Challenges and Solutions of Medicaid Beneficiary Communication

Handling Medicaid beneficiary communication can be a complex undertaking, more challenging than what payers face with most employer sponsored health plan members. But new insight from Adaptation Health’s Louisiana Medicaid research brief may shed some light on effective strategies.

Effective Medicaid communication relies on both effective means of transmitting the messages and effective timing and language.

Louisiana’s Medicaid program itself is going through a major shift which, if not handled correctly, could result in much confusion among beneficiaries. The Medicaid department recently dropped its contracts with Medicaid managed care organizations due to a mismanaged bid process. The dropped contracts covered 90 percent of the state’s Medicaid beneficiaries. 

State Medicaid officials have promised to maintain steady coverage for all program beneficiaries through five emergency, year-long contracts which the governor signed. 

In the wake of this event, the Pelican State must ensure strong beneficiary communication in order to navigate this difficult period of the program’s history. It partnered with the nonprofit organization, Adaptation Health, to assess the effectiveness of its eligibility and enrollment communications and member engagement.

Adaptation Health collaborated with a dozen Louisiana healthcare organizations to connect with members who had negative experiences with the Medicaid program’s communication to see what could have improved their experience.

The study included thirty-five Medicaid beneficiaries who had lost their coverage or whose child had lost coverage or whose communications with Louisiana’s Medicaid program had been muddled or overwhelming. Interviews were held over the phone as well as in focus groups across the state. 

Adaptation Health’s research on Louisiana resulted in five key findings on Medicaid communication challenges and consumer preferences:

• Deadlines to submit enrollment and eligibility information were announced too close to the deadline itself and caused confusion.
• Beneficiaries who received letters could tell that the letters held significant content and, upon opening them, found the contents were clear.
• Beneficiaries were overwhelmed by the volume of communication, which was in part due to the Medicaid program’s efforts at both informing and engaging the members.
• Beneficiaries understand information best in different ways and Medicaid programs need to be aware of the communication process.
• Beneficiaries expressed a wide variety of ways they prefer to receive information.

The beneficiaries’ feedback demonstrated that snail mail letters—the Louisiana program’s primary method of communication—were an ineffective form of member engagement. While the actual content was clear, the letters often came late or so close to the deadline that beneficiaries had little opportunity to act on the information.

Participants also shared that varying levels of urgency attached to each letter made it difficult to prioritize and overwhelming to process. 

The single stream of communication was not customizable enough for the needs of this group which, even in its small sample size, had a wide variety of opinions regarding the means and regularity of communication they expected from the Medicaid program. Participants mentioned snail mail, email, text, or phone calls as preferred means of communication.

Despite the variable preferences for communication channels, the participants largely agreed they wanted communication to contain clear signals of authenticity. Payers are constantly fighting off scams and fraud and members are well-aware of those risks. Beneficiaries wanted to be sure that the communication channels were trustworthy.

“The issue in urgency, frequency, and dosage are potentially impacted by an improper communication strategy,” the brief explained. “In order to drive engagement, there is likely a consideration to how, in what way, and in what dosage communication should be made to individual members.”

While this study was by no means a broad survey of the entire Louisiana Medicaid population, it provided some insights into issues already identified by other surveys. 

A September 2018 study by Deloitte explored Medicaid members’ use of technology as a method of healthcare communication. 

Employer sponsored health plan members have only the slightest edge on Medicaid beneficiaries in technology ownership, the study found. Eighty-six percent of Medicaid beneficiaries own smartphones, as opposed to 94 percent of employer sponsored health plan members. And 69 percent of Medicaid beneficiaries own tablets, in contrast to almost 80 percent of those with employer insurance.

This statistic, however, may not be as relevant in states with largely rural populations, where internet access can contribute to poor healthcare communication.

Furthermore, experience has shown that even if Medicaid members do have a range of technologies available, the style of communication itself can bungle efforts at communicating critical Medicaid information.

Arkansas’s work requirements program is a prime example. The program cost over 17,000 Arkansas residents their Medicaid coverage due to both communication method and communication style. Over 30 percent of Medicaid enrollees did not reply to the state’s request for work hours because they lacked internet access and nearly 18 percent were simply confused about the process.

The issue is not constrained solely to Medicaid programs. Healthcare payers can face similar communication challenges in addressing consumers, as well.

For both, at the heart of the issue lies one common problem: effectively communicating with a diverse spectrum of members. This study suggests that the answer lies in both communication channel options and language or timing of communication.