As Medicaid work requirements are implemented across states, agencies face a difficult balancing act: maintaining program integrity and compliance while preventing procedural disenrollment that leaves eligible members without coverage.
The challenge isn’t theoretical. Lessons from the Medicaid redetermination process during the pandemic unwinding showed how quickly administrative barriers can disrupt access to care. Millions of members lost coverage—not due to ineligibility, but because of missed notices, outdated contact information, or difficulty navigating complex reporting systems.
The Core Challenge: Hard-to-Reach Medicaid Members
For many members, the barrier to compliance isn’t a lack of willingness but a lack of access. Hard-to-reach members, such as those with unstable housing, limited internet access, low digital literacy, or complex health and social needs, are often left behind by traditional communication and reporting systems.
Research suggests that roughly one in five Medicaid members falls into this category. Without proactive, tailored engagement, these members are at disproportionate risk of losing coverage due to procedural disenrollment, even when they meet all eligibility criteria.
Lessons from the Unwinding
States that embraced Medicaid engagement solutions—including mobile-friendly platforms, proactive outreach, and strong partnerships—were able to reduce churn and improve coverage continuity. These lessons provide a roadmap for meeting work requirements while preserving access to care for vulnerable populations.
A Framework for Protecting Coverage
Preventing unnecessary Medicaid coverage loss under work requirements demands a layered approach that combines technology, outreach, and community collaboration:
- Simplified, Accessible Technology
Member-friendly platforms support Medicaid eligibility reporting, offering multilingual interfaces, ADA-compliant design, and real-time compliance updates.
- Omni-Channel Outreach
Text messaging, email, phone calls, and in-person visits meet members where they are, improving engagement and reducing procedural disenrollment.
- Data-Driven Insights
Analytics dashboards help agencies identify at-risk members and prioritize resources for those most likely to lose coverage without intervention.
- Human-Centered Support
Trusted community health workers and peer navigators provide in-person assistance for members who need help understanding work requirements or completing documentation.
- Cross-Sector Collaboration
Partnerships with workforce agencies, social services, and local organizations make it easier to address barriers such as job documentation, transportation, or exemption education—reducing administrative burdens for agencies.
Balancing Integrity and Access
Medicaid leaders are under pressure to demonstrate program integrity, eligibility accuracy, and cost containment. By adopting a hybrid strategy of technology-enabled engagement and human-centered support, states can meet compliance objectives without sacrificing health equity or access to care.
Looking Ahead
As Medicaid work requirements evolve, the opportunity is clear: build systems that are proactive, inclusive, and efficient. With the right infrastructure, states can reduce churn, improve program efficiency, and protect coverage for the people who depend on it most.
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about best practices for implementing Medicaid work requirements.