Clear language and human-centered design can help Medicaid enrollees keep their coverage

June 24, 2022

A Medicaid form with "Approved" stamped on it.Michigan’s expanded Medicaid program, the Healthy Michigan Plan (HMP), has provided health insurance coverage to hundreds of thousands of Michiganders since its launch in April 2014. In 2019, a work requirements bill was passed, requiring HMP enrollees to report a minimum of 80 hours of work per month to keep their insurance benefits. In order to reduce the number of people who might lose coverage unnecessarily, MDHHS developed a robust  communication strategy, incorporating input from users, and applying human-centered design approaches. The Center for Health and Research Transformation (CHRT) at the University of Michigan evaluated this work. Results from the evaluation are published in this month’s JAMA Health Forum.

The CHRT team led 11 focus groups and fielded a survey to collect data from community health navigators who help enrollees complete the administrative requirements needed to obtain and maintain coverage. Navigators reported that many of the steps taken by the state to improve the implementation of work requirements for beneficiaries were helpful.  

While Medicaid communications are traditionally text heavy and technical, MDHHS used simplified language, streamlined the format, and employed attention-grabbing colors and icons in letters to beneficiaries. 

“MDHHS worked with external communication experts and this novel approach had a very positive impact,” said Patrick Kelly, lead author of the evaluation, who completed the survey while serving on CHRT’s research and evaluation team. “Respondents reported that traditional Medicaid form letters may get lost in the shuffle and be challenging for beneficiaries to understand…. With the revamped letters, it appeared that beneficiaries’ attention was drawn to the envelopes and many brought the letters with them when meeting with navigators to discuss next steps.” 

While navigators reported overall improvements from traditional Medicaid communications, they remained concerned that the policy itself was very complex to understand, and therefore to apply. This included some challenges regarding the communication around exemptions and concerns about internet, telephone, computer, and language barriers. 

Research shows that administrative burdens can lessen the effectiveness of public health programs. The state of Michigan took steps to shift the administrative burden from individual beneficiaries by using administrative data where possible to automatically exempt and deem people in compliance with the policy. “This is a great improvement for the enrollees who are not always in a position to handle administrative requirements,” said Kelly.

In spite of all these efforts, about 80,000 enrollees were on track to lose their health insurance coverage had the policy continued to be implemented.

Lessons learned from this study could be effectively applied to other public benefit programs and policies to improve implementation and ensure that everyone can receive the benefits they are entitled to.

“As the federal public health emergency will soon end and many individuals will need to re-apply to maintain Medicaid coverage, state Medicaid agencies can learn from Michigan’s experience by using enhanced human-centered design approaches to communicating with beneficiaries,” says Dr. Renu Tipirneni, a widely regarded expert on the impact of health reform policies and programs on low socioeconomic status, aging, and other vulnerable populations, and on delivery of care in the health care safety net.


Cited article:
Kelly RP, Marcu G, Hardin A, Iovan S, Tipirneni R. Health Navigator Perspectives on Implementation of Healthy Michigan Plan Work Requirements. JAMA Health Forum. 2022;3(6):e221502. doi:10.1001/jamahealthforum.2022.1502