Are you prepared for the Medicaid PHE unwind?

The most important public health crisis since COVID-19.

As the Public Health Emergency (PHE) declared in March 2020 begins to unwind, states must have a comprehensive plan to renew every Medicaid participant and provide ineligible individuals and families a seamless transition to other sources for healthcare. Medicaid programs, which have seen unprecedented growth (28%) over the past few years, have over 90 million citizens currently enrolled. It is estimated that as many as 14 million people may lose Medicaid coverage through the 12 month PHE unwind period. The PHE unwind has become a major cause for concern for Medicaid recipients since it places the future of their health care in an uncertain state. If it isn’t managed well, it could lead to one of the largest public health crises since the COVID-19 pandemic.

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The Medicaid program is a vital health insurance program that provides coverage for millions of low-income Americans. Medicaid coverage includes vaccinations, preventive medicine, routine checkups, and more. Without proper health coverage, millions of people would not have access to the care they need. Alternative sources of healthcare can be costly and provide less coverage for these families. Other programs such as SNAP and TANF may also rely on the enrollment and renewal of Medicaid, which may create secondary concern for residents that qualify for more than one program.

The large-scale effort of the PHE unwind has raised significant concerns for state Health Departments, many of which are short staffed today. Running 90+ million recipients through Medicaid redetermination over a 12 month period is something that has never been done before. Providing a solid transition plan to the 15 million Medicaid recipients estimated to no longer qualify for Medicaid is critical to insure continuity of care and averting a crisis for our local hospitals and emergency rooms. Most Departments of Health & Human Services do not have sufficient staff to offer a white glove approach to managing their members through this process. Tracking and reporting on the status of these  members in near real-time is critical to ensure no one falls through the cracks. Many Medicaid participants have moved since the last time they were required to establish their eligibility, exacerbating the challenge of outreach as we lead up to the PHE unwind. Many of the Agencies who are responsible for managing the PHE unwind lack the resources and technology to support such a significant spike in outreach and application volume. The PHE unwind is causing state leadership to evaluate their current processes, workflows, and technologies to understand where improvements can be implemented quickly to meet this challenge. The best approach to address this once in a lifetime spike in volume is to leverage technology to automate as many manual processes as possible to allow organizations’ staff to focus their time and energy on supporting their members through the process.

As states prepare for this unprecedented event, Healthy Together has provided a checklist of key areas to ensure a smooth transition for Medicaid administrators and members:

  1. Ensure you have a comprehensive outreach and communication plan.
  2. Prioritize health equity so access to renewals and healthcare is available to all who qualify.
  3. Eliminate manual processes to free up staff to focus on the members that have the most urgent needs.
  4. Provide dashboards and reporting of key metrics for Executives, Federal Reporting and the Public. This will provide the Executives the information needed to make informed decisions and provide transparency to the public on the program’s success.

Here are the biggest challenges and steps states can take to prepare for the PHE unwinding:

Outreach & Communication

Ensuring benefit recipients are informed of changes is of the utmost importance. To conduct outreach, departments need access to recipients' most up to date personal information.

More than 2 years have passed since the PHE began. Individuals and families have moved, have new phone numbers, and have changed emails. To reconnect with residents, state agencies  should use every communication method at their disposal to ensure contact information is up-to-date and accurate for immediate and future needs. Using technologies like email, SMS (text messaging), automated voice messaging, and in-app messaging with push notifications to communicate with residents is direct, in-expensive, and familiar to residents.

Reminder and follow up messages can be scheduled if no replies are received within a certain window of time to further improve the likelihood of contacting residents. Systems that send these messages to residents can provide helpful insights like knowing if emails are valid or if phone numbers are landlines (which can trigger an automated phone call instead of an SMS). Residents can also respond easily through these mediums and proactively begin the renewal process without having to wait for mailed documents.

By adopting modern technologies for mass outreach, members can be reminded of soon to expire benefits, become aware of new Medicaid processes and be encouraged to update their personal information (i.e. change in address, provide an email or mobile phone number, and set up an online account). Automation of these messaging and communication processes can help departments get recipients prepared earlier. Multimodality outreach that includes paper mailing, phone calls, email, text and other digital methods ensures departments have all recipients covered.

Health Equity

Ensuring your program focuses on health equity is the only way to ensure that it’s easy for underserved communities to participate.

The PHE unwind highlights the need for members and employees to have self-serve tools at their fingertips. There is a need to transition to a native mobile app and web approach to support how residents access information, applications, resources, communication, etc. By adopting these tools, the strain on staff can be minimized, as residents can have full transparency into the status of their application and what’s needed to complete enrollment.

It’s important to highlight accessibility features and multi- language support to provide all individuals with equal access. Through trusted translation services, residents that prefer a specific language for communication, renewals, and other requirements can easily adjust their language of choice; residents can then respond with confidence in the language they are comfortable with.

