Reaching Medicaid Members to Understand, Act on, and Stay Compliant with New Medicaid Eligibility Requirements
Medicaid members are already harder to reach and engage in their healthcare. Helping them understand
and stay compliant with new eligibility requirements will necessitate an end-to-end solution to reduce
the risk of significant churn. Early signals from states like Nebraska, where work requirements are being
implemented, point to a meaningful increase in the level of engagement required from members.
The Challenge
H.R. 1 introduces new complexity for managed care organizations and their Medicaid members. Organizations will need to help members on a state-by-state basis understand:
- What is required to maintain eligibility, including logging in monthly to document qualifying activities.
- What constitutes as proof of compliance across a variety of different areas, including working, job searching, caregiving, and education.
- That they now have to renew coverage every 6 months instead of yearly.
- Whether or not they are exempt, such as in the case of disability
If not addressed correctly, plans will experience unnecessary churn, reduced renewal rates, and increased operational cost.
The Revenue Risk of Redetermination
Plans will face an estimated $2 million in lost revenue annually for every 1,000 members disenrolled due to failure to comply with redetermination requirements.
Our Approach
Behavioral Engagement That Drives Action, Not Just Awareness
We design and execute end-to-end engagement strategies that guide even the hardest-to-reach members through each step of the process. We deliver:
Hyper-personalized Segmentation and Targeting
to identify members at risk of churn, based on recency of joining, past churn behavior, and income-level data.
Optimized End-to-End Journeys
to better accommodate Medicaid populations with disabilities to help them address their more complex needs.
Optimized Outbound Collateral and IVR Scripts
infused with behavioral science principles to improve response and urgency, reducing confusion, friction, and drop-off.
Updated Branding
to increase trust and improve communication layouts for easier consumption.
More Effective Ways to Reach Hard-to-Engage Members
through data management, channel selection, and call center operational performance, including caller ID management and spam mitigation.
Every interaction is built to move members forward– not just inform them.
Impact
90%
80%
2x
Keep Members Covered. Keep Revenue Intact.
Where are members falling out of the redetermination process today— and what would it take to keep them engaged through renewal?
