Who Doesn’t Text in 2022? Most State Medicaid Programs

Phil Galewitz, Kaiser Well being Information

West Virginia will use the U.S. Postal Service and an internet account this summer time to attach with Medicaid enrollees in regards to the anticipated finish of the covid public well being emergency, which is able to put many recipients liable to shedding their protection.

What West Virginia received’t do is use a type of communication that’s ubiquitous worldwide: textual content messaging.

“West Virginia isn’t set as much as textual content its members,” Allison Adler, the state’s Medicaid spokesperson, wrote to KHN in an e-mail.

Certainly, most states’ Medicaid applications received’t textual content enrollees regardless of the urgency to achieve them about renewing their protection. A KFF report revealed in March discovered just 11 states stated they might use texting to alert Medicaid recipients in regards to the finish of the covid public well being emergency. In distinction, 33 states plan to make use of snail mail and at the least 20 will attain out with particular person or automated telephone calls.

“It doesn’t make any sense when texting is how most individuals talk right now,” stated Kinda Serafi, a associate with the consulting agency Manatt Well being.

State Medicaid companies for months have been getting ready for the tip of the general public well being emergency. As a part of a covid reduction regulation accredited in March 2020, Congress prohibited states from dropping anybody from Medicaid protection except they moved out of state throughout the public well being emergency. When the emergency ends, state Medicaid officers should reevaluate every enrollee’s eligibility. Tens of millions of individuals may lose their protection in the event that they earn an excessive amount of or fail to offer the knowledge wanted to confirm earnings or residency.

As of November, about 86 million people have been enrolled in Medicaid, in keeping with the Facilities for Medicare & Medicaid Providers. That’s up from 71 million in February 2020, earlier than covid started to ravage the nation.

West Virginia has greater than 600,000 Medicaid enrollees. Adler stated about 100,000 of them may lose their eligibility on the finish of the general public well being emergency as a result of both the state has decided they’re ineligible or they’ve failed to answer requests that they replace their earnings data.

“It’s irritating that texting is a way to fulfill individuals the place they’re and that this has not been picked up extra by states,” stated Jennifer Wagner, director of Medicaid eligibility and enrollment for the Middle on Funds and Coverage Priorities, a Washington-based analysis group.

The issue with counting on the Postal Service is {that a} letter can get hidden in “junk” mail or can fail to achieve individuals who have moved or are homeless, Serafi stated. And e-mail, if individuals have an account, can find yourself in spam folders, she famous.

In distinction, surveys present lower-income People are just as likely to have smartphones and cellphones as the overall inhabitants. And most of the people often use texting.

In Michigan, Medicaid officers began utilizing textual content messaging to speak with enrollees in 2020 after constructing a system with the assistance of federal covid reduction funding. They stated texting is a cost-effective option to attain enrollees.

“It prices us 2 cents per textual content message, which is extremely low cost,” stated Steph White, an enrollment coordinator for the Michigan Division of Well being and Human Providers. “It’s a terrific return on funding.”

CMS officers have instructed states they need to contemplate texting, together with different communication strategies, when attempting to achieve enrollees when the general public well being emergency ends. However many states don’t have the know-how or details about enrollees to do it.

Efforts so as to add texting additionally face authorized boundaries, together with a federal regulation that bars texting individuals with out their consent. The Federal Communications Fee dominated in 2021 that state companies are exempt from the regulation, however whether or not counties that deal with Medicaid duties for some states and Medicaid managed-care organizations that work in additional than 40 states are exempt as nicely is unclear, stated Matt Salo, government director of the Nationwide Affiliation of Medicaid Administrators.

CMS spokesperson Beth Lynk stated the company is attempting to determine how Medicaid companies, counties, and well being plans can textual content enrollees throughout the constraints of federal regulation.

A number of states instructed KHN that Medicaid well being plans will probably be serving to join with enrollees and that they count on the plans to make use of textual content messaging. However the requirement to get consent from enrollees earlier than texting may restrict that effort.

That’s the scenario in Virginia, the place solely about 30,000 Medicaid enrollees — out of greater than 1,000,000 — have agreed to obtain textual content messages immediately from the state, stated spokesperson Christina Nuckols.

In an effort to spice up that quantity, the state plans to ask enrollees in the event that they wish to choose out of receiving textual content messages, fairly than ask them to choose in, she stated. This manner enrollees would contact the state provided that they don’t wish to be texted. The state is reviewing its authorized choices to make that occur, she stated.

In the meantime, Nuckols added, the state expects Medicaid well being plans to contact enrollees about updating their contact data. 4 of Virginia’s six Medicaid plans, which serve the majority of the state’s enrollees, have permission to textual content about 316,000, she stated.

Craig Kennedy, CEO of Medicaid Well being Plans of America, a commerce group, stated that the majority plans are utilizing texting and that Medicaid officers will use a number of methods to attach with enrollees. “I don’t see this as a detriment, that states will not be texting details about reenrollment,” he stated. “I do know we will probably be serving to with that.”

California officers in March directed Medicaid well being plans to make use of a variety of communication methods, together with texting, to make sure that members can retain protection if they continue to be eligible. The officers instructed well being plans they may ask for consent via an preliminary textual content.

California officers say in addition they plan to ask enrollees for consent to be texted on the enrollment utility, though federal approval for the change just isn’t anticipated till the autumn.

Just a few state Medicaid applications have experimented lately with pilot applications that included texting enrollees.

In 2019, Louisiana labored with the nonprofit group Code for America to ship textual content messages that reminded individuals about renewing protection and offering earnings data for verification. In contrast with conventional communication strategies, the texts led to a 67% improve in enrollees being renewed for protection and a 56% improve in enrollees verifying their earnings in response to inquiries, stated Medicaid spokesperson Alyson Neel.

Nonetheless, the state isn’t planning to textual content Medicaid enrollees in regards to the finish of the general public well being emergency as a result of it hasn’t arrange a system for that. “Medicaid has not but been in a position to implement a textual content messaging system of its personal resulting from different company priorities,” Neel stated.

KHN (Kaiser Well being Information) is a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is without doubt one of the three main working applications at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering data on well being points to the nation.