West Virginia will use the U.S. Postal Service and a web based account this summer time to attach with Medicaid enrollees in regards to the anticipated finish of the covid public well being emergency, which is able to put many recipients vulnerable to dropping their protection.

What West Virginia gained’t do is use a type of communication that’s ubiquitous worldwide: textual content messaging.

“West Virginia isn’t set as much as textual content its members,” Allison Adler, the state’s Medicaid spokesperson, wrote to KHN in an electronic mail.

Certainly, most states’ Medicaid packages gained’t textual content enrollees regardless of the urgency to achieve them about renewing their protection. A KFF report revealed in March discovered just 11 states stated they’d use texting to alert Medicaid recipients in regards to the finish of the covid public well being emergency. In distinction, 33 states plan to make use of snail mail and a minimum of 20 will attain out with particular person or automated telephone calls.

“It doesn’t make any sense when texting is how most individuals talk right this moment,” stated Kinda Serafi, a associate with the consulting agency Manatt Well being.

State Medicaid companies for months have been making ready for the top of the general public well being emergency. As a part of a covid aid legislation authorised in March 2020, Congress prohibited states from dropping anybody from Medicaid protection until they moved out of state throughout the public well being emergency. When the emergency ends, state Medicaid officers should reevaluate every enrollee’s eligibility. Thousands and thousands of individuals might lose their protection in the event that they earn an excessive amount of or fail to supply the knowledge wanted to confirm earnings or residency.

As of November, about 86 million people had been enrolled in Medicaid, in accordance with the Facilities for Medicare & Medicaid Providers. That’s up from 71 million in February 2020, earlier than covid started to ravage the nation.

West Virginia has greater than 600,000 Medicaid enrollees. Adler stated about 100,000 of them might lose their eligibility on the finish of the general public well being emergency as a result of both the state has decided they’re ineligible or they’ve failed to reply to requests that they replace their earnings info.

“It’s irritating that texting is a method to fulfill folks the place they’re and that this has not been picked up extra by states,” stated Jennifer Wagner, director of Medicaid eligibility and enrollment for the Middle on Funds and Coverage Priorities, a Washington-based analysis group.

The issue with counting on the Postal Service is {that a} letter can get hidden in “junk” mail or can fail to achieve individuals who have moved or are homeless, Serafi stated. And electronic mail, if folks have an account, can find yourself in spam folders, she famous.

In distinction, surveys present lower-income People are just as likely to have smartphones and cellphones as the overall inhabitants. And most of the people often use texting.

In Michigan, Medicaid officers began utilizing textual content messaging to speak with enrollees in 2020 after constructing a system with the assistance of federal covid aid funding. They stated texting is a cheap technique to attain enrollees.

“It prices us 2 cents per textual content message, which is extremely low cost,” stated Steph White, an enrollment coordinator for the Michigan Division of Well being and Human Providers. “It’s an amazing return on funding.”

CMS officers have instructed states they need to contemplate texting, together with different communication strategies, when making an attempt to achieve enrollees when the general public well being emergency ends. However many states don’t have the know-how or details about enrollees to do it.

Efforts so as to add texting additionally face authorized limitations, together with a federal legislation that bars texting folks with out their consent. The Federal Communications Fee dominated in 2021 that state companies are exempt from the legislation, however whether or not counties that deal with Medicaid duties for some states and Medicaid managed-care organizations that work in greater than 40 states are exempt as nicely is unclear, stated Matt Salo, government director of the Nationwide Affiliation of Medicaid Administrators.

CMS spokesperson Beth Lynk stated the company is making an attempt to determine how Medicaid companies, counties, and well being plans can textual content enrollees inside the constraints of federal legislation.

A number of states instructed KHN that Medicaid well being plans can be serving to join with enrollees and that they anticipate the plans to make use of textual content messaging. However the requirement to get consent from enrollees earlier than texting might restrict that effort.

That’s the state of affairs in Virginia, the place solely about 30,000 Medicaid enrollees — out of greater than one million — have agreed to obtain textual content messages immediately from the state, stated spokesperson Christina Nuckols.

In an effort to spice up that quantity, the state plans to ask enrollees in the event that they wish to decide out of receiving textual content messages, slightly than ask them to decide in, she stated. This fashion enrollees would contact the state provided that they don’t wish to be texted. The state is reviewing its authorized choices to make that occur, she stated.

In the meantime, Nuckols added, the state expects Medicaid well being plans to contact enrollees about updating their contact info. 4 of Virginia’s six Medicaid plans, which serve the majority of the state’s enrollees, have permission to textual content about 316,000, she stated.

Craig Kennedy, CEO of Medicaid Well being Plans of America, a commerce group, stated that the majority plans are utilizing texting and that Medicaid officers will use a number of methods to attach with enrollees. “I don’t see this as a detriment, that states aren’t texting details about reenrollment,” he stated. “I do know we can be serving to with that.”

California officers in March directed Medicaid well being plans to make use of a variety of communication methods, together with texting, to make sure that members can retain protection if they continue to be eligible. The officers instructed well being plans they might ask for consent by way of an preliminary textual content.

California officers say in addition they plan to ask enrollees for consent to be texted on the enrollment utility, though federal approval for the change just isn’t anticipated till the autumn.

A number of state Medicaid packages have experimented in latest years with pilot packages that included texting enrollees.

In 2019, Louisiana labored with the nonprofit group Code for America to ship textual content messages that reminded folks about renewing protection and offering earnings info for verification. In contrast with conventional communication strategies, the texts led to a 67% improve in enrollees being renewed for protection and a 56% improve in enrollees verifying their earnings in response to inquiries, stated Medicaid spokesperson Alyson Neel.

Nonetheless, the state isn’t planning to textual content Medicaid enrollees in regards to the finish of the general public well being emergency as a result of it hasn’t arrange a system for that. “Medicaid has not but been in a position to implement a textual content messaging system of its personal resulting from different company priorities,” Neel stated.

Phil Galewitz: [email protected], @philgalewitz