What is Medicaid "unwinding?"

Ever since the COVID Public Health Emergency was declared, annual Medicaid redetermination was put on hold.

That means that for the last few years, millions of people have stayed on Medicaid that technically didn’t qualify.

In February, states began their Medicaid redetermination processes, with the potential for Medicaid disenrollment to start April 1, 2023.

Several million people will become uninsured as a result of this, and it’s estimated that 25% of them will qualify for an ACA marketplace plan.

In this Beyond the Basics webinar presented February 21, 2023, the Center on Budget and Policy Priorities (CBPP) describes what assisters can expect when states begin to unwind the Medicaid continuous coverage requirement that ends March 31, 2023, including how to mitigate coverage losses and help people navigate transitions to marketplace coverage.

How can I get in front of prospects?

Without a doubt, this is going to be a grassroots marketing initiative.

Many of the people who fit this customer profile have moved and Medicaid doesn’t know their current address. Direct Mail = bad idea.

If they are lower income, they may also change their phone number from time to time if they are using pre-paid phone services.

And aside from promoting your brand on social media, you won’t have the ability to directly target people who qualify using audience filters.

So then…how do you find these people?

1. Healthcare Providers

First of all, we anticipate that many of them will not even know they’ve lost their Medicaid until they actually go to their healthcare provider.

Therefore, your first step is to proactively network with providers in your local area who accept both Medicaid and ACA plans.

Offer to help them “retain their patients who are losing Medicaid.”

We have lots of provider marketing resources that we can customize to your agency. Just reach out and ask for support!

2. Community Outreach

Second, you should offer your support to organizations that serve lower-income Americans. This includes places like food pantries, church ministries, community outreach nonprofits, etc.

Every market has these organizations. Do they know that you can help people who are losing Medicaid? If not, it’s time to get in front of them.

3. Book of Business

It’s highly likely that your existing clients know someone who will be impacted by the Medicaid unwinding. And referrals are the best leads!

Reach out to your existing book of business and briefly let them know that some of their friends or family members might be losing their Medicaid soon and that if it happens, send them your way.

And if you get referrals, don’t forget those thank-you cards!

CMS Focus Group

CMS recently published the results of their message testing focus groups with English and Spanish-speaking individuals with Medicaid.

Here is what they found:

  • Many are not hearing about re-enrollment or redetermination, so this may not be top of mind

  • If faced with the loss of Medicaid, most say they believe it would be worth their time to go to HealthCare.gov to see if they are eligible for financial help to lower their monthly premiums

  • Only about half believe HealthCare.gov has plans they can afford or plans that would be as good as Medicaid

  • Messages that focus on savings, minimizing healthcare costs, and comprehensive coverage were seen as motivational

Additional findings:

  • Referencing $10 plans was compelling, whereas saying “low cost” was seen as too subjective.

  • Important to emphasize what plans cover as a sign that the plans are high quality.

  • English speakers appreciated empathetic messages such as: “Losing your coverage can be scary.”

  • Spanish speakers appreciated references to “family” more than English speakers.

  • Spanish speakers struggled with the term “financial help” (is it a loan?). While this worked well for English speakers.

Implications - Effective outreach should:

  • Mention that plans are affordable with specific dollar messaging (e.g. $10)

  • Mention that plans are high quality and cover specific services (e.g. doctor’s visits, prescription drugs, emergencies, etc.)

  • African Americans were the most skeptical and will require targeted outreach.

  • For Spanish speakers, inclusion of the concept of “family” is


  • Build empathic messaging to connect to people who have lost their health coverage.



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