Mailing benefit program information is the least common denominator for all residents and will likely never go away; however when and how mailing is used can be smarter. If other methods of outreach and communication result in no contact, then mailing information to the last known address of the resident could be used instead of mailing as the first method of communication. Other ways that mailing can be smarter is by including QR codes to fill out information online or in a mobile application so residents can review and submit renewal details in a secure and timely manner and according to their personal preference. Printing and Mailing services can also track mailings to residents and can know if a letter was delivered to the address or returned to sender or other important statuses. This data can then be shown to administrators on a dashboard to give greater visibility into mailings to residents.

Optimizing for Ex-Parte

Under Medicaid regulations, states are required to attempt coverage renewal without requiring action from the member (also known as ex-parte). Ex-parte is achieved by reviewing “all federal, state, and commercial data sources that are reliable and relevant” (i.e., Internal Revenue Service (IRS) tax information, Social Security Administration Employee Workforce Number, etc.) and attempting to confirm ongoing eligibility. If the ex-parte process confirms eligibility, members are notified their coverage has been renewed. Members are then asked to review the information used during the ex-parte process to ensure accuracy. If the information is accurate the member needn’t do anything else. If the information is incorrect then members are asked to provide updated information and submit it back to the state. If the ex-parte process does not succeed, residents need to be involved to help review and update their information manually. States will follow traditional processes to send renewal forms and require the member to re-apply for coverage.

Optimizing ex-parte processes creates benefits for both benefit recipients and state agencies. In addition to making sure eligible individuals retain coverage the ex-parte process will reduce gaps in coverage that can increase costs over time. Administrators can also expect  a reduction in manual processes, reducing the burden on the state to manually reach out and assist individuals in re-applying for coverage.

Utilizing a service that can integrate with data sets from the state department will help in building a complex algorithm that can expedite and improve the ex-parte processes.

Managing Renewals

The standards and expectations of transparency have increased significantly in many aspects of resident’s lives. When an online purchase is made, people expect to know if it has been fulfilled, packed, shipped, where it is en route, and when it will be delivered - down to the hour. When a pizza is ordered, people expect and want to know if the pizza is being made, when it’s in the oven, if the pizza is en route, and when it is going to be delivered - down to the minute. This level of transparency and awareness does not currently exist in the various benefits programs’ renewal process and results in an increase in costly customer service hours. Providing this level of detail reduces a substantial number of hours and staff required to field many calls. A tremendous cost and resource savings can come from solving this challenge the right way.

In preparation for the PHE ending and the associated waivers expiring, state departments need to ensure that the right individuals are receiving proper notifications in a timely manner and in a way that caters to the individual's needs. While getting the mode of communication correct can have a transformative impact, getting it in the most familiar language to the individual, catering to those with disabilities or visual impairments is important as a sizable percentage of individuals on Medicaid make up seniors, disabled individuals and those for whom English is a second language.

Finding solutions that meet residents where they are to create a more self-sufficient path for renewal is key. Renewal resources for members should consist of ways to check in on and submit all parts of their application (i.e. income verification, personal information) without the need for administrators to field phone calls and engage in manual efforts. Methodical and automated tools can promote engagement, adoption, retention, and transparency.  


To efficiently manage the volume of redeterminations and renewals that will need to take place over a very short period of time a dashboard with Key Performance Indicators is required. This interactive dashboard can provide your Staff and Executives with near real time information on the status of the various members throughout the process empowering them to proactively address areas of concern. Metrics on application pending/completed, renewals initiated, beneficiaries due for renewal during a specific timeframe, Medicaid fair hearings completed/pending and total beneficiaries due for renewal are an example of some of the KPI’s that are needed. There are also several reporting requirements mandated by the Consolidated Appropriations Act that will need to be processed monthly. Much of this information may exist in separate systems so the ability to easily consolidate it, do a quality assurance review of it and submit it will be key. Lastly, the ability to provide the general public access to a dashboard showing KPI’s on how your organization is doing throughout the PHE unwind will be important to provide transparency and reduce anxiety.

The Bottom Line

Ultimately, it’s important for your department to have the following to ensure your state is well prepared for the PHE unwind:

  1. An outreach and communication plan that includes a native app with integrated communications i.e. sms, email, mail and push notifications.
  2. Processes that prioritize health equity to provide access to underserved communities with robust accessibility features.
  3. Technology infrastructure to automate resident outreach and communication, application status checks and ex-parte.
  4. A data dashboard that reports on metrics that matter most to your department, allowing for execs to have real-time access to enrollment percentages, response rates and more.

If you would like to learn how Healthy Together can support your organization through this process, reach out to our team below.

Learn more about our Medicaid solution.