Since its inception nearly 60 years ago, Medicaid has transformed into an essential resource to ensure access to quality and affordable healthcare for a diverse population—including families with limited income, pregnant women, and people with disabilities. Medicaid enrollment experienced significant growth over the past decade, reaching a record high of 86.7 million beneficiaries in 2021 as a result of the continuous enrollment provision during the COVID-19 pandemic public health emergency (PHE).
Two years later, state Medicaid programs are in the midst of a complex redetermination period as they review the eligibility of about 90 million beneficiaries. Over the next year, up to 15 million people are expected to lose coverage as health plans settle back into pre-pandemic eligibility numbers.
Since the start of the Medicaid redetermination period in April 2023, more than 5 million Americans have lost their Medicaid benefits. But the reason for a majority of terminations is troubling—74% of disenrolled individuals had their coverage terminated for procedural reasons. These procedural disenrollments happen when individuals fail to complete the renewal process, which can occur if the state has outdated contact information or if the enrollee doesn’t understand the process or didn’t complete renewal within a specific timeframe. None of these reasons being of actual merit of no longer qualifying for their Medicaid program. Yet many people who are disenrolled for these “red tape” reasons may still be eligible for Medicaid coverage. As the redetermination period continues, Medicaid managed care health plans need to pivot and find ways to boost member engagement and minimize procedural losses.
Florida’s Medicaid Coverage Gap Sparks Concerns
The latest data from states that have begun the Medicaid redetermination process reveals its already worse than expected, especially in states that have yet to adopt the Affordable Care Act’s Medicaid expansion. The current state of Medicaid in Florida is particularly concerning. Florida supports one of the largest Medicaid populations in the country with over 4 million enrollees. However, the covered population has already decreased by hundreds of thousands since the state started unenrolling individuals. In its first month of the unwinding period, of the 461,322 people whose eligibility was checked, 54% were terminated. Most of those terminated (82%) had their cases closed due to procedural reasons.
Between the sheer number of Medicaid terminations and the failure to expand Medicaid, the coverage gap in Florida is concentrated among children, young adults, and parents. Medicaid eligibility for adults in non-expansion states is extremely low, and in some cases even part-time work may make individuals ineligible for Medicaid. These individuals should not have to choose between healthcare and work and potentially hinder their ability to maintain economic self-sufficiency. Additionally, in Florida, there are many individuals living in rural areas and there’s a high rate of uninsured beneficiaries struggling to access quality care.
The federal government recently issued a warning letter to the Florida Agency for Health Care Administration to call out their lack of compliance to federal guidelines for the redetermination process. Specifically, the agency’s call center is failing to provide prompt assistance to the state’s poorest families, and their performance has had a disproportionate impact on minorities, who are less likely to have broadband or internet access, transportation, or jobs that grant them time away to meet with Medicaid enrollment staff. In late August, a lawsuit was filed by three Floridians, including two young children, claiming that the state’s Medicaid redetermination process did not provide them adequate information and denied them a pre-termination hearing.
Ancillary, Non-Medical Benefits Can Help Address Concerns
To ensure Medicaid quality and accountability, the Centers for Medicare and Medicaid Services is responsible for evaluating how health plans are reinvesting government dollars to directly benefit beneficiaries. As a way to address coverage gap concerns Medicaid programs, the state of Florida and health plans need to work together to ensure their non-medical services result in improved access to care and economic self-sufficiency for the state’s most vulnerable populations.
Evidence shows that Medicaid coverage helps to improve receipt of preventive health care, access to care, and out-of-pocket spending burdens. Florida health plans should take advantage of this opportunity to put focus back on quality and performance measures, like optimizing member satisfaction and addressing social determinants of health (SDoH). More and more Medicaid managed care health plans are finding value in intervening to improve factors related to SDoH. Every Medicaid managed care health plan is different, and while flexibility may vary at the state level to provide certain value-added benefits, common additions include housing assistance, behavioral health services, and non-medical transportation.
Transportation Drives Economic Self-Sufficiency Among Medicaid Populations
Transportation to medical appointments has been offered as a benefit since the very beginning of the Medicaid program and continues to help address SDoH that prevent Medicaid beneficiaries from accessing healthcare. Today, non-emergency medical transportation (NEMT) remains critical for the Medicaid population. Beyond NEMT, transportation is a key non-medical factor in supporting the economic self-sufficiency of Medicaid beneficiaries. Transportation enables beneficiaries to get to a job, pick up a prescription, or attend an exercise class. Further, access to transportation drives down short and long-term healthcare costs by proactively addressing potential issues and avoiding expenses like ER visits.
When deciding how to deliver ancillary services like transportation, Medicaid agencies should partner with benefit providers that can offer support during the redetermination period and beyond. Especially during periods of high call volume and operational challenges, health plans can look to their benefit providers to assist with calls and member support.
SafeRide Health offers a differentiated approach with a one-stop-shop platform that provides not just traditional transportation modalities and needs, but also meets the unique needs of any Medicaid member with services like meals and lodging and mileage. Unlike traditional transportation solutions, SafeRide’s modern NEMT technology provides data collection, reporting, and analytics—allowing health plan administrators to identify efficiency improvements, proactively avoid potential fraud and abuse risks, and drive results to the bottom line. With our customizable and data-driven approach, we collaborate with Medicaid managed health plans and empower them to generate better member engagement, deliver greater access to care, and drive better health outcomes. To learn more about the ways SafeRide helps Medicaid managed care health plans simplify transportation benefits and streamline their transportation programs, visit our platform page.