Unintended Consequences of Medicaid Unwinding: The Human Side

As the COVID-19 public health emergency came to an end, states have begun reassessing Medicaid eligibility, in a process referred to as the “Medicaid Unwinding.” On paper, this sounds straightforward. But in reality, the process has led to a cascade of unintended consequences, leaving many vulnerable people without the coverage they need, and unprecedented challenges for MCOs to navigate.

Real Stories of Real People: The Human Side of Unintended Consequences

At Agilian, we’ve seen firsthand how these unintended consequences play out. In one state, a software bug led to the wrongful disenrollment of hundreds of beneficiaries. Among them were families with newborns in neonatal intensive care, suddenly facing astronomical medical bills with no insurance. The confusion and fear these families experienced were palpable. And unfortunately, their stories are not unique.

In another case, we worked with an MCO that discovered a systemic error that had been causing wrongful disenrollments for years. One woman, a cancer patient in the middle of chemotherapy, received a notice that her coverage had been terminated. Without insurance, she couldn’t afford her treatments. Thankfully, the error was corrected, but not before she endured weeks of uncertainty and fear.

For MCOs, this means…

MCOs are facing unprecedented challenges in business, administration, operations, and technology.

• Financial losses due to wrongful disenrollments

• Increased administrative burden

• Disruption of care continuity

• Compliance risks

• Membership growth and retention risks

• Operational challenges

What Can Be Done? Moving Forward After Unwinding

So, what can be done to prevent these unintended consequences?

• Unified data infrastructure

• Automated tools and processes

• Enhanced communication channels

• Predictive analytics

• Interoperable systems

How an MCO overturned the disenrollment of 20% of its members

By implementing a centralized data system, automating data management processes, and developing an intuitive dashboard for enrollment data, an MCO was able to recover 20% of its members. Read the full white paper for more information.

Medicaid unwinding was never meant to cause harm, but the reality is that many people have been caught in the crossfire of bureaucratic errors and systemic issues. By recognizing the human impact of these unintended consequences, we can work together to create a more compassionate, effective healthcare system. It’s about more than fixing errors—it’s about safeguarding the health and well-being of those who depend on Medicaid every day.

Let’s not let these stories be forgotten. Let’s use them as a call to action to improve the system for everyone.