Carrie Kozlowski: Why Are Medicaid Disenrollment Rates Spiking?

More than 16 million Medicaid enrollees have been disenrolled across the US, as of February 1, 2024, according to KFF's Medicaid Enrollment and Unwinding Tracker. In reporting states, 33% of individuals who completed their renewal process experienced disenrollment, while 67%, equivalent to 32.5 million enrollees, had their coverage renewed.¹

Carrie Kozlowski, OT, MBA, COO, and co-founder of Upfront Healthcare, shared her perspective on the major contributor to this nation-wide gap in care.

Transcript

The data from the Kaiser Family Foundation indicate that 16.4 million Medicaid enrollees have been disenrolled. What are the key factors contributing to this disenrollment trend?

I start, always—when I think about this problem—with who owns this? So, who's responsible, ultimately, for making sure a patient is enrolled in Medicaid? And I don't think that's clear: Is it CMS? Is it the state? Is it the provider who last saw them—the health system who's seen them the most?

Across the board, I don't think we have clarity on who's responsible for enrolling patients in Medicaid or ensuring continuing care. What's disappointing is, I think we universally talked for the last year [saying], “Hey, this might happen, oh no, this is happening. Uh-oh, it's getting worse.” And yet, we still don't see the accountability stepping up. And so when it comes to that, I think it's probably largely a policy problem and a lack of clarity as a result of that ownership.

In the end, this solution is going to come from whoever's feeling the pain, right? And it's going to be the financial pain that motivates folks, because action will follow the dollar, or it's going to be folks who are strongly committed to equity service and community—the health systems and provider groups just have as a core value and have incorporated that into their budgeting and financial system.

Where they're all going to get stuck, whether they're motivated by dollars, or motivated by equity and responsibility, is just going to be the silo thinking that we have in health care and the idea of what's possible, right? So we're gonna get stuck, I think potentially, in a lot of point solution opportunities where we'll make some impact. But to universally move the needle is going to be I think, challenging for health systems who want to take action.

I'll say what I don't think the issue is—it's not technology. We can solve this problem with technology.

You can create trusted, frictionless experiences; we can reach patients with omni channels, text, email, etc. We can do human-centered design and trusted content that's relevant. But until we figure out who owns the problem, and how those people are going to implement processes to be responsible, and how we're going to execute, I think we're going to be stuck for a little while, unfortunately. And that's where we're going to need to see, probably at the policy and macro levels of influence, what we need to do. And we're starting to see some of that, I think, with the federal pushing on the states but not enough, in my opinion.

Reference

Medicaid enrollment and unwinding tracker. KFF. February 1, 2024. Accessed February 6, 2024. https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/?mc_cid=f50ef0ecd6&mc_eid=2973aabf62