How to engage Medicaid members for more equitable outcomes

When the COVID-19 public well being emergency expires, practically 80 million Medicaid members could have their eligibility redetermined. This redetermination will disproportionately impression members of under-resourced communities, which comprise nearly all of Medicaid members. Nevertheless, many Medicaid members are unaware of this danger of protection loss resulting from low engagement with their plan.

This is only one of many causes Medicaid plans have to give attention to bettering engagement to assist their members. Data of well being plan advantages informs a better customary of take care of members. Sadly, social determinants of well being, socioeconomic standing, race, and most popular language are too usually not factored into plan communications, leading to low response charges. Tailor-made outreach that acknowledges these important components can enhance engagement, set up belief, and end in higher well being, satisfaction, and high quality rankings.

Establishing belief and constructing client well being profiles to enhance care

Overcoming boundaries to care requires examination of three key components, together with particular person habits, social determinants of well being (SDoH), and reachability and communication preferences. Medicaid members have the best charges of poverty and sometimes expertise different challenges, similar to insufficient entry to transportation, which stop common check-ups. Engagement alternatives can enhance outreach and member retention to attain equitable well being outcomes throughout a big selection of well being plan packages (Determine 1).

Enrollment and Onboarding


Preventive Care

Situation Administration and Episodic Care


Enrollment in Medicaid MCO

Well being and SDOH Evaluation

Establishing a Medical House

Managing Situations


  • Welcome outreach
  • PCP project
  • ID card distribution


  • Mail, cellphone, or digital well being danger evaluation and ensuing care
  • Member motion plans together with member schooling or enrollment in care administration packages


  • Annual wellness go to
  • Vaccinations
  • Preventive dental (in some states)


  • Persistent circumstances: diabetes, bronchial asthma, COPD, coronary heart illness, melancholy
  • Prenatal and postpartum care post-hospital discharge


  • Annual eligibility evaluate
  • Renewal of advantages


Determine 1. Medicaid member engagement alternatives.

Empathy ought to be on the forefront of communications as plans adapt their messages for a number of audiences, going past easy translation to seize cultural nuances. That is bolstered by a “whole-person” strategy to care administration, which considers the whole image of member information to optimize understanding of sufferers’ wants. Inequities are maintained within the healthcare system by means of failure to shut gaps in care and unequal useful resource distribution when important member information is missed. Segmentation of plan membership permits plans to focus on every inhabitants on the proper time with the proper message.

How can plans fight low engagement and enhance high quality scores?

Finally, plans that spend money on proactive member engagement methods will yield greater high quality scores and ship a greater member expertise and well being outcomes. Learn our new white paper and find out how Medicaid plans can assist whole-person, culturally competent, and equitable care—from enrollment to renewal.

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