When the COVID-19 public health emergency (PHE) ends and Medicaid, CHIP, SNAP, and TANF waivers expire, will your human services agency be ready? The PHE was just extended through October and may remain in place through the end of 2022. Either way, the impact of the PHE ending will be felt soon.
When states begin to resume eligibility reviews, up to 15 million people could lose their current Medicaid or CHIP coverage through a process called “the unwinding.” (Also worth noting: around one in four Americans are currently enrolled in Medicaid or CHIP.) At the same time, tens of millions of SNAP participants could see a reduction in coverage too (or lose it entirely) when emergency allotments and administrative flexibilities end.
On top of this, consider everything that has changed since the beginning of the pandemic:
- Continuous eligibility has created a backlog of renewals
- Expanded benefits have increased applications and caseloads
- Agencies plan to continue supporting hybrid or fully remote work
- Human services agencies are juggling an unprecedented staffing crisis and workforce shortages
Preparing Your Human Services Agency for “The Unwinding”
Although it’s ultimately up to states to put processes into place for navigating the pending unwinding period, there are certain things your agency can be doing now to make sure you’re prepared to follow those processes and continue to serve clients without disruption whenever the time comes.
Here are some best practices and resources we’ve collected to help you plan for:
- Communicating with clients
- Identifying clients most at risk of losing resources
- Collecting, managing, and accessing documents and information
- Enabling your workforce to handle an uptick in cases and work
- Streamlining your lobby and appointment scheduling
Communicating with Clients
Communicating with clients will be critical to ensure no person falls through the cracks during the unwinding period. In fact, the Centers for Medicare & and Medicaid Services (CMS) has published an entire resource dedicated to this topic, “Medicaid and CHIP Continuous Enrollment Unwinding: A Communications Toolkit,” that includes what, when, and how to communicate changes, along with other advice.
If you haven’t already, now is a good time to start making sure you have the right contact information for each client you’ll need to reach, as well as (ideally) multiple channels for reaching them. Some examples:
- Mailing out letters to let people know they need to update their contact information.
- Collecting email addresses and phone numbers to let clients know their case is at risk of closing.
- Researching texting applications to send notifications, in addition to or in place of mail.
Additionally, some advice:
- Be proactive. We heard during a recent Human Services IT Advisory Group (HSITAG) meeting that when the state of California mailed out letters informing people to update their contact information, about 2 million people didn’t respond. The state is now working to find these people before the unwinding begins to hopefully not have clients experience a gap in coverage.
- Beware of supply chain issues. Supply shortages have been impacting agencies for a while now and will continue to cause problems with paper-based communication methods. For example, we’ve heard of some agencies who can’t get envelopes to send out their letters and notices.
Another CMS resource, “Top Ten Fundamental Actions to Prepare for Unwinding and Resources to Support State Efforts,” reiterates the need for multiple communication methods: “Use multiple strategies to obtain updated beneficiary contact information to mitigate coverage losses at renewals. Key strategies include managing returned mail, partnering with health plans, providers (including Indian health care providers), using multiple modalities to reach individuals (e.g., mail, email, text), and maintaining beneficiary contact, including through trusted stakeholders.”
Identifying Clients Most at Risk of Losing Resources
Some vulnerable populations may be more at risk of losing their benefits. Many of these clients have complex medical needs and may need assistance on how to reapply and continue their eligibility. A few examples we’ve heard:
- Adoption assistance or kinship children who have turned 18 and no longer qualify for automatic Medicaid eligibility.
- Elderly or disabled clients who have had continuous eligibility and may not know they’ll be required to report/verify again.
- Homeless or transient clients who are hard to reach for renewals and redeterminations.
Some agencies are exploring the possibility of having dedicated staff who could assist these clients to make sure they fully understand the impacts of the PHE ending and help them continue to get the resources they need.
Other agencies are looking at software products designed to help automate the identification of clients are likely eligible or ineligible for benefits. Clients that fall under the “likely ineligible” category will need their cases manually reviewed.
The Center on Budget and Policy Priorities has some additional guidance on this topic in their article, "Careful Planning Now Can Reduce Health Coverage Losses When Medicaid COVID-19 Continuous Coverage Ends."
