There's a way to fund retention work that most plans haven't considered.
Right now, it typically lives in admin, a budget that's flat or frozen almost everywhere. Good retention work gets pitched, gets approved in principle, and then sits behind headcount caps and cost controls that have nothing to do with whether the work pays off.
Here's the piece that changes the equation: under 42 CFR § 438.8, retention infrastructure that identifies members at risk of procedural disenrollment can qualify as a quality improvement activity. That means it can route through medical expense instead of administrative spend.
Same work. A budget that isn't fighting for scraps.
And the quality connection goes further than where the dollars sit. A member who's about to churn doesn't just cost you premium. They cost you data. Care management investment gets directed at members who are already on their way out. Denominators fill with people who were never going to be measurable long enough to count. That shows up as:
In state quality incentive programs tied to performance categories, that noise adds up. Coverage gaps, not care gaps, can quietly pull down scores and put incentive dollars at risk.
There's a pattern we keep running into across markets: this work often lands directly inside a plan's existing Quality Improvement Projects. When retention shows up as a QIP outcome, it isn't just funded correctly. It's funding itself, and often more than that.
We think this deserves a second look: retention isn't just an outreach line. It's a data problem with a quality outcome, and there's a funding path built for exactly that.
More on how this works in practice, coming soon.
#Medicaid #MedicaidManagedCare #HealthPolicy