Colorado Access, the largest regional accountable entity (RAE) in Colorado’s Medicaid program, is preparing to help members keep health insurance coverage in anticipation of the state’s disenrollment of Medicaid coverage in May. Starting April 1st, states are no longer required to continually cover enrollees regardless of eligibility changes and will begin the process of redetermining eligibility for beneficiaries.
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Colorado Access confirmed its Medicaid and CHP+ enrollment across Denver, Adams, Arapahoe, Douglas, and Elbert counties reached 688,881 in February 2023, an increase of some 208,000 members from three years prior.
Gretchen McGinnis, senior vice president of healthcare systems and accountable care at Colorado Access, told State of Reform that the organization has been coordinating with the Department of Health Care Policy and Financing (HCPF), system providers, and community partners on communication, education, and outreach ahead of redeterminations.
HCPF has been running its “Update Your Address” campaign through most of last year in anticipation of the PHE unwinding. For members who have their information updated in the system and are predetermined to be eligible, the renewal will be processed automatically without any action required.
“That’s one of the things that I have to give huge kudos to HCPF and the state in general—that they’ve worked really hard to try to find every mechanism that can facilitate that involvement so that as many folks as possible don’t have to take action,” McGinnis said. “And so that then leaves more resources for us at Colorado Access and our community partners and providers to then focus on the folks that do need to take action.”
McGinnis said because the Medicaid population tends to be more transient, finding members after three years and getting their addresses updated pose a challenge. Colorado Access has been supporting local engagement and navigation, working with trusted community partners like the Colorado Coalition for the Homeless to have dedicated outreach workers to support those experiencing homelessness by meeting them where they are.
Colorado Access has also developed a series of informational videos in multiple languages, offering training and resources to providers on referring patients to real-time eligibility and phone support.
McGinnis said there will be increased activity over the next 12 months on outreach to the entire Medicaid population—more than 1.6 million members—on renewals.
The state has also prioritized targeted outreach to high-need members, as well as those with chronic physical or severe behavioral health conditions.
“So we’re going to be doing direct calls to those high-need patients, or members who are renewing on a monthly basis,” McGinnis said. “We’re ramping up our customer service call center and our care management teams to do that. One of the questions that we have as an organization looking over this 12-month time period is wanting to make sure that we’re evaluating these approaches.
In a sense, we’ve got a 12-month (continuous quality improvement) process, so we’re going to see this first month of individuals going through renewal. We’re planning on doing direct outreach calls, mailing, text campaigns, (interactive voice response), community outreach, provider outreach, and then we set up some processes internally to say, ‘Alright, let’s look at what the ROI was on those things.’ How many members did we get a hold of? How many of them did they actually get positively redetermined or did we get them connected to another source of care?”
The organization will evaluate the various approaches and be prepared to pivot, migrating staffing and resources into the methods that are working.
McGinnis said she is heartened to see the community and healthcare system come together on this process. She emphasized the goal was to ensure those who are eligible for Medicaid and CHP+ remain on those programs and those who are eligible for marketplace coverage successfully transition to other plans.
“Colorado Access has been around for almost 30 years and we’ve been in the Medicaid business for that entire period of time,” McGinnis said. “So we’ve seen lots of different iterations of eligibility changes—the implementation of CBMs and CHIP conversions, the implementation of the PEAK system—all sorts of other eligibility changes, system changes, [and] transaction system changes. So we’re experienced with what this could look like.”