At the beginning of the COVID-19 public health emergency in March 2020, it was crucial to make sure that as many people as possible could access the medical services, testing and care that they needed. Part of that effort included making an important adjustment to Medicaid, a public health care program for people with low income (also called Medical Assistance [MA] in Minnesota).

Continuous coverage rules were put in place, suspending the need for people enrolled in Medicaid to renew their coverage each year. Typically, people with Medicaid need to complete a renewal (also called a redetermination) once a year. This involves sending in paperwork along with proof of income – all to confirm that they’re still eligible for the program and that their coverage can continue. The March 2020 continuous coverage rules put those renewals on pause.

However, legislation passed by Congress at the end of 2022 placed an end date of March 2024 for that suspension of Medicaid renewals. As a result, between now and May 2024, 1.5 million Minnesotans on Medicaid will need to take action to have their eligibility renewed. If not, they’ll lose their coverage.

This unwinding period is going to be a massive effort, one that is going to need help from not only community advocates, but also from health care professionals, family, friends and neighbors. Leigh Grauman, licensed social worker and director of training and policy implementation at Portico Healthnet, talks with Dr. Haley and Dr. Jackson about what people with Medicaid need to do, the challenges ahead and what can be done to help get the word out. Listen to the episode or read the transcript.

What people on Medicaid need to do

If you receive health coverage through Medicaid, there are a few actions you can take right now to be ready to renew:

• Make sure that your contact information is up to date with the county where you live – the renewal process is paper-based, so all of your renewal forms are going to be mailed to the address on file. If you’ve moved within the past three years and haven’t updated your address with the county, the renewal paperwork will go to the old address – which means you may not receive it. If you don’t know who to contact, the MN Department of Human Services has a list of county contacts on their website.
• Open and respond to any mail you get from the Minnesota Department of Human Services (DHS) – As Leigh says in the episode, “it sounds that simple, but it can be very overwhelming for people receiving paperwork and not knowing what to open. So, they’re sending out the renewal notices in Minnesota with a special envelope that has a blue circle on it that says ‘Important information enclosed. If you receive that envelope, open it. It means that you have to take action to maintain your insurance coverage.” As the DHS says, “Remember: The circle in blue means it’s time to renew.”
• Check to see when you need to renew – It may have been several years since either signing up for or renewing Medicaid. If you’ve forgotten what your renewal month is, you can look it up on the DHS website.
• Get in touch with a navigator like those at Portico Healthnet – Portico has trained, certified, multilingual and community-based navigators whose job it is to help people apply for and renew their coverage, with all services provided free of charge. There are also hundreds of additional navigators throughout the state of Minnesota – it’s easy to find one near you.

New challenges and existing disparities

In the more than three years since the beginning of the COVID-19 public health emergency, 1.5 million Minnesotans have joined either MA or MinnesotaCare – that’s 1 in 4 Minnesotans that have their health insurance through a public program. And while it’s great news to have fewer people who are uninsured in the state, the mammoth renewal effort ahead poses immediate challenges.

The first is awareness. A recent Kaiser Family survey of Medicaid enrollees found that 65% are unaware that renewals will be resuming. And while a good amount of current enrollees will expectedly lose their coverage due to having a new job or earning more income, there’s a fear that many more will, as Leigh puts it, “lose coverage simply because of technical reasons, simply because of not completing the paperwork.”

In fact, as of June 2023, 76% of the over million people who have already lost their Medicaid coverage did so because they didn’t file their paperwork – all based on technicalities or lack of verification. All of this underlines the importance of getting the word out about Medicaid renewals.

However, media campaigns and information available on the internet can only reach so many people. Without access to the messages or the inability to understand them because of a language barrier, the chances of losing coverage due to not renewing increase substantially.

As Leigh says, “we have years and years of history and experience in this state to tell us the groups that are most likely to lose their coverage for these procedural reasons. It’s people of color, it’s people who speak a primary language other than English, it’s people who are experiencing homelessness or move a lot.” In other words, the very populations the Medicaid program is designed to support. It can be hard to report and prove income when you work multiple jobs or have an income that varies, which can put crucial coverage at risk.

Also, this is all happening at a time while there are still significant disparities across race and ethnicity when it comes to health insurance access in Minnesota. While Minnesota’s current overall statewide uninsured rate is at a historical low of 4%, the uninsured rate for BIPOC Minnesotans increased from around 7% to over 10%, even with protections in place. With the challenge of a paper-based renewal system that requires many people to process, the concern is that those disparities will only get worse.

Getting the word out

According to Leigh, this truly is an “all hands on deck moment.” The best thing that everyone can do to help get the word out is to raise awareness. Talking to friends, colleagues and neighbors is an important first step, directing them to the DHS website and to get in touch with a navigator.

Health care organizations and professionals also have a unique and potentially effective role, especially with their access to information about the type of health insurance patients have. Looking for ways to incorporate Medicaid renewal into standard interactions with patients – whether face-to-face or by including the DHS website in standard paperwork – can be tremendously helpful. For professionals who have access to renewal information like those who work in patient financial services, timely notices along with specific guidance can be even more effective.

In addition, recently passed state legislation has released more funding for state and county agencies, as well as community-based organizations and navigator organizations, to increase staff and get more creative with outreach. One of the first results of that additional help is the Minnesota DHS’s efforts with texting enrollees about Medicaid enrollments, with more approaches in the works.

However, it’s important to remember that while the current focus is on the unwinding period, the work isn’t going to end when the period is up. There are longstanding problems with how Medicaid plans are renewed, starting from its complex and paper-based process. Support will continue to be needed to create effective solutions moving forward.

To hear more from Leigh, including what has and hasn’t changed in her 15 years with Portico Healthnet and the additional challenges that the unwinding period poses, listen to this episode of Off the Charts.