Collecting, Managing, and Accessing Documents and Information
Chances are your caseworkers have been keeping pace with their current workload because you haven’t had to process renewals and can accept verifications over the phone instead of requiring the usual documents and paperwork. But will your current systems and processes hold up when renewals return to regular operations and cause an immediate uptick in document submissions?
Think about all the ways documents and information can enter your agency—mail, fax, email, customer portal, or in-person drop-off, to name a few. Without proper technology, it’ll require multiple workers, multiple steps, and a lot of time and paper to get all this information in the same place. A manual system like this won’t hold up through the unwinding.
A modern electronic document management system (EDMS) that streamlines application, renewal, and change processes will become even more valuable when caseworkers must start working through a backlog of extended renewals on top of their already increasing caseloads. A client portal is also a must have in today’s world when looking at systems to cut tedious steps out of just to get verification documents into a system. A system designed with human services in mind will help:
- Intuitively collect documents and upload directly to an electronic case file
- Automatically connect documents, forms, photos, and other content to the client and/or case
- Allow clients to submit documentation in a secure portal for any device – tablet, computer, or smart phone
- Automatically funnel multiple input channels into one workstream
- Make case and client data immediately available to all workers electronically as soon as it’s scanned into the system
- Allow caseworkers to find and filter case content by date or content type so they can quickly and easily find what they need
- Organize, track, and route work over the life of the case to ensure compliance and timeliness
- Integrate with other systems to create a bridge for effectively sharing client data and case information
- Provide options for mass import of client data and documents for processes in which document volume is high and/or complex
Enabling Your Workforce to Handle an Uptick in Cases and Work
Automating routine tasks to keep up with increased service demand has been a significant theme over the past couple of years. This need will only keep growing when waivers expire.
Consider the tools you initially put in place to help staff pivot at the start of the pandemic. If you haven’t done so already, now is the time to re-evaluate them for their long-term viability. Are they still providing value to your staff? Will they help them keep up with additional work to come? Do they allow them to prioritize tasks that require a human’s attention? All of these are important considerations to ensure your staff doesn’t get even more overloaded than they already are.
Here, technology that allows caseworkers to manage this oncoming work is only one piece of the puzzle. With unprecedented turnover and staffing shortages, the workforce has already been stretched so thin. It’s critical that you have strategies you have in place to make your workers feel supported through these pending changes. A few of our resources may help here:
- What’s Working to Solve the Staffing Crisis in Human Services?
- How to Re-Focus on Worker Well-Being and Foster Psychological Safety
- Hybrid is Here to Stay: How to Support Remote Teams in Human Services
It’s important to remember that some of your newer staff have never worked “the old way” and will need to be trained on how to handle all these new processes. Additionally, many of these workers are true “digital natives” who were brought up using technology and will expect simple, intuitive software to support their job. This is also true for many clients who have never experienced a time being on benefits when it wasn’t during a PHE. They’ve never had to do renewals/re-determinations before either.
Streamlining Your Lobby and Appointment Scheduling
Whether your agency intends to re-open your lobby or manage appointments remotely, you will likely need to rethink operations to keep up with an inevitable uptick in activity caused by the unwinding.
- How will you handle the influx of redeterminations and new intakes?
- How will you ensure caseworkers can complete applications and redeterminations within mandated timeframes when they apply again?
- How can you serve in-person clients efficiently without causing too much congestion?
- How can you improve clients’ experiences while minimizing the amount of time they spend in the agency?
- How can you reduce lines at the front desk? How can clients check themselves in?
- How are you managing caseload distribution to make sure work is evenly distributed and clients are served quickly?
So many current business processes for managing appointments were designed around people coming into the agency, but that’s no longer the norm. Sure, some clients will still want to come in to speak with a caseworker, but many clients will prefer to complete the process autonomously instead. It’s important to have technology that accommodates both.
We don’t know yet when the unwinding process will begin, but these steps can help you be ready whenever it does. That way, you can focus on helping clients navigate the pending changes.
While Northwoods can’t directly help you with everything, we can help your agency modernize technology and alleviate some stress in a few key areas—specifically document management, appointment management, and client engagement. Reach out if you’d like to speak with one of our social services experts.
Director of Advocacy Laura Haffield, Product Marketing Manager Lauren Hirka, Director of Customer Success Chuck Barber, and Director of Services Jon Eakins contributed to this post.