Last month, Utah Medicaid Director Jennifer Strohecker led a panel discussion on the state’s eligibility redetermination process during the 2023 Utah State of Reform Health Policy Conference, where she outlined some of the mechanisms in place to close the health coverage gap.
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The Utah Department of Health and Human Services (DHHS) has been working closely with state and federal partners on meeting key metrics and goals.
CMS has issued regulations and guidance around redeterminations, such as requiring states to first attempt an ex parte renewal for all beneficiaries before sending out renewal forms.
The Utah Department of Workforce Services (DWS) has been conducting the eligibility reviews since March 1st and closely coordinating with DHHS on ex parte renewals.
“We need to go through the exercise of reviewing all elements that are available to us electronically before having to reach out to the individual to have them complete the form and [the ex parte process] is also a reporting element,” Strohecker said. “So you will see on our CMS reports that are submitted that we are applying that process and diligently using [ex parte] as a mechanism so that we don’t have to [reach out] to the individual.”
DHHS is also required to report on specific metrics designed to demonstrate progress on the timely processing of renewals. To maintain transparency in its efforts, DHHS has launched a dashboard on eligibility renewal data that will be continuously updated throughout the 12-month unwinding period.
Strohecker affirmed that Utah was in compliance with all the metrics and standards that have been put in place, which include requirements around communication.
“We are certainly in compliance with these federal guidelines for data reporting and transparency,” Strohecker said. “There is regular routine reporting that we will be doing to CMS throughout the duration of the public health emergency.
As the end of the year also came about with the Consolidated Appropriations Act, it was at the same time as well that CMS increased the accountability of states to do this properly—not just report on it, but to follow certain standards and to be in compliance with these standards—was essential in order to a continue with unwinding and be continued with enhanced funding that states have been able to get during this extended eligibility enrollment period.”
Strohecker said the strategy around communication has been to maintain clear and consistent messaging to members—update your address, know when your review date is, and take action on notices issued around that date.
Utah is reviewing more than 500,000 cases during the 12-month unwinding period, but there is no clear estimate of how many people will be disenrolled because some members might be disenrolled solely because they didn’t take action to renew—even if they remain eligible.
State agencies identified 86,000 cases for review in the first two-month period, and the first disenrollment notices were mailed to Medicaid members in late April.
The state has separated members into two groups: those likely to remain eligible and those likely to be ineligible but who potentially qualify for another program.
“DWS has the ability to do a complete case review and determine that that individual is not eligible for Medicaid, but they would be eligible and qualify for marketplace—their case is automatically transferred over to the exchange [and] they are notified of this,” Strohecker said. “But it’s important that the person acts—we can’t enroll them in the marketplace, they need to take that step to enroll in the marketplace plan.
So that’s where we’re relying on our partners here to help facilitate some of that work. But there is a window of time where they’re still covered by Medicaid and could transition of course—there’s a longer window to get marketplace enrollment. This is really how our cycle will proceed month to month. For our first month of unwinding, [a higher number of disenrollments] is what you can expect as we roll out our beginning phase of this year-long process.”
Joining Strohecker on the panel to discuss the system-level coordination taking place around redeterminations were stakeholders from SelectHealth, the University of Utah Health Plans, and the Utah Health Policy Project (UHPP).
Russ Elbel, assistant vice president of Medicaid at SelectHealth, spoke to the importance of utilizing all of the health system’s communication channels in reaching impacted members and closing coverage gaps.
“One of the great things that Utah Medicaid has done for us is [it] provided two files,” Elbel said. “One, which will be called a closure file, will have an indicator in there—if someone is qualified for the federal marketplace, or if they’ve been unable to reach them and they may still be eligible for Medicaid. So that’s one file that’s going to be extremely useful for us.
The second is a file that will let us know when their redetermination date is coming up. And so health plans will have strategies to use both of those files. So the redetermination date will be a way for us to communicate with members and prevent them from ever ending up in the bucket of the closure file.”
SelectHealth has been using social media, web pages, newsletters that reinforce keeping personal information up to date, and its network of providers to conduct outreach through mediums like mail, email, text, and phone to assist members with maintaining coverage.
University of Utah Health Plans will deploy its customer service teams to notify members that their renewal date is approaching with reminders to submit their applications, which could entail utilizing community health workers to track individuals down if actions are not taken. But ensuring action can be challenging, according to CEO Chad Westover.
While not ideal, Westover said the health plan’s ability to directly engage patients through touchpoints attached to the University of Utah Health’s delivery system should assist in gathering updated information and signing them up for coverage on the spot. Yet the lag between when their coverage ends and their next healthcare visit would create a coverage gap.
“But we also need to reach out to the community and the community groups that are touching these people’s lives on a daily basis,” Westover said. “Take Care Utah, for example, will use an [English as a Second Language] outreach with our members so that they don’t miss the opportunity to complete that information.”
Take Care Utah is a UHPP initiative that works directly in the community, including with federally qualified health centers, to meet individuals where they are and assist with navigating the health system, applying for coverage, and conducting case management throughout the eligibility process.
It relies on federal grants to employ and subcontract a team of culturally competent assistants who offer support in more than 13 languages.
Matt Slonaker, executive director of UHPP, said the organization could work again with community health workers who were extraordinary during the COVID-19 pandemic in administering vaccines to disproportionately impacted populations.
“But the message I want to bring is, we have to be all hands on deck if we get to a position where we’re seeing too many folks losing coverage [and] showing up uninsured. And there are systems in place and plans in place to mitigate that, but are those systems working?”