In the months since the federal COVID-19 Public Health Emergency (PHE) concluded, a reported 1.5 million have lost Medicaid coverage, and millions more remain at risk of losing coverage. The pandemic policies that enabled record-high coverage levels have expired, putting a huge burden on health and human service agencies. State Medicaid agencies and health insurance exchanges face a daunting task in keeping Americans insured, but one that can be accomplished by leaning on technology to provide a simple consumer experience that enables individuals to make an informed decision about their health care coverage. For states operating a State-Based Exchange (SBE), they now have a clear advantage post PHE to better serve consumers.
Americans have become frequent and savvy online shoppers, and now expect the same level of ease and convenience whether they are purchasing clothing or health coverage. Unfortunately, this isn’t always the case when shopping for a health care plan —it can be complicated and confusing for most people and exacerbated by poor health plan literacy. A Kaiser Family Foundation (KFF) survey quizzed Americans on basic health insurance terms and only four percent understood them all. A Harris Poll survey found that over half of Americans don’t know the full scope of what their current plan offers them. And now, many of those at risk for losing Medicaid coverage aren’t even aware their coverage is in jeopardy. KFF estimates that between 5.3 million and 14.2 million people could lose Medicaid coverage because of no longer qualifying, or simply falling through the cracks.
SBEs have a distinct advantage during the Medicaid redetermination process to help these at-risk populations. Many of those who are determined to be no longer eligible for Medicaid will qualify for both coverage and tax credits on an Affordable Health Care (ACA) Exchange. SBEs and the technology built to support them offer better opportunities for data integration with Medicaid agencies, along with a more seamless customer service experience. While states that operated on HealthCare.gov are limited to a one-size-fits-all technical solution, SBEs are able to partner and innovate with their State Medicaid Agencies, enhancing the Account Transfer process to create a seamless transition for consumers between Medicaid and the SBE.
Many SBEs have done just that -- leveraging technology and working shoulder to shoulder with state Medicaid agencies. Because of technology and coordination, many SBEs entered the end of the continuous coverage period well positioned to ensure residents would seamlessly transition from Medicaid to the state exchange, receive an automatic eligibility determination, have a Special Enrollment Period created for them, and receive outreach about their eligibility and enrollment options.
Technology is the linchpin of any consumer experience and SBE states have a unique ability to implement modern solutions, such as conversational Artificial Intelligence (AI) and mobile apps for enrollment professionals. These tools empower consumers and power users to get better information and make more informed choices, for themselves, their families, and the consumers they support. GetInsured, for example, applies principles of personalization to health insurance e-commerce. Layers of data combined with decision support tools provide product recommendations to fit consumer’s needs and circumstances.
In states operating on the federal exchange via HealthCare.gov, consumers must call the federal call center if they have any questions or concerns. But those on the other end may lack state-specific knowledge, which can frustrate consumers. Not only is it frustrating, but it can lead to errors and delays if the wrong information is provided. State-based call centers possess the local knowledge needed to answer residents’ questions more accurately.
The nation’s uninsured rate dropped to a record low during the pandemic, but we cannot let our guard down and slide backwards. SBEs are well-suited to ensure we don’t leave millions of Americans without coverage because of their unique ability to deploy consumer-friendly technology. With Medicaid redeterminations in full swing, continuing to prioritize consumer-focused technology could be the difference between yet another health care crisis or sustaining record progress.
Jason Sparks is the Sr. Director, Engineering and Operations Program Management at GetInsured, the nation’s leading SaaS technology provider for state-based health insurance exchanges. Jason has worked in the information technology and operations management domain for more than twenty years, including most recently nearly four years of experience as Chief Information Officer for the District of Columbia’s state-based marketplace, DC Health Link. He is an experienced technology leader, with a proven track record of successfully leading complex technology implementation and Maintenance and Operations projects to completion.
