In December 2022, President Biden signed a $1.7 trillion Omnibus spending bill that ended the Medicaid continuous enrollment requirements introduced under the Public Health Emergency in March of 2020. In states with managed Medicaid, MCOs have an opportunity to proactively support their members in navigating the redetermination process successfully to ensure continuous coverage. The federal government has also made their expectations clear for member outreach and engagement, including rigorous reporting requirements – in an aim to minimize administrative denials.
Our model reliably surfaces members likely to struggle to navigate the redetermination process on their own, using a combination of claims, demographic, enrollment, and non-clinical data, combined with industry-leading AI capabilities. The actionable insights generated by the model empower plans to proactively engage members in the redetermination process, better support them throughout it, and minimize the impact on coverage, as well as the size of your managed Medicaid line of business.
- Proactively identify members in need of support to maintain eligibility
- Engage these members earlier and more effectively with tailored outreach strategies
- Minimize coverage gaps, member churn, and the impact on the size of your overall Medicaid business