Medicaid Enrollment Surges: How Health Plans Can Best Care for Chronically Ill Members during COVID
September 4, 2020

What was once projected to be a relatively flat year for Medicaid enrollment actually became an unexpected enrollment surge due to the COVID-19 pandemic. Enrollment growth is ongoing and is expected to remain high into 2021.


What does this Medicaid enrollment surge mean for health plans? How can Medicaid managed care organizations (MCOs) ensure their new and existing members with chronic diseases are adhering to their care plans, despite being physically removed from the clinical setting due to the pandemic?

Medicaid and COVID: Changes in enrollment since the start of the pandemic

The counter-cyclical nature of Medicaid enrollment is such that when the economy is down, enrollment generally trends upward, and vice versa. Most recently, Medicaid enrollment peaked in:

  • 2002 and 2009, due to recessions
  • 2010, when the Affordable Care Act (ACA) was passed
  • 2015, the first full year in which major ACA coverage expansions (e.g., Medicaid expansion) were implemented

COVID-induced economic distress and widespread job loss are largely responsible for increased Medicaid enrollment in 2020. As more people lose their jobs, their primary source of income, and their employer-based insurance coverage, their health insurance status changes. Many end up qualifying for Medicaid, especially in states that have chosen to expand Medicaid. (In states that have not expanded Medicaid, more people are likely to end up uninsured.)

What these changes mean for Medicaid health plans

In a trickle-down effect, higher enrollment means that Medicaid MCOs are tasked with keeping more people healthy in a climate where healthcare delivery has transformed. Under normal circumstances, chronic condition management is tightly linked to clinical, ambulatory care settings.


But now, members are being encouraged to manage their conditions from home due to COVID precautions. And in some cases, they’re choosing to avoid healthcare facilities to minimize their risk of coronavirus exposure.


Many new and existing enrollees already faced the challenge of uncontrolled chronic conditions and are at risk for negative health outcomes because of it. Without gaining control of their conditions during the pandemic, their health will likely continue to deteriorate over the next several months to years as we adapt to a COVID world.


This can lead to costly consequences for members and health plans. Members will be more likely to experience the cumulative effects of uncontrolled chronic disease, leading to increased morbidity, higher utilization of expensive health resources like emergency rooms and urgent care facilities, and therefore, higher costs.


So how can health plans support their members—especially their high-risk, difficult-to-manage, and newly-diagnosed populations—with disease state management from home?

How financial incentives can help Medicaid enrollees get and stay healthy during the pandemic and beyond

Wellth is a digital solution that uses financial incentives and individualized conversations to support and increase your members’ chronic condition care plan adherence. Offering incentives that are meaningful, usable, and instant can be the key to improving care plan adherence, especially in a time when consistent disease state self-management is critical.


Wellth is a powerful tool for health plans and an impactful one for members because it addresses the root causes of poor self-management through the principles of behavioral economics (BE). BE acknowledges that there’s often a gap between what someone intends to do and what they actually do. It’s simply a part of human nature.


For example, members may fully intend to take their medications on time, check their blood sugar before meals, or monitor their blood pressure daily. But that doesn’t mean they’ll always do it, especially because many members have competing priorities and urgent needs in addition to maintaining good health.


Oftentimes, generating the momentum needed to establish healthy habits like these is the steepest barrier to overcome. Strong incentives—financial incentives, in particular—bolster that momentum and make those barriers more easily surmountable.


Offering financial incentives upfront for completing care plan-based tasks motivates those same individuals to follow through on these tasks in order to keep the monetary reward they already have access to. In this way, the incentive helps close the gap between their intent and their behavior, increasing the likelihood that members stick to their care plans and build the habits necessary to manage their disease states appropriately.


The beauty in this arrangement is that as healthy habits are established, members become more confident in their ability to remain consistent, and positive health outcomes become more evident. The external financial reward ultimately fuels motivation from within to continue good disease state management habits, even after the financial incentive is no longer offered.


When more of your members are reliably managing their disease states consistently and accurately, you reap the rewards of more positive health outcomes, reduced utilization, and less healthcare spending.


Download the Wellth Program Summary to learn how we can support your health plan members in establishing healthier habits, during COVID and beyond.


  • Drug Channels Institute analysis of National Health Expenditure Accounts, Office of the Actuary in the Centers for Medicare & Medicaid Services. Figure for 2019 reflects CMS projection. Figure for 2020 reflects estimates by Health Management Associates. Published on Drug Channels on April 15, 2020