Protecting Continuity of Care: Why Medicaid Member Engagement Must Guide HR1 Implementation
MedZed's Vice President of Quality and Compliance Programs, Dana Miller-Martinez, shares why keeping vulnerable Medicaid members connected to care must remain a priority as new requirements take effect.
As Medicaid programs prepare for changes under H.R. 1 (HR1), healthcare organizations face growing challenges around eligibility verification, reporting requirements, and coverage redeterminations.
But amid these administrative changes, one critical question remains: How do we ensure vulnerable Medicaid members continue receiving the care they need?
In a recent article published by Healthcare Business Today, Dana Miller-Martinez, Vice President of Quality and Compliance Programs at MedZed, explains why continuity of care must be central to HR1 implementation—not simply an outcome organizations hope to achieve.
When Administrative Barriers Become Healthcare Barriers
For Medicaid members managing complex medical, behavioral health, and social needs, maintaining coverage can already be difficult.
Housing instability, transportation challenges, limited access to technology, and difficulty navigating healthcare systems can make completing paperwork or responding to eligibility notices particularly challenging.
The consequences can extend far beyond losing coverage.
In her article, Miller-Martinez highlights that during the post-pandemic Medicaid unwinding, more than 25 million people were disenrolled, with nearly seven in ten disenrollments occurring for procedural reasons rather than eligibility determinations.
These disruptions can result in delayed treatment, missed medications, worsening chronic conditions, and potentially avoidable emergency department visits.
For health plans, successful implementation must mean more than completing administrative requirements. It must also mean keeping eligible members connected to care.
Moving Beyond Traditional Member Outreach
Phone calls, mailed notices, and digital reminders remain important communication tools. However, they may not be sufficient for reaching members facing significant social and healthcare challenges.
At MedZed, our Community Health Navigators take a more personalized approach.
By meeting members where they are, our teams help individuals understand requirements, navigate documentation, address barriers, and connect with healthcare and community resources.
This relationship-driven model can help health plans support members through complex administrative processes while maintaining meaningful engagement.
Why Continuity of Care Matters for Health Plans
As HR1 implementation progresses, Medicaid health plans must balance operational requirements with the responsibility to support member health.
Maintaining continuity of care can help organizations:
Reduce the risk of eligible members losing coverage because of administrative barriers.
Support ongoing treatment and medication access.
Strengthen engagement with hard-to-reach populations.
Address health-related social needs that interfere with care.
Help prevent avoidable deterioration in health and unnecessary utilization.
The central message is clear: Administrative compliance and quality outcomes should work together—not compete for attention.
Read the Full Article
In Healthcare Business Today, Dana Miller-Martinez explores the implications of HR1 implementation and why protecting continuity of care should guide how healthcare organizations approach upcoming Medicaid changes.
Partner With MedZed to Keep Members Connected to Care
As Medicaid requirements evolve, engaging vulnerable populations and helping members navigate barriers to care will become increasingly important.
MedZed partners with Medicaid health plans to reach hard-to-engage members, address health-related social needs, support care coordination, and help individuals remain connected to essential healthcare services.
Our combination of community-based navigation and technology-enabled support helps healthcare organizations extend their reach while focusing on the members who need assistance most.
Is your health plan preparing for HR1 implementation?
Contact MedZed to learn how our member engagement and care management solutions can support your organization and the members you serve.
