Automating Processes Can Help Prevent Avoidable Losses of Coverage: William Schpero, PhD, MPhil, MPH

William Schpero, PhD, MPhil, MPH, from the Weill Cornell Graduate School of Medicine, spoke about how automating the implementation of the Medicaid work requirements, set to go into effect in 2027, could help to mitigate avoidable loss of coverage at the state and federal level.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Is there anything that can be done to mitigate the effect of the Medicaid work requirements?

I think there are a number of steps that could be taken for the federal and state levels to mitigate coverage losses, to prevent avoidable losses of coverage as a result of the implementation of work requirements under the One Big, Beautiful Bill Act. At the federal level, I think there are really 2 important steps. One is, I already mentioned that states have this really short timeline to ensure compliance: about a year and only 6 months following the release of the specific regulations that outline how work requirements should be implemented next summer. I think if Congress were to go ahead and extend that deadline for states, that would allow states to ensure that all their systems are set up as well as possible to mitigate avoidable losses of coverage. To be clear, the law does allow states to apply for an extension. So they can apply for up to a 2-year delay in implementing requirements if they demonstrate good faith efforts to meet the original deadline. But I think even really automating that, where states get an additional year or 2 to ensure compliance, could go a long way to reducing the burden on states, allowing them to develop some best practices, share those best practices, ensure they're doing everything they can, again, to mitigate avoidable losses of coverage.

I think also, as I mentioned at the outset, a lot of folks will qualify for exemptions. I think if the regulations are written in a way that gives states more leeway in terms of how those exemptions are defined, allowing states to be more generous in implementing those exemptions, we know that will go a long way toward mitigating coverage losses, given that we think most people in this population are working, and it's not that they would lose coverage because they're not working but because of the barriers associated with reporting and demonstrating compliance with with the law. I think those are all things that can be done at the federal level.

I think at the state level—and I know states are really invested in this right now—doing everything they can to sort of automate processes so that, for as many people as possible, the state can pull from existing data sources, whether it be state wage data or data from other programs like the SNAP program, the food stamp program, where the state already has information on folks' income or work status. The more the state can do to automate work reporting, the more states can also do to automate exemptions. Pulling from claims data, from clinical data, information on whether folks will qualify on the basis of their clinical characteristics or other observable characteristics. The more the state can do to ensure that folks don't have to report on their own to be compliant with the law, the better. That, again, is something I know states are very focused on that will go a long way toward mitigating avoidable losses of coverage.

Also, the more states can do to reduce reporting friction, for some segment of folks, states won't be able to automate reporting—they'll have to ask for more information. The more states can invest in really easily accessible portals, folks that engage in outreach to help people report, and then more broadly just outreach and engaging with community based organizations, provider organizations, other folks who are regularly engaging with this population of Medicaid enrollees to get the word out and to provide some clear direction on how they can ensure they're compliant with the law so they don't lose their coverage.