Margaret A. Murray, M.P.A., ACAP CEO, on Medicaid enrollment and work requirements

Medicaid enrollment has declined since 2023 amid post-pandemic eligibility redeterminations, but it remains above pre-pandemic levels — and how that story unfolds next may hinge on outreach and texting to beneficiaries, according to Margaret A. Murray, M.P.A., founding CEO of the Association for Community Affiliated Plans (ACAP) and a longtime member of the Managed Healthcare Executive (MHE) editorial advisory board.

In this excerpt of an interview with MHE, Murray said that enrollment declines during the “unwinding” that started in 2023 as automatic enrollment related to the COVID-19 public health emergency ended varied widely by state, in part because some Medicaid enrollees had been continuously covered for three years and were not fully aware their coverage was up for renewal. One lesson from the pandemic era, she said, was the value of reaching beneficiaries by text; CMS and the Federal Communications Commission expanded the allowable use of texting for eligibility-related outreach, and ACAP’s member managed care organizations used it extensively.

Murray said those same outreach tools will matter even more as Medicaid moves into a new phase shaped by federally mandated work requirements and renewal rules. ACAP opposed the provisions, she said, but with the requirements now law, its member plans are focused on helping as many eligible people as possible stay covered. “Medicaid is US” is the association’s tagline, Murray said, reflecting its position that people have a right to be enrolled in the program.

Murray said ACAP expects continued enrollment decreases and is concerned that eligible people — including those who qualify because they are working, volunteering, in school, or under a frailty exemption — could lose coverage simply because they have not completed required paperwork. She pointed to continuous 12-month enrollment for children as a program success ACAP has championed to reduce churn, though she noted that the parents of children in Medicaid expansion populations in 41 states will now be subject to the new work requirements.