White paper: How to engage Medicaid members for more equitable outcomes

When the COVID-19 public health emergency expires, nearly 80 million Medicaid members will have their eligibility redetermined. This redetermination will disproportionately impact members of under-resourced communities, which comprise the majority of Medicaid members. However, many Medicaid members are unaware of this risk of coverage loss due to low engagement with their plan.

This is just one of many reasons Medicaid plans need to focus on improving engagement to support their members. Knowledge of health plan benefits informs a higher standard of care for members. Unfortunately, social determinants of health, socioeconomic status, race, and preferred language are too often not factored into plan communications, resulting in low response rates. Tailored outreach that acknowledges these critical factors can improve engagement, establish trust, and result in better health, satisfaction, and quality ratings.

Establishing trust and building consumer health profiles to improve care

Overcoming barriers to care requires examination of three key factors, including individual habits, social determinants of health (SDoH), and reachability and communication preferences. Medicaid members have the highest rates of poverty and often experience other challenges, such as inadequate access to transportation, which prevent regular check-ups. Engagement opportunities can improve outreach and member retention to achieve equitable health outcomes across a wide array of health plan programs (Figure 1).

Enrollment and Onboarding


Preventive Care

Condition Management and Episodic Care


Enrollment in Medicaid MCO

Health and SDOH Assessment

Establishing a Medical Home

Managing Conditions


  • Welcome outreach
  • PCP assignment
  • ID card distribution


  • Mail, phone, or digital health risk assessment and resulting care
  • Member action plans including member education or enrollment in care management programs


  • Annual wellness visit
  • Vaccinations
  • Preventive dental (in some states)


  • Chronic conditions: diabetes, asthma, COPD, heart disease, depression
  • Prenatal and postpartum care post-hospital discharge


  • Annual eligibility review
  • Renewal of benefits


Figure 1. Medicaid member engagement opportunities.

Empathy should be at the forefront of communications as plans adapt their messages for multiple audiences, going beyond simple translation to capture cultural nuances. This is bolstered by a “whole-person” approach to care management, which considers the complete picture of member data to optimize understanding of patients’ needs. Inequities are maintained in the healthcare system through failure to close gaps in care and unequal resource distribution when critical member data is overlooked. Segmentation of plan membership enables plans to target each population at the right time with the right message.

How can plans combat low engagement and improve quality scores?

Ultimately, plans that invest in proactive member engagement strategies will yield higher quality scores and deliver a better member experience and health outcomes. Read our new white paper and learn how Medicaid plans can support whole-person, culturally competent, and equitable care—from enrollment to renewal.

Read the white paper


Roberto Arce
As senior vice president of engagement and health equity, Roberto Arce is focused on improving healthcare outcomes through Cotiviti’s Risk Adjustment, Network, Quality, and Consumer Engagement solutions. Roberto and the Eliza team strive to use healthcare analytics and intelligent engagement outreach solutions to drive closure in care gaps, improve consumer quality, and move population health across various cohorts and cultures.

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