How do you not fall off a cliff? If you’re hiking along, say, the nearly 300-mile, North-South rim of the Grand Canyon, you stay on the trails, heed the warning signs, and never get too close to the edge. But what if the edge is exactly where the trail leads — and no matter what you do, you can’t avoid it?
That’s the reality millions of mothers on Medicaid may face if federal policy changes accelerate redeterminations and disrupt or downright eliminate care and coverage for some of the program’s most vulnerable members.
Redetermination and its impacts: The Medicaid maternity cliff is very real, and we already know the damage that redeterminations can do. Paused during the pandemic, redeterminations resumed in April 2023 and resulted in a loss of coverage for 25 million people. More than three years later, new federal policy changes have put that coverage cliff back in full view. The One Big Beautiful Bill is expected to increase both the frequency and impact of redeterminations, causing enrollment turnover and care disruptions that are even tougher to manage.
Many mothers on Medicaid already expect to lose coverage at some point due to redeterminations and most payers are bracing for moderate to major disruption of coverage and care. This includes delayed or avoided prenatal/postpartum, high-risk pregnancy, and specialty care. New financial barriers will play a role in access to these critical services.
The added impacts to health equity, birthing complications, and a maternal health system that is already in crisis put health plan leaders in an incredibly challenging position.
Predictable but perilous: Redeterminations serve a purpose, including protecting the fiscal integrity of a government that is more than $47 trillion in debt and that economists have declared insolvent based on the Treasury Department’s own financial statements.
In addition, health insurance will always be a churn enterprise — in general and for Medicaid in particular. Redeterminations play a rightful role in that churn but are so complicated that members risk losing vital coverage due to clerical errors, not just their financial eligibility. KFF reported that nearly 70% of members impacted by The Great Unwinding were disenrolled for paperwork or procedural reasons, and many joined the ranks of the uninsured.
Though predictable, redeterminations seem always to result in crisis. Coverage loss puts mothers and babies in peril. And when members lose coverage abruptly — especially if that coverage disappears mid-pregnancy or in the weeks after delivery — health plan leaders face gaps in care continuity that create significant financial and operational risk.
In the dotted line between policy and pregnancy, health plans must be ready, not reactive, if a mother’s coverage runs out mid-journey.
What health plan leaders can do: Payers must cover the care gaps that emerge from Medicaid redeterminations to bring members, and bottom lines, back from the brink. In my conversations with health plan leaders, five strategies dominate:
Increase targeted outreach and education. Know which members are at risk of losing coverage and why. Once identified, outreach and education must be proactive, personal, multilingual, and multichannel, with the right message delivered at the right time to inspire action.
Leverage partnerships. Work with providers and community organizations to manage disruption from coverage drop-offs. This step also helps identify members at risk of losing coverage and can help health plans act quickly to help them re-enroll or find another plan.
Identify opportunities to improve utilization and outcomes. Close care gaps and address unmet needs before members lose coverage. Conduct outreach during renewals to connect members with care they need but aren’t using.
Streamline transitions to other coverage. Facilitate warm handoffs to other types of coverage when Medicaid eligibility ends (e.g., marketplace plans, CHIP, commercial). This continuity-of-coverage pathway protects members, limits care disruption, and helps reduce higher-cost care when members regain coverage.
Forecast utilization changes. Analyze historical data to predict how redeterminations will affect the risk profile of the Medicaid population. Use these projections to adjust budgets and resources. Right-size programs for financial and operational stability as enrollment fluctuates.
Each of these strategies has financial implications, as do the budget cuts that effective plan leaders must be poised to make as they re-tool their programs following redeterminations.
The stakes for health plan leadership: Consumers and health plans see the same crisis looming, but both feel powerless to stop it. And yet, redeterminations are not a temporary disruption. They are a recurring stress on an already fragile system. Leaders who respond, not react, can build a more resilient health plan.
After all, when you know the cliff is there, there’s no reason to test its edge.
For more insights, please download our latest market report and survey findings, where 50 health plan leaders and 300 pregnant or recently pregnant women, as well as their caregivers, spotlight the looming loss of coverage and care disruption from Medicaid redeterminations — including who’s most at risk and how to curb the crisis. More than half of mothers on Medicaid (52%) anticipate losing coverage while 84% of payer leaders expect moderate to severe disruption due to these redeterminations.
