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Mayuresh Joshi

Posted on January 02, 2024 | 2 min read

Navigating the Shift: Members Transitioning from Medicaid to ACA


Consumer Experience

Operational Excellence

Regulatory Compliance

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Medicaid Enrollment Management

In the last couple of years member enrollment churn has increased in both quantity and complexity. This trend is expected to continue, due in large part to the post-pandemic public health emergency (PHE) unwinding: the Kaiser Family Foundation estimates that between 8 and 24 million members could lose Medicaid coverage by May 2024. Traditional and legacy enrollment systems have struggled to handle the increase in enrollment volume, which has led to poor member experiences, care access issues and, in some cases, members getting kicked out of the system entirely. Industry analysts have also reported an uptick in member enrollments outside the annual enrollment period, due to Medicaid redeterminations occurring more quickly than in previous years.

State Medicaid populations are expected to decrease or remain unchanged in 2024, which means millions of members will be moving off of Medicaid and onto new plans—and ACA plans will inevitably be impacted. ACA membership is known for its churn and complex enrollment and reconciliation processes. Health plans have traditionally struggled to manage these operational complexities and capitalize on the financial opportunities this growing market segment offers.

As members transition from Medicaid to ACA, proactive communication is essential. Providing clear information about forthcoming changes and how it impacts the member’s coverage will go a long way in ensuring a smooth transition.

Understanding the unique needs of these transitioning members is key. Members may have become accustomed to certain Medicaid benefits, so helping them understand the array of services available under the ACA is vital. Consider creating user-friendly guides, hosting webinars, or even setting up dedicated helplines to address their queries and concerns. A little extra effort in communication can make a world of difference.

It is also vital for plans to keep a close eye on the healthcare landscape. Policy changes, adjustments to eligibility criteria, and updates to ACA provisions can influence your members’ experiences. Staying informed and keeping your members in the loop will further instill confidence in your commitment to their well-being.

Collaboration is the name of the game. Establishing partnerships with community organizations, local healthcare providers, vendors, and advocacy groups can help bridge gaps and ensure a holistic approach to supporting your transitioning members. These collaborations can offer valuable insights and resources to help your members effectively navigate the intricacies of the ACA.

As the shift occurs, consider enhancing your digital platforms to facilitate a smoother experience for both your team and your members. Streamlining processes, making information easily accessible, and incorporating user-friendly interfaces can contribute significantly to member satisfaction during this transition.

Lastly, celebrate the positive aspects of this change. Embrace the opportunity to enhance the quality of care for your members, leverage the expanded network of providers under the ACA, and champion the overall well-being of those you serve.

The transition from Medicaid to ACA is a positive and transformative journey. By proactively communicating, understanding member needs, staying informed, collaborating with stakeholders, and leveraging the right technology solutions, your plan can navigate this shift with ease.

Interested in learning about how Edifecs can enhance your enrollment process? Contact us or visit here to learn more.

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