduced the number of eligible individuals losing Medicaid for paperwork or procedural reasons. Following the lessons learned during the unwinding will help to mitigate harm as H.R. 1’s onerous policy changes are implemented.
But there’s a difference when it comes to communicating semi-annual renewals mandated by H.R. 1 because the policy only applies to a portion of the Medicaid population — expansion adults. So how should states communicate that only some enrollees will need to renew Medicaid twice each year? Communications experts suggest that targeted communications to expansion enrollees will be less likely to cause confusion among other Medicaid enrollees than broad-based outreach that was prevalent during the unwinding that applied to everyone enrolled in Medicaid coverage who had been protected by the continuous coverage provision during the pandemic. They recommend that states focus on key lessons from unwinding – sending frequent reminders using different modes of communication, encouraging enrollees to keep their contact information up to date with the Medicaid agency and to be sure to read agency communications. Almost all states (45) post information on the importance of reporting changes and keeping an eye out for agency mail. State strategies range from video tutorials and simplified reporting forms to flyers and detailed instructions, although several remain specific to unwinding.
The growth in online services and social media provides states with low-cost, effective ways to reach Medicaid enrollees or individuals who are potentially eligible. Adopting the lessons learned from the unwinding and refreshing any lingering unwinding self-help tools should be a priority for states as we approach the implementation of semi-annual renewals for a subset of Medicaid enrollees. But even more important will be the need for states to create new tools to assist expansion enrollees with meeting work/community engagement requirements beginning no later than January 1, 2027. We’ll address this topic in a second part of this blog next week.