By Marie Stinebuck, MBA, MSN, RN, ACM
Children are losing Medicaid at alarming rates. This update provides key information, advocacy resources, and action steps for hospital case managers.
Medicaid Unwinding Update: Strategies for Case Managers
This blog is a follow-up to a blog I wrote last year discussing the expected outcomes related to the unwinding of Medicaid beneficiaries as the COVID-10 Public Health Emergency (PHE) ended. Medicaid has historically served as a vital safety net, particularly during economic hardship. The unprecedented stability of the continuous enrollment provision during the COVID-19 pandemic marked a distinct departure from typical coverage fluctuations. As states now unwind this provision, millions of individuals face potential loss of or disruptions in their healthcare coverage. This update aims to highlight the significant effects of this change and offer guidance for hospital case managers.
Unwinding in Numbers
As of January 2024, 14 million individuals had been disenrolled from Medicaid, while 27 million had successfully renewed their coverage. However, as of November 2023, 36% of Medicaid enrollees were unaware of the unwinding process. There is increasing concern about children disproportionately losing coverage, leading to federal guidance being issued to nine states to improve their renewal processes.
Outreach and Systems Challenges
Historically, states heavily relied on mailed notices to communicate Medicaid changes. However, these notices need to be revised in the current unwinding process. States increasingly use email, text messages, and phone calls to improve communication. Arizona's experience demonstrates the positive impact of proactive outreach, with about half of those completing their renewal successfully reinstating their coverage.
Unfortunately, system issues and staffing shortages are hindering the renewal process for many states. These challenges are forcing time-consuming manual workarounds and causing delays. The consequences of these delays are particularly severe for children.
As Jennifer Tolbert of the Kaiser Family Foundation notes in the PBS Newshour report, "Children account for about 40% of those disenrolled." These delays and procedural hurdles can create unnecessary gaps in coverage, leaving children needing access to essential healthcare. Even temporary disruptions in Medicaid for children can negatively affect their health, development, and educational outcomes.
What to Do About Inappropriate Disenrollment
If you or your patients believe you've been incorrectly removed from Medicaid, there are steps to take. Each state has specific appeal processes. You can find contact information and instructions on your state's Medicaid website. It's also helpful to contact local advocacy organizations that can offer assistance.
Be the Difference: Case Manager Actions During Medicaid Unwinding
Now is the time for action. As a case manager, you have the unique ability to make a tangible difference in the lives of those affected by the Medicaid unwinding. Stay informed, guide your patients through the renewal process, and become a champion for those who need it most. Your dedication will ensure continuity of care for the most vulnerable.
You are invited to join us in Nashville, TN, September 20-22 for the fall session of CMSA Case Management Boot Camp! This unique opportunity to start strong in case management or get back to basics includes two and a half days of interactive in-person instruction, where you'll dive into:
• Ethical practices
• Healthcare reimbursement
• Versatile skill sets
• Communication techniques
Experience interactive exercises, group discussions, and case studies to deepen your learning. Plus, earn 19.5 RN, SW, and CCM CEs! Register now at 
https://cmsa.org/cmsa-boot-camp/
Bio: Marie Stinebuck, MBA, MSN, RN, ACM, is the Chief Operations Officer of Phoenix Medical Management, Inc., the leading case management firm. Marie has practiced as a nurse for the past 26 years with 18 years in the field of case management. Marie has served in executive leadership roles with oversight of case management, utilization review, denials prevention, clinical documentation improvement, and medical record integrity. Marie has authored articles for RACmonitor and other case management resources and is a weekly contributor on Finally Friday. She has served as a board member for the Arizona Chapter of the American Case Management Association (ACMA) and holds an MBA, and an MSN in Leadership.