Impact
- In just 10 months, we were able to enroll 140,000 people, nearly 70% of the state’s aged, blind, or disabled Medicaid population, in a renewal process that did not require clients to take any action.
- Our work to implement ex parte renewals reduced the time it took for caseworkers to process a renewal from 70 minutes to 11 minutes per case—translating to $4.6 million in annual savings for the state.
- We expect that Minnesota seniors and people who are blind or have a disability will get an extra $636 million in Medicaid benefits each year thanks to ex parte renewals.
The challenge
Health care benefits like Medicaid are critical for many people who are elderly or living with disabilities, who often rely on them for daily needs. But like any program that has eligibility criteria people have to meet, there’s a renewal process—which clients may not know about, and is often burdensome. Clients who don’t make it through the renewal process are often cut off from benefits for which they’re still eligible; then, they reappear a short time later at the program’s front door as new applicants. Processing new applications and re-enrolling longtime clients is more time consuming and expensive than a regular renewal—leaving state administrators, caseworkers, and clients with more work to do. For a few years following the COVID-19 Public Health Emergency, most people using Medicaid didn’t have to renew because of continuous enrollment provisions in federal pandemic legislation. But when that came to a close, states across the country were faced with an enormous challenge: processing renewals for hundreds of thousands of people, all at once.
Our approach
“Ex parte” renewals are a process by which government renews benefits using data that’s already available—essentially, a state can evaluate if someone is still eligible for Medicaid before sending any renewal paperwork, and if they are, automatically renew them. The Centers for Medicare & Medicaid Services already requires states to do this for all Medicaid cases—but many states don’t attempt ex parte renewals because their legacy systems don’t have this capability.
In Minnesota, the state was already using ex parte renewals for their Modified Adjusted Gross Income (MAGI) Medicaid population, which serves people who are parents, children, or pregnant, for example. But the non-MAGI program, which serves people who are age 65 or older, blind, or disabled, was using an older system that required clients to renew annually, even though the circumstances that qualified them for the program were unchanging.
We worked with Minnesota to implement a new ex parte process within their existing legacy system to help increase the number of people whose benefits are renewed automatically, with a specific focus on the mon-MAGI population. A key part of this work was working within that legacy system—because we know that replacing a system like that is a much bigger endeavor, with a significantly higher investment of time and money.
We began with a two-county pilot, and then later a four-county-pilot. At each stage of the process, we worked closely with county and state workers in policy, operations, and tech to understand how to roll out a process change in their legacy benefits management system. In both pilots, we held working sessions, giving county eligibility workers the opportunity to troubleshoot live cases with Minnesota Department of Human Services (DHS) policy and operations experts in the room. Building side-by-side with caseworkers who understood the intricacies and complexities of the process allowed us to turn their feedback into process improvements and ensured we stayed aligned with requirements and constraints.
Automation to save caseworker time was also a big part of our process. We worked with Minnesota IT Services (MNIT) and DHS operations experts to develop policy guidelines for identifying cases likely to be successfully renewed ex parte, and now, the state creates an automated list that indicates which cases the counties should try to renew ex parte. Additionally, we worked to create automatically generated notices that clearly inform clients their Medicaid has been renewed, so that clients know they don’t need to take any further action.
Outcomes
Ex parte renewals are a clear win-win-win. Caseworkers get an easier process for renewing simple cases and have more time to spend on complex ones. Clients get renewed benefits without having to go through a burdensome process. The state saves money and resources. What we proved in Minnesota has implications for the entire country.
We proved here that legacy systems don’t have to be blockers. Starting small and iterating, in this case, taking an existing system and improving processes within it, can have huge results. We were able to enroll nearly 70% of the state’s aged, blind, or disabled Medicaid population in an ex parte renewal process—and it now takes caseworkers an average of 11 minutes per case to process a renewal, down from 70 minutes. The state will save $4.6 million each year as a result. Our work with Minnesota shows that there is a more equitable and efficient process for renewing benefits, and a similar process could work in states across the country. Minnesota wasn’t alone in not using ex parte renewals for people who are elderly, blind, or disabled—a 2022 analysis of 40 states showed that 40% didn’t have an ex parte process for these populations. That means there’s a big opportunity to take the learnings from this state and apply them elsewhere. We can remove barriers to benefits renewal, make caseworkers’ lives easier, and save state resources, all while building trust in government.
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