Stop the Churn: Medicaid Redeterminations, Revenue Risk, and the Outreach That Works
Picture your front desk as a bucket under a slow-dripping ceiling. You can mop all day, but if you don’t fix the drip, the floor keeps getting wet. Medicaid redeterminations have become that drip…quiet, constant, and expensive…soaking patient access, staff morale, and your month-end cash.
Before racing to “do more outreach,” pause and ask: where exactly is the bucket leaking? Is it renewal mail not reaching patients, kids losing coverage when parents churn, or ex parte auto-renewals failing for people who should be renewed? That reflection sets up action that actually moves revenue and protects care.
What’s happening (and why it hits cash)
As states wrapped up continuous-coverage “unwinding,” ~25 million people were disenrolled. Across the unwinding period, about 7 in 10 losses were procedural (paperwork/address issues), not true ineligibility. Today, enrollment has stabilized around 78.4 million (April 2025), still above pre-pandemic levels, but churn itself creates costly gaps in coverage and care. Month-to-month, states now renew most people and a majority via ex parte (verified automated renewal) (e.g., 55% in April 2025), yet performance varies widely by state. - KFF
For FQHCs, CHCs, and small hospitals, churn shows up as:
Volatile self-pay mix (more presumptive charity/bad debt).
Delayed care returning as higher acuity and lower quality scores.
Staff burnout from rework (rescheduling, financial counseling, payer calls).
Longer DNFB (Discharged, Not Final Billed) and more small-balance write-offs as eligibility toggles mid-episode.
Reality check: In April 2025, among people due for renewal, 75% were renewed, 16% disenrolled, and 10% were procedural, a big improvement from early unwinding, but still a steady drip you feel in cash and capacity.
A focused outreach playbook (built for safety-net realities)
1) Start with your own data.
Pull patients with Medicaid in the past 18 months who now show as self-pay or inactive coverage. Tag pediatrics, OB/postpartum, and high-risk chronic cohorts first. Quick win: create an “Eligibility At-Risk” flag in your PM/EHR to fire at scheduling, check-in, and outreach.
2) Stand up a lightweight “Medicaid Help Desk.”
Not a new department; just a named pathway: a dedicated phone option, a text keyword (“MEDHELP”), a walk-up at the front desk. Script three things: confirm contact info, check renewal status, and book a renewal + care appointment pair (eligibility assistance followed by a well-visit).
3) Automate reminders the way payers do.
Text in the patient’s preferred language with short links to your help page and the state portal. Use a simple cadence (day 0, 7, 21) and escalate to live calls for high-risk cohorts. Keep messages about care continuity (“keep your child’s asthma meds covered”), not bureaucracy.
4) Make redetermination a team sport at check-in.
Add two pre-visit questions: “Any Medicaid mail lately?” and “Has your address or phone changed?” If yes, route to on-site assist. Empower MAs with a one-pager and QR codes to state resources. Celebrate “saves” in morning huddles to boost morale.
5) Fix ex parte failure points.
If your state’s ex parte rate lags, convene IT, RCM, and enrollment to improve data matching (employer/wage feeds, address hygiene, SSN errors). Even small lifts in ex parte reduce manual chases and stabilize coverage; nationally, ex parte accounts for the majority of renewals and ranges widely by state.
6) Partner beyond your walls.
Libraries, WIC sites, schools, shelters, churches: equip them with your renewal flyer and a direct line to your Help Desk. Host brief evening or Saturday “coverage clinics” with snacks and childcare; low cost, high trust.
Tie it to value-based care (so it sticks)
Churn corrodes VBC performance: gaps in care, missed med refills, and attribution loss. Bake outreach into operations:
Track coverage-days restored as a quality enabler.
Pair renewal outreach with HEDIS-relevant touchpoints (child well-care, immunizations).
Use closed-loop SDOH referrals (transport/phones) to raise completion of renewals and kept visits.
What to measure weekly (so you know it’s working)
Reach-to-renewal rate: # members contacted ÷ # successfully renewed (target: >30% within 30 days).
Ex parte lift: month-over-month percentage-point gain (small gains stabilize thousands of visits).
At-risk panel stabilized: % of flagged patients back to active coverage within 45 days.
Cash indicators: Medicaid bad-debt trend; DNFB days for Medicaid encounters.
Staff signals: front-desk rework minutes/visit; fewer re-registrations = happier teams.
A gentle 4-week sprint
Week 1: stand up the Help Desk, import your “at-risk” list, launch bilingual texts.
Week 2: train check-in staff; add the two screening questions.
Week 3: host a 3-hour coverage clinic; bring laptops and snacks.
Week 4: review metrics; tune scripts; expand to a second cohort (dental or pediatrics).
Fix the drip, and the floor dries: steadier coverage, calmer staff, and cash that shows up on time.
If you’d like a steady hand to turn this playbook into action, Agatha Consulting can partner with your team. We’ll tailor workflows to your state rules and systems, set up a small dashboard for reach-to-renewal, ex parte lift, and DNFB, and coach leads so the work sticks after we step back. Quiet support, practical tools, measurable wins…so your staff can breathe and your patients stay covered.