New Updates, Efficiencies in New Member Enrollment

The coronavirus pandemic has led to changes in the ways payers are attracting, enrolling, and retaining members in health care plans. Some of these recent changes and emerging strategies may stick around well beyond this historic health event.

Following a year of widespread turmoil, findings from the Commonwealth Fund Health Care Coverage and COVID-19 Survey from March 2021 to June 2021, indicate that nearly half of all respondents had been affected by the pandemic in at least one of three notable ways: contracting COVID-19, losing income, or losing employer-sponsored health care coverage. In response to the public health emergency, a massive relief effort included bills passed by Congress and changes made by the Biden administration—with some geared toward helping Americans enroll in coverage.

On average, payers have made it easier for new members to enroll during the pandemic, according to Susan Cantrell, CEO of the Academy of Managed Care Pharmacy. The Marketplace has focused on making it both simpler and more attractive for potential members to enroll or make changes midyear, and federal subsidies have made premiums more affordable for individuals.

In addition to the federal Marketplace implementing the American Rescue Plan on HealthCare.gov, state-based Marketplaces (SBM) have played a central role in making the expanded subsidies available to consumers. Several states expanded eligibility for Medicaid, changed their enrollment status, made it simpler to apply for Medicaid, or decreased the premiums associated with the Children’s Health Insurance Program, Ms Cantrell added.

In September, the Centers for Medicare & Medicaid Services (CMS) announced $20 million in grant funding, allocated under the American Rescue Plan, for the 21 SBMs to build upon their recent progress. The financial support will make it possible to update technology, improve outreach initiatives, or enhance other operational systems in an effort “to help make health care coverage enrollment smoother.”

In some instances, the funding will be put toward updating Marketplace eligibility and enrollment platforms. And some SBMs are looking to use the funds to modernize or expand the capacity of their call centers, Rachel Schwab, a research associate at the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms, explained in an October 21 blog post.

Conducting outreach and educating consumers is another central focus for many of the grantees, she noted, and several of the outreach campaigns include a health equity component aimed at traditionally underinsured and uninsured groups. New Mexico’s Marketplace will strengthen its outreach efforts geared toward Native American communities, whereas Arkansas’s Marketplace will look to engage rural and multicultural communities. Vermont, meanwhile, intends to dole out mini-grants to organizations serving vulnerable populations, such as workers in industries that were especially harmed by the pandemic.

In addition, SBMs are looking ahead and preparing for the eventual end of the public health emergency. According to a Kaiser Family Foundation analysis of enrollment trends, Medicaid enrollment grew by nearly 17% (representing close to 11 million enrollees) from February 2020—right before the pandemic hit—to April 2021. These enrollment increases may reflect the economic fallout caused by the pandemic as Americans experienced income and job loss, the analysis noted, as well as provisions requiring states to ensure continuous coverage.

During the pandemic, states are unable to unenroll a Medicaid beneficiary when their eligibility changes (without a request from that individual). But when the public health emergency ends, millions will be redetermined as ineligible for Medicaid, Ms Schwab pointed out. A sizable percentage of those losing coverage are expected to qualify for subsidized marketplace plans, however, so there could be a mass migration down the road. SBMs are preparing in various ways, such as conducting a market analysis to better understand this upcoming shift (Virginia) or creating and carrying out related training programs (Maryland).

Medicaid enrollment has reached its highest level in the country’s history because of the waivers addressing the administrative burdens states were facing in managing enrollment, said Chris Gay, MBA, CEO of health care technology company CareAdvisors. As a result, health plans are scrambling to develop strategies to maintain this level of engagement beyond the pandemic.

They are also ramping up programming to address health disparities and attract new members. “In the Medicaid managed care space, you see significant ramp up and inclusion of social service supports that are codified in the Medicaid managed care bidding process,” he explained. In Ohio, for example, “every single awardee for renewal of their Medicaid managed care included significant social service support, referral relationships, support for food security, housing, and other social needs domains.”

The New York State Department of Health’s August 2021 concept paper to CMS outlined a Medicaid 1115 waiver demonstration request that includes a sizable portion of investment in social care networks intended to engage members. There is anticipation that this will be included in the bidding process for Michigan, too. Furthermore, the current Medicaid managed care request for proposal process in California includes pilot programs around Whole Person Care to support social services. “So you see widespread adoption of these new engagement methods throughout the country,” Mr Gay added.

For Medi-Cal, the state of California’s Medicaid program, plans do not directly enroll individuals, explained John Baackes, CEO of L.A. Care Health Plan, the largest publicly operated health plan in the country. The Department of Public Social Services (DPSS) or other social services offices take on that responsibility. One of the main ways people previously applied for Medi-Cal was in person at a DPSS office or with certified application assistance. However, during the lockdown, DPSS offices were closed and in-person assistance was not taking place, so online and phone applications
grew.

Community partnerships became more crucial than ever during the pandemic, especially regarding enrollment, according to Janis Rizzuto, MA, director of communications for CalOptima—Orange County, California’s Medi-Cal plan. CalOptima worked with the Orange County Social Services Agency to help make enrollment more accessible to those who may qualify based on a pandemic-related income reduction. The agency’s mobile enrollment services, offered out of vans, were paired with CalOptima’s mobile COVID-19 vaccine clinics.

Seven events drew in over 5200 people to get their vaccines and learn about social services such as Medi-Cal coverage. Since the start of the pandemic, CalOptima has gained nearly 150,000 members, she noted, in part through increased outreach and a greater awareness of Medi-Cal.

“Increased collaboration among public agencies during the pandemic has been a positive change that CalOptima will hold on to beyond the public health emergency,” Ms Rizzuto said. Collaboration on Medi-Cal enrollment also sparked an effort to partner on CalFresh, California’s Supplemental Nutrition Assistance Program. Orange County Social Services Agency and CalOptima are working together to identify those who may benefit from CalFresh based on Medi-Cal participation.

“Overall,” she added, “the pandemic has inspired more emphasis on comprehensive support and service integration for vulnerable populations who need it most.”

As everyone gears up for the end of the public health emergency and the resumption of redeterminations, Mr Baackes pointed out that advocates have suggested continuous eligibility remain for several groups, including children younger than five years. There is already legislation in place to enable postpartum moms to hold onto their Medi-Cal coverage for an entire year following birth, he added, regardless of a change in circumstance.

“As we consider when the pandemic ends and the public health emergency might expire, we need to consider not only how we provide coverage but also how we assure equity and inclusivity for the most vulnerable,” Ms Cantrell said. Although the subsidies under the American Rescue
Plan Act are temporary, she foresees “a longer-term shift toward more choices and autonomy for new members,” especially considering the way the pandemic has magnified health care disparities.

Expanded coverage was a big theme for the Biden election platform, she added, and “how that comes to fruition once we move past the public health emergency remains to be seen.”

Adjustments of special enrollment periods and telehealth seem to be improvements that will outlast COVID, according to Evan Curcic, a solution consultant at Managed Markets Insight & Technology. Increased competition in state offerings is another improvement that is a byproduct of the ACA expansion. “All in all,” he added, “these improvements were much needed and will hopefully continue to make patients’ lives easier long after the pandemic.” ν