Contributed: Medicaid Denouement Highlights Digital Divide and Creates Urgency for Accessible Technology

2023 will be remembered, sadly, as the year millions of Americans were taken off Medicaid. As states reset their Medicaid eligibility rules post-pandemic, faster “unfolding” out of the door is seen that what was expected.

Even though the public health emergency, which guaranteed continued coverage to enrollees, barely completed in May, 1,625,000 people on Medicaid had already been deregistered as of July 5, 2023. Many people lost their coverage for avoidable procedural reasons rather than eligibility issues. Preventing millions more people across the country from experiencing coverage gaps, or even worse, loss of coverage, requires a solid understanding of the kinds of supports, tools, and educational materials that are accessible and helpful to this specific population.

With all the innovations the healthcare industry has seen in recent years, it’s tempting to lean towards a technology-driven approach. Technology can transform the healthcare system, but it’s all too easy to ignore simple technology and the barriers to access that can mean life or death for too many.

Studies have shown that low-income individuals and families—those most dependent on Medicaid for health care—have below-average access to Internet services. In fact, more than one in six people living in poverty do not have access to the Internet. While initiatives like the Equitable Broadband Access and Deployment (BEAD) Program— a $42.45 billion grant program created in the bipartisan Infrastructure Act — are proposed to address the “digital divide,” these solutions are the future state. Many Medicaid enrollees need help now.

The most important thing people on Medicaid can do is update their contact information to avoid losing coverage due to administrative issues. The burden is entirely on the patient, as “postal mail” with reminders will not always reach recipients, especially if they have moved during the pandemic. And if Medicaid enrollees don’t have web access, they also don’t get online reminders. Ultimately, there is a huge awareness issue that needs to be addressed along with the access issue.

With these tough hurdles, reinventing technology offerings is a necessity. How can existing solutions be complemented with new ways to alert Medicaid enrollees to what’s happening, help them maintain coverage, and benefit from the health technology tools available today?

Turn information into action

There are no “black and white” solutions when it comes to access issues, including the outcome of Medicaid. But if vendors accept that they are dealing with shades of gray and explore a more nuanced approach, technology can be leveraged to make a difference, as shown in the three ideas and corresponding actions below.

Idea #1: While overall internet access is limited among Medicaid enrollees, zooming in further, it is evident that a lack of home internet connection (i.e. broadband) is the real problem, with many people able to access online resources using their smartphones (i.e. mobile broadband or cellular data).

Online resources that explain how Medicaid enrollees can update their information with their state programs, manage coverage gaps, and find alternate sources of care if they lose coverage are incredibly helpful, but these platforms should be optimized for mobile viewing rather than assuming enrollees can view these resources on the desktop. It’s also ideal to use short URLs that are easy to remember and type on the phone’s small keypad.

Preview #2: Much of the Medicaid population is made up of communities of colorof which trust in institutions like government and healthcare professionals is often low. This is discouraging compared to what is happening with Medicaid since these institutions are currently the main sources of information. But there are individuals within these communities who can help.

Addressing the social determinants of health (defined as “the conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality of life outcomes and risks”) is critical to improving health outcomes for people with low incomes and disabilities. States have authority to treat SDOH through Medicaid. This means identifying resources to meet needs for housing, transportation, healthy food and more.

Community-based organizations that serve people’s needs tend to be led by people who know the people they serve very well and, as a result, enjoy a high level of trust. Community leaders can not only ensure that essential information about maintaining Medicaid coverage is provided to enrollees, but they can also provide high-speed internet access to ensure that digital tools ranging from educational resources to telehealth visits are available to the Medicaid population.

Some companies employ care navigators in low-income communities who come to people’s homes and bring Wi-Fi enabled tablets. This is a very effective strategy for supporting the use of health technologies, as the Medicaid population is arguably the one who will benefit the most from internet-based services like telehealth, as they tend to have higher rates of chronic disease and poorer health outcomes that the general population and additional touchpoints with providers via telehealth have the potential to solve this problem.

Idea #3: A hybrid approach is not only helpful when it comes to caregiving; it’s also a great way to deliver health-related educational content.

As stated earlier, technology is having a huge impact on opening up access to care, but it’s not the end of the world, it’s everything for consumers. One of the many lessons of the pandemic is that the future of healthcare is likely hybrid in nature.

For example, telehealth will not replace in-person care, but will remain a mainstay of the system that opens up the possibility of many other points of contact with patients, especially those with chronic conditions that require consistent adherence to treatment plans. Educational content should be disseminated in the same way, supplementing online resources such as Medicaid Information Centers with newspaper ads, flyers, and events in communities with large numbers of Medicaid enrollees at risk of losing coverage.

In Washington, DC, for example, a public health campaign called the “Don’t wait to update” campaign is launched and will include grassroots outreach through community events, as well as a toolkit that community organizations can tap into.

Health actors must continue to work to reduce the digital divide. Yet they must also work within the current system to develop short-term solutions that make health technology tools more accessible because there is no innovative technology that can compensate for an individual’s inability to access basic care through programs like Medicaid.