Navigating the Impact of Federal Medicaid Reforms
Part 2: Operational Realities for MCOs
As redetermination cycles are likely to increase, Medicaid Managed Care Organizations (MCOs) are operating under increasing pressure. Member coverage is at risk of being lost — not always because individuals are ineligible, but because the system isn’t equipped to keep up. Outdated Medicaid infrastructure limited real-time data sharing, and communication gaps make it harder for MCOs to meet rising performance expectations. The stakes are high, and the challenge ahead is clear: engage members effectively, equitably, and in time.
Effective communication is a function of equity.
Ali Rizer of ATI Advisory emphasized that while Medicaid eligibility systems are the backbone of Medicaid, they were never designed to handle this level of pressure at scale. Too often, the result is that eligible individuals lose coverage during Medicaid redetermination, not due to changes in income or status, but because communication fails them.
“This is where we lose people, not because they’re no longer eligible, but because the system fails to reach them in time,” Rizer explained.
Timeliness and clarity are critical. Redetermination letters can be easily missed or misunderstood. To reach your members, you need to speak their language, both literally and figuratively. That means investing in language access, multimodal outreach and automated outreach, and tools that feel accessible and not intimidating.
Morgan Craven of ATI Advisory reiterated that outreach must reflect the linguistic and cultural diversity of Medicaid enrollees. “You can’t just send a letter in English and expect it to get the job done,” she said. Member engagement depends on personalized, culturally competent communication.
John Gorman, founder of Nightingale Partners, offered a systems-level perspective, underscoring that real-time data sharing between states and MCOs is essential. If MCOs find out too late that a member has lost coverage, it’s nearly impossible to intervene before a lapse in care occurs.
The solution isn’t just better coordination; it’s better infrastructure.
Plans must invest in modern systems that support automation, personalization, and responsiveness. That includes everything from smarter eligibility notifications to enhanced customer service support. In short, technology must do more than track compliance; it must actively support people throughout the Medicaid redetermination process.
MCOs can’t afford to treat these changes as a temporary compliance hurdle.
They must build long-term capacity to deliver consistent, high-quality member engagement across diverse populations. Investing now, knowing that these changes are coming through legislation and regulation, will better set MCOs up for success regardless of what the administration throws at them.
As an MCO or Medicaid stakeholder, ask yourself:
Are we communicating with our members in culturally and linguistically appropriate ways?
Do we have the infrastructure to act in real time when coverage is at risk?
Are we leveraging technology to serve people, not just process paperwork?
What’s happening now is more than a redetermination cycle. It’s a stress test for Medicaid’s ability to adapt, and a defining moment for MCOs to step into leadership roles that shape the future of health equity.
In Part 3, we’ll turn to the big-picture impact: how Medicaid reform can drive accountability, advance health equity, and deliver member-centered care that truly improves lives.
Missed the webinar? Click here to watch the replay and download a summary of key insights and concrete actions MCOs can take right now.