Though COVID-19 is still a part of our lives, the federally-declared Public Health Emergency (PHE) may come to an end as early as January 2023. When that happens, many administrative processes that have been postponed as a result of the PHE will restart—including the need for people to renew their Medicaid enrollment. Over the course of the 14 months after the PHE’s expiration, millions of people will need to go through the renewal process or else lose access to their healthcare (and potentially their food assistance or other benefits that are jointly administered).
That will be hard on families—and it’ll also be hard on states that will likely see an increase in churn. Churn occurs when eligible clients’ benefits are discontinued, but they reapply soon afterward. When this happens, clients have to be processed as new cases, meaning more unnecessary work for clients and caseworkers. But states can and are taking steps to address this by implementing low-cost technology solutions that reduce churn by improving communication with clients—ultimately leading to better outcomes for families and caseworkers.
Why is churn so important to prevent?
When individuals churn, it results in a sudden loss of coverage that cuts their families off from critical access to food, medical care, housing assistance, and other safety net services. These individual are still financially eligible for benefits, but they often are unaware of or unable to meet reporting and renewal requirements. Sometimes this is a result of missed or misunderstood communications—or of complex and confusing procedural tasks that are required to keep benefits.
One study found that CalFresh (California’s name for SNAP) recipients are nearly six times more likely to leave the month they must submit their paperwork to keep benefits—even though at least 55% (and likely closer to 75%) of those who leave the program are estimated to be eligible. Similarly, an audit in Tennessee found that two-thirds of children lost access to their TennCare/CoverKids Medicaid coverage because of incomplete or unreturned paperwork, despite continuing to be eligible for benefits.
In many cases, it isn’t until these individuals try to use their benefits that they realize they’ve lost coverage. This happens at critical moments, like when an EBT card is denied at the checkout counter or a medical provider informs someone their health insurance is no longer valid.
These moments can be stressful and destabilizing for individuals and families who rely on safety net services. This cycle not only results in wasted time and frustration for the client, but also tremendous burdens for benefits providers.
The impact of churn on government agencies
For caseworkers and government agencies, churn can be a major financial and logistical issue. In most states, individuals who churn must submit an entirely new application, which typically requires more resources than other reports or a renewal. That extra workload can quickly add up. Here’s why:
- Churn is common: In Louisiana, one in four SNAP recipients churn in a given year. Recent data from California finds that 20% of all SNAP applications are submitted by households that were enrolled in benefits within the previous 90 days.
- Churn is expensive: In 2015, each instance of Medicaid churn was estimated to cost government agencies up to $600. The U.S. Department of Agriculture Food and Nutrition Service estimates each instance of SNAP churn costs an average of $80, which is three times the cost of a renewal.
- Churn strains capacity: When churn occurs, state and local administering agencies must spend additional time processing requests. For instance, SNAP reapplications take two to three times longer to process than a renewal. Agencies also see an increase in calls center activity from clients who are confused about their loss of benefits or have questions about regaining access.
Preventing churn with client-centered communications
Client-centered communications are thoughtfully designed and delivered messages that meet clients where they are. These communications provide key information about benefits and reporting and renewal requirements that can increase engagement and participation rates. The following guidelines offer steps governments can take to reduce churn and help clients keep their benefits.
Digitizing communication channels is critical. Government agencies need to meet clients where they are—on their phones and online. Many states have a paper-based reporting and renewal system, but traditional mail can be unreliable, and paper notices may not reach individuals without a consistent mailing address or stable housing. Texting and email are often far more effective tools to reach clients and explain important administrative steps they need to take to keep benefits, like interview appointments or paperwork due dates. In Michigan, Code for America partnered with Civilla to launch a two-way text messaging pilot between caseworkers and residents. The ability for clients to quickly communicate with caseworkers and submit paperwork digitally via their phone reduced the state’s determination time by three days and increased the application approval rate from 53% to 67%.
The importance of texting can’t be overstated. Text message notifications can reach clients who would otherwise be missed, like those without access to a computer. When Code for America worked with Louisiana to implement a texting intervention, nearly 27,000 clients opted-in with dramatic results: WIC recipients saw a nearly 80% increase in kept appointments (with 52% of clients successfully renewing over the baseline of 29%), SNAP renewals increased by 37%, and Medicaid renewals increased by 67%.
Frequent notifications should be used throughout the process to note important deadlines. These can tell clients when to submit a report or start a renewal application, attend an upcoming appointment, complete online forms or submit outstanding documentation, and check their application status. One of the best parts about a solution like this is that it may not be as heavy a lift as it seems—many text message and email notifications can be sent using affordable, user-friendly, off-the-shelf software, which means they can be quickly implemented without coordinating across vendors or existing internal systems.
Using clear language makes all the difference. Reporting and renewal processes, deadlines, and grace periods are confusing. Well-designed reminders that use plain language don’t just encourage people to act, but also clarify the process, next steps, and the consequences of not taking action.
What’s most important to note is that churn is a conquerable challenge. With tested, effective strategies, benefits providers can save money, reduce caseworker loads, and, most importantly, make life easier for clients— all with the added benefit of creating a more dignified, equitable, and modernized safety net experience.
Code for America partners with states to implement a variety of strategies designed to combat churn. If you are interested in learning more about how your state agency can partner with Code for America to reduce churn, submit our partnership form and we’ll be in touch.