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Contributed: Medicaid unwinding highlights digital divide, creates urgency for accessible technology

2023 will be known, sadly, as the year millions of Americans were removed from Medicaid. As states reset their Medicaid eligibility rules post-pandemic, more rapid “unwinding” out of the gate is being seen than was predicted.

Even though the public health emergency, which guaranteed continuous coverage for enrollees, just ended in May, 3,289,000 people on Medicaid have been disenrolled as of July 21, 2023. Many people lost their coverage for avoidable procedural reasons rather than eligibility issues. To prevent millions more people across the country from experiencing gaps in coverage—or worse yet, loss of coverage—there needs to be a solid understanding of the types of support, tools and educational materials accessible and helpful to this specific population.

With all the innovation the healthcare industry has experienced in recent years, defaulting to a tech-first approach is tempting. Technology can transform the healthcare system, but it’s all too easy to overlook the simple technology and access barriers that can mean life and death for too many.

Studies have shown that low-income individuals and families—those most likely to rely on Medicaid for their healthcare—have below-average access to Internet services. In fact, more than one in six people in poverty have no internet access. While initiatives like the Broadband Equity Access and Deployment (BEAD) program—a $42.45 billion grant program created in the Bipartisan Infrastructure Law—are being put forward to remedy the “digital divide,” these solutions are 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 because of administrative issues. The burden is squarely on the patient because “snail mail” with reminders won’t always reach recipients, especially if they moved during the pandemic. And if Medicaid enrollees don’t have access to the web, they’re not getting reminders online either. The bottom line is there is a massive awareness problem that needs to be tackled along with the access issue.

With these challenging hurdles, reimagining tech offerings is a necessity. How can existing solutions be supplemented with new ways to alert Medicaid enrollees about what’s happening, help them keep their coverage, and benefit from the health tech tools available today?

Turning insights into action

There are no “black and white” solutions when it comes to access issues, including with Medicaid unwinding. But if providers 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 by the three insights and corresponding actions below.

Insight #1: While overall access to the internet is limited among Medicaid enrollees, when zooming in further, it is apparent that a lack of home internet connection (i.e., broadband) is the real issue; many people are 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, deal with gaps in coverage and find alternative sources of care if they lose coverage are incredibly helpful—but those platforms need to be optimized for mobile viewing rather than assuming enrollees can view these resources on desktop. It’s also ideal to use short URLs that are easy to remember and to type into a phone’s small keypad.

Insight #2: Much of the Medicaid population is comprised of communities of color, whose trust in institutions like government and healthcare professionals is often low. This is disheartening in relation to what’s happening with Medicaid since these institutions are currently the primary 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 key to improving health outcomes for low-income and disabled individuals. States are empowered to address SDOH via Medicaid. That means identifying resources to address needs around housing, transportation, healthy foods and more.

Community-based organizations that address the population’s needs tend to be run by individuals who are incredibly knowledgeable about the people they serve and, as a result, have a high level of trust. Community leaders can not only ensure that critical information about retaining Medicaid coverage is delivered to enrollees, but they can also provide broadband 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 into peoples’ homes and bring Wi-Fi-enabled tablets. This is a very effective strategy for supporting the use of health technology because the Medicaid population arguably stands to benefit the most from internet-based services like telehealth, as they tend to have higher rates of chronic disease and worse health outcomes than the general population and additional touchpoints with providers via telehealth have the potential to address this issue.

Insight #3: A hybrid approach is not just helpful when it comes to care delivery; it’s also an excellent way to deliver educational content related to health.

As stated earlier, technology makes a huge impact in opening up access to care, but it’s not the “end all, be all” for consumers. One of the many learnings 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 in the system that opens up the possibility for many more touchpoints with patients, particularly those with chronic conditions that require consistent adherence to treatment plans. Educational content should be delivered in the same way, supplementing online resources like Medicaid information hubs with newspaper ads, flyers and events in communities with high numbers of Medicaid enrollees at risk of losing coverage.

In Washington, DC, for example, a public health campaign called “Don’t Wait to Update” campaign is launching and will include grassroots outreach through community events, as well as a toolkit that community organizations can leverage.

Healthcare stakeholders should continue working to address the digital divide. Still, they must also work within the current system to develop short-term solutions that make health tech tools more accessible because there’s no innovative technology that can make up for an individual’s inability to access basic care through programs like Medicaid.

Doug Hirsch is the cofounder and chief mission officer of drug cost and telehealth company GoodRx. Hirsch was among the first 30 employees at Yahoo!, where he conceived and managed the earliest online communities, including GeoCities and Yahoo! Groups. In 2005, he joined Facebook as vice president of product. Later, Hirsch founded DailyStrength, a community for people facing health and life challenges. DailyStrength was acquired in 2008 by HSW International. 


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