Who doesn’t text in 2022? Most state Medicaid programs

West Virginia will use the US Postal Service and an online account this summer to catch up with Medicaid registrants about the expected end of the COVID-19 public health emergency, which is putting many recipients at risk of losing their coverage to lose.

What West Virginia won’t do is use a globally ubiquitous form of communication: text messaging.

“West Virginia is not set up to text its members,” Medicaid spokeswoman Allison Adler wrote in an email to KHN.

In fact, most states’ Medicaid programs will not text enrollers, despite the urgency of reaching out to extend their coverage. A Kaiser Family Foundation report published in March was found only 11 states said they would use SMS to notify Medicaid recipients of the end of the COVID public health emergency. In contrast, 33 states plan to use mail, and at least 20 will make contact with individual or automated phone calls.

“It doesn’t make sense when most people communicate via text messages today,” he said Somehow Serafia partner of the consulting firm Manatt Health.

State Medicaid agencies have been preparing for the end of the public health emergency for months. As part of a COVID relief bill passed in March 2020, Congress prohibited states from removing people from Medicaid coverage unless they moved out of the state during the public health emergency. When the emergency ends, state Medicaid officials must reevaluate each enroller’s eligibility. Millions of people could lose insurance coverage if they earn too much or fail to provide the information needed to verify income or residency.

As of November 2021, approx 86 million people were enrolled in Medicaid, according to the Centers for Medicare & Medicaid Services. That’s up from 71 million in February 2020, before COVID began to ravage the nation.

West Virginia has more than 600,000 Medicaid enrolled. Adler said about 100,000 of them could lose their eligibility by the end of the public health emergency because either the state has determined they are ineligible or they have failed to respond to requests to update their income information.

“It’s frustrating that texting is a means of meeting people where they are and that hasn’t been taken up by states more,” he said Jennifer WagnerDirector of Medicaid Eligibility and Enrollment for the Center on Budget and Policy Priorities, a Washington-based research group.

The problem with relying on the postal service is that a letter can be hidden in “junk” mail or can’t reach people who have moved or are homeless, Serafi said. And emails, when people have an account, can end up in spam folders, she noted.

In contrast, polls show that Americans are lower-income just as likely to have smartphones cell phones like the general population. And most people use SMS regularly.

In Michigan, Medicaid officials began using text messaging to communicate with enrollments in 2020 after building a system with federal COVID relief funds. They said SMS is a cost-effective way to reach subscribers.

“It costs us 2 cents per text, which is incredibly cheap,” said Steph White, enrollment coordinator for the Michigan Department of Health and Human Services. “It’s a great return on investment.”

CMS officials have told states to consider texting and other methods of communication when attempting to reach enrollers at the end of the public health emergency. But many states don’t have the technology or information about the enrolled to do this.

Efforts to add texting also face legal obstacles, including a federal law that bans texting people without their consent. The Federal Communications Commission ruled in 2021 that state agencies are exempt from the law, but whether counties that assume Medicaid obligations for some states and Medicaid managed care organizations that operate in more than 40 states are also exempt is unclear, said Matt Salo. Executive Director of the National Association of Medicaid Directors.

CMS spokesperson Beth Lynk said the agency is trying to figure out how Medicaid agencies, counties and health plans can text enrollers within the limitations of federal law.

Several states told KHN that Medicaid health plans will help connect with participants and expect the plans to use text messaging. But the requirement to obtain consent from participants before sending an SMS could limit that effort.

That’s the situation in Virginia, where only about 30,000 Medicaid enrollments — out of more than a million — have agreed to receive text messages directly from the state, spokeswoman Christina Nuckols said.

To increase that number, the state plans to ask enrollers if they would like to opt-out of receiving text messages instead of asking them to opt-in, she said. That way, those enrolled would only contact the state if they didn’t want to receive SMS. The state is examining its legal options to achieve this, she said.

In the meantime, Nuckols added, the state expects Medicaid health plans to contact enrollers to update their contact information. Four of Virginia’s six Medicaid plans, which serve the majority of the state’s enrolled individuals, are permitted to text about 316,000, she said.

Craig Kennedy, CEO of Medicaid Health Plans of America, a trade group, said most plans use text messaging and Medicaid officials will use multiple strategies to engage with participants. “I don’t see it as a downside that states don’t send SMS information about re-enrollment,” he said. “I know we will help with that.”

California officials mandated the use of Medicaid health plans in March a variety of communication methods, including SMS to ensure members can retain coverage if they remain eligible. Officials told the health plans they could ask for approval through an initial text.

California officials say they also plan to ask enrollers for permission to text on the enrollment application, though federal approval for the change isn’t expected before the fall.

Some state Medicaid programs in recent years have experimented with pilot programs that involved sending text messages to participants.

In 2019, Louisiana partnered with nonprofit group Code for America to send out text messages reminding people to renew insurance coverage and provide income information for verification. Compared to traditional communication methods, texting resulted in a 67 percent increase in enrollments being renewed for coverage and a 56 percent increase in enrollments verifying their income in response to requests, said Medicaid spokeswoman Alyson Neel.

Despite this, the state has no plans to notify Medicaid registrants of the end of the public health emergency because it has no system in place to do so. “Medicaid has not yet been able to implement its own text messaging system due to other agency priorities,” Neel said.

KHN (Kaiser Health News) is a national newsroom producing in-depth journalism on health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).

Copyright 2022 Kaiser Health News. To see more visit Kaiser Health News.

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