Medicaid redetermination has begun: Here’s how HR benefit managers can provide support

With the help of an agent or broker, HR benefit managers can be a supportive resource for at-risk Medicaid beneficiaries.

Now that the pandemic-era rules requiring continuous Medicaid coverage have ended, states are processing eligibility redeterminations. For the first time since March 2020, states are returning to regular eligibility and enrollment. This makes Medicaid redetermination the single largest health coverage transition event since the first open enrollment of the Affordable Care Act and Medicaid expansion.

At the outset, estimates showed that as many as 17 million Americans could lose access to Medicaid. Two months into the process, advocates are sounding the alarm bell over the disproportionate number of disenrollments in states that have accelerated redeterminations, leading to loss of coverage.

There’s a common misconception that Medicaid beneficiaries are unemployed, when in fact, over 60% of non-elderly and non-disabled Medicaid adults worked full or part-time in 2021. For this reason, employers may not initially be aware that they could have employees who are impacted by these changes.

Because of the inherent complexity in making these health care choices, some Medicaid beneficiaries may not know where to begin in evaluating alternatives. Many may struggle finding individual coverage options, assume premiums are too high, or not realize they may qualify for premium tax credits or other lower-cost coverage.

Other individuals may not realize that they could be losing Medicaid coverage until the point of seeking health care services when their coverage could be denied.

Fortunately, HR benefit managers — in partnership with others in the health care ecosystem — can step in to help. Here are some key ways they can support at-risk Medicaid beneficiaries to help them stay covered.

Drive employee awareness and education

Roughly 65% of enrollees aren’t even aware that Medicaid redetermination is happening. This is a huge information gap that HR benefit teams can help address. It’s important to recognize that Medicaid Redetermination isn’t a one-size-fits-all approach, and employees on Medicaid will undoubtedly have different paths. Some may continue to be eligible for Medicaid after states complete redeterminations, while others will be disenrolled and find themselves in need of either group or individual coverage.

Since every state is taking a different approach to unwinding, managers first need to identify the states where there are employees who are Medicaid beneficiaries and learn about their plans and timeline for redetermination. This will inform their employee communications — that is, what’s happening, when it’s taking place, and how employees can either enroll in the group insurance plan or other affordable health care options.

It’s possible that HR benefit managers have already heard from employees who lost Medicaid coverage. If this is the case, then managers need to determine whether these employees are eligible for their employer sponsored health plans, as this would be the next best coverage option. Employees may not know that they can transition to another plan without a gap in coverage. This is where managers play a crucial role since they can help impacted employees understand if they’re eligible to enroll in the group health plan.

Offer access to health care exchanges

As a second option for consideration alongside an employer health plan, managers should offer access to the health care exchanges. They can do this by referring employees to a web broker, or directly to HealthCare.gov or a state-based exchange, where their employees will be able to evaluate their individual coverage options.

Working with web brokers can bring a guided experience both online and over the phone — at no cost to either the employer or employee — that beneficiaries won’t typically have when shopping for coverage on their own. If employers have decentralized workforces with Medicaid beneficiaries in different states, a web broker can help navigate these nuances.

Lastly, web brokers provide upfront education about individual health plans, in-network doctors, and information on qualifying tax credits. This can be especially helpful for non-benefited employees, who may find it hard to navigate the shopping process when they have multiple sources of income. A web broker can aggregate their income and determine if they’re eligible for free or highly subsidized health care premiums that employees may not have been aware they can receive.

Related: Health care is a top priority in 2023, say American workers

Medicaid redetermination is a once-in-a-decade event that will impact millions of Americans. But with a coordinated, collective effort to reach, educate, and inform Medicaid beneficiaries about their options, HR professionals can provide a safety net to keep this at-risk population from falling through the cracks.

Bryan Giaimo is the GM of Enterprise Solutions at Stride Health.