FAQ: Ways Health Plans Can Assist Members in Medicaid Redetermination

Most Medicaid enrollees who lost coverage during the unwinding were removed for procedural reasons, and expansion adults will soon face renewals twice a year along with new work requirements, according to SriVani Ganti, MSHC, vice president of member engagement at mPulse, who spoke with The American Journal of Managed Care^® about where members get stuck at renewal and how health plans can communicate differently.

Where do members most often get stuck during the Medicaid renewal process?

Members most often stall on documentation, confusing state portals, shifting deadlines, and jargon-heavy instructions, and those whose income does not arrive as a regular paycheck have a particularly hard time, Ganti said.

"Documentation can be a really complex process, especially if you're a gig worker. Your pay stubs may not actually fit cleanly into the state requirement templates," she said.

Many members abandon applications within state portals, particularly when the process relies on insurance or state jargon. That burden falls hardest on people with limited health literacy or English proficiency and on those without stable internet access.

Why is a single renewal notice from the state not enough?

In a KFF survey of adults enrolled in Medicaid before the unwinding began, 29% said they did not remember receiving renewal information, a figure that rose to 33% among enrollees with a high school education or less.¹ Ganti noted that renewal letters are often sent to outdated addresses and never forwarded.

"If you're not aware of what you're supposed to do, it inherently becomes difficult to close a gap," she said.

She also acknowledged that health plan teams are having to do a lot with a lot less, which can make it tempting to send state-approved language once and stop there. However, disenrolling and later reenrolling a member carries its own administrative cost, which she estimated at around $500 per member who is disenrolled per renewal period.

"All of that adds up very quickly," Ganti said, adding that retention is key to a plan's overall financial picture.

What did the unwinding reveal about why people lost coverage?

Most people who lost Medicaid during the unwinding were removed for procedural reasons rather than a determination that they were ineligible. Of 89.0 million redeterminations completed from March 2023 through September 2024, 26.8 million (30%) ended in disenrollment. About 70% of those disenrollments were procedural, according to the Government Accountability Office.² Procedural terminations occur when a state cannot confirm eligibility, often because paperwork was not returned, so some of those members likely remained eligible.

"It wasn't because they were not eligible. It was because of paperwork error," Ganti said of the many members who were disenrolled on procedural grounds. "That's not on the member."

Among people disenrolled during the unwinding, 23% reported being uninsured at the time of the KFF survey.¹

"When you lose your coverage, the cost becomes astronomical, and then the outcomes become terrible because people are delaying care because they simply cannot afford it," Ganti said.

How should plans rethink language, channels, and messaging?

Plans should write in plain language, translate materials into members' preferred languages, and spread outreach across several channels rather than relying on mail, which members may not check often or may never receive after a move, according to Ganti.

"A text message can go a long way," she said, adding that the same is true of email.

She also urged plans to borrow from consumer-facing industries. mPulse builds its outreach on a behavioral framework that assesses a member's capability, opportunity, and motivation to identify the barriers most likely to stop them from acting.

On motivation, Ganti said repeated reminders to "renew your health care so you don't lose your benefits" lose their effect over time. Framing the message around what the member stands to lose, such as thousands of dollars in out-of-pocket costs, can break through where routine messaging does not.

"Within health care, we don't always want to think about our members as consumers, but the fundamental is that's what they expect," she said. "They expect better streamlined digital engagement experiences across all of their needs."

How will 6-month renewals and work requirements change the burden on members?

The 2025 federal budget reconciliation law requires states to redetermine eligibility every 6 months for adults covered through the Affordable Care Act Medicaid expansion, starting with renewals scheduled on or after December 31, 2026.³ The law also requires many expansion adults aged 19 to 64 years to document at least 80 hours per month of work or other qualifying activities. States must implement the requirement no later than December 31, 2026, although those showing a good faith effort to comply can receive an exemption lasting until the end of 2028.

Ganti noted that members who now submit several months of pay stubs and proof of residency once a year will need to do so twice a year, and many will also need to log their work or volunteer hours. She said the work requirements will be especially hard on caregivers and gig workers, whose circumstances do not fit neatly into the categories the requirements assume.

"All of these things already are a lot to do once a year, and now they're having to do it twice a year," she said.

What does an end-to-end approach to redetermination look like?

mPulse has partnered with Mirza, a company that Ganti said functions as a common application for Medicaid and other social services, including the Supplemental Nutrition Assistance Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; housing subsidies; and child care subsidies. The partners describe the arrangement as the first end-to-end Medicaid redetermination solution, covering the process from first notice through application submission.⁴

Ganti said mPulse handles the front end, running behaviorally tailored, multichannel outreach that tracks where members are in the process, identifies barriers, and directs them to Mirza. Mirza, in turn, screens eligibility, consolidates applications, guides members through gathering documents, can pull pay stubs through payroll integrations, and submits applications to the state as the member's authorized representative before monitoring their status.

Ganti framed the effort as a matter of dignity. Members navigating Medicaid already have "a lot on their plate," she said, and a simpler process gives them "a little bit more of an equal footing."

Managed Care Implications

For Medicaid managed care organizations, the unwinding showed that most coverage losses were procedural and that state notices alone did not reach nearly 3 in 10 enrollees. Twice-yearly renewals and monthly work reporting for expansion adults will double the number of renewal deadlines those members face and add work-activity documentation to the paperwork, according to Ganti.

Plans that treat renewal support as a member experience function, with current contact information, plain-language and multilingual messaging, digital channels, and help gathering documents, are positioned to retain more eligible members and avoid the administrative cost of reenrolling them. How well plans identify where members abandon the process and act on it will shape their enrollment stability under the new requirements.

References

1. Lopes L, Sparks G, Presiado M, et al. KFF survey of Medicaid unwinding. KFF. April 12, 2024. Accessed October 27, 2026. https://www.kff.org/medicaid/kff-survey-of-medicaid-unwinding/
2. Medicaid and Children's Health Insurance Program: disenrollments after COVID-19 varied across states and populations. Government Accountability Office. June 24, 2025. Accessed October 27, 2026. https://www.gao.gov/assets/890/882477.pdf
3. Health provisions in the 2025 federal budget reconciliation law. KFF. August 22, 2025. Accessed October 27, 2026. https://www.kff.org/report-section/health-provisions-in-the-2025-federal-budget-reconciliation-law-medicaid/
4. Ganti S. Disrupting Medicaid redetermination: say goodbye to procedural blockers. mPulse. October 8, 2026. Accessed October 27, 2026. https://mpulse.com/blog/blog-medicaid-redetermination-end-to-end-solution/