The Real Risks Facing Medicaid: What Health Plan Leaders Are Seeing — and How MedZed Is Responding

As national conversations around Medicaid continue to focus on eligibility churn, coverage loss, and the impacts of HR1, front-line leaders are raising concerns that run far deeper. In a recent MedCity News article, MedZed CEO Scott Schnell joined other industry voices to highlight the underreported risks that health plans, providers, and communities are already grappling with — and what must happen next to stabilize the system.

At MedZed, we see these challenges every day in our work with health plans and vulnerable members across California and beyond. And we believe that addressing them requires a new approach: one that blends data, trust, human connection, and on-the-ground navigation.

Below, we explore the themes raised in the article and how MedZed is working to create solutions that meet the moment.

1. The “Quality-Metrics Math Problem” No One Is Talking About

In the MedCity News feature, Scott highlights a key issue health plans increasingly face:

Quality metrics are being applied to entire populations even though a sizeable portion of members are disengaged or unreachable.

This creates a mathematical impossibility. Even with high-performing clinical partners and aggressive outreach strategies, plans are being penalized for metrics they cannot realistically meet.

How MedZed Helps:

• Our Community Health Navigators make in-person, trust-based connections with members who have been historically disengaged.

• We help bring members back into care, close gaps, and improve HEDIS performance.

• Our field teams overcome barriers that digital tools alone cannot — transportation, mistrust, fear of systems, competing life priorities.

The result: more reachable members and a more achievable path toward quality improvement.

2. Redetermination Churn and the Hidden Cost of Instability

As Scott notes, eligibility redeterminations are no longer an annual event — and the increased churn has real operational and financial consequences.

Plans lose premium revenue when members fall off the rolls. Providers experience unpredictable visit volumes. Care continuity is disrupted. And members living with complex medical or social needs return months later with worsened conditions.

How MedZed Helps:

• Our teams proactively assist members with paperwork, documentation, and system navigation.

• We conduct in-home support to prevent avoidable churn.

• We help re-engage members who have already fallen out of coverage.

Stability isn’t just an administrative win — it’s a health outcome win.

3. A Growing Crisis in Provider Networks

Rural and safety-net providers are facing shrinking margins and increased operational demands. Many are reducing services, limiting availability, or leaving Medicaid networks entirely. This creates regions where members simply have nowhere to go.

How MedZed Helps:

• We meet members in their homes, removing geographic barriers.

• Our model extends the reach of health plans in areas where provider access is limited or unstable.

• We coordinate care, reduce unnecessary ED use, and connect members to the nearest available clinical resources.
  

Where provider gaps exist, MedZed becomes a crucial bridge.

4. Trust Is the Foundation of Engagement

One of the strongest themes in the MedCity News article — and in Scott’s perspective — is that trust determines outcomes.

Members who have felt overlooked or misunderstood by the system are unlikely to answer calls from plans or respond to digital outreach. But they respond differently when a MedZed Navigator knocks on their door.

How MedZed Helps:

• We build relationships first, interventions second.

• Our teams are trained in trauma-informed care, cultural humility, and motivational interviewing.

• We spend time understanding a member’s lived experience — barriers, fears, goals, and priorities.
  

Trust transforms engagement. Engagement transforms outcomes.

5. The Path Forward: Solutions That Meet Reality

MedZed’s work in Enhanced Care Management (ECM) and Community Supports (CS) is designed around the challenges highlighted in the article:

• The need for deeper engagement → In-person navigation

• The need for quality improvements → Gap-closing workflows and care coordination

• The need for stability → Redetermination support and re-engagement

• The need for access → Community-based interventions
  

We are committed to partnering with health plans and communities to build systems that are both sustainable and human-centered.

Read the Full MedCity News Article

To explore more insights from Scott and other leaders, read the full piece here:👉 https://medcitynews.com/2025/09/health-plan-leaders-reveal-underreported-medicaid-challenges-anticipated-risks-and-solutions/

Learn More About MedZed’s Work

MedZed is actively expanding partnerships to support Medicaid members with complex needs through ECM, CS, and care navigation services nationwide.

Contact us to learn more:👉 Contact | MyMedZed