Contributed: Medicaid dismantling highlights digital divide, creates urgency for accessible technology

2023 will be known, sadly, as the year millions of Americans were kicked off Medicaid. like states reset their post-pandemic Medicaid eligibility rules, faster-than-anticipated “unwinding” is being seen out of the gate.

Although the public health emergency, which guaranteed continued coverage for enrollees, only ended in May, 1,625,000 people in Medicaid had already disenrolled as of July 5, 2023. Many people lost their coverage for avoidable procedural reasons rather than eligibility issues. To prevent millions more people across the country from experiencing gaps in coverage—or worse, loss of coverage—there must be a solid understanding of the types of supports, tools, and educational materials accessible and useful for this specific population.

For all the innovation the healthcare industry has experienced in recent years, it’s tempting to fail at a technology-first approach. Technology can transform the healthcare system, but it’s all too easy to overlook simple technology and access barriers that can mean life and death for many.

Studies have shown that low-income individuals and families—those most likely to rely on Medicaid for their health care—have below-average access to Internet services. In fact, more than one in six people in poverty do not have access to the Internet. While initiatives like the Broadband Equity Access and Deployment (BEAD) program—a $42.45 billion grant program created in the Bipartisan Infrastructure Act—are being introduced to remedy the “digital divide,” these solutions are future state. Many Medicaid enrollees need help now.

The most important thing people on Medicaid can do is update their contact information to avoid losing coverage due to administrative issues. The burden is squarely on the patient, because “snail mail” with reminders will not always reach recipients, especially if they moved during the pandemic. And if Medicaid enrollees don’t have web access, they aren’t getting online reminders either. The bottom line is that there is a massive problem of awareness that needs to be addressed along with the issue of access.

With these challenging obstacles, reimagining technology offerings is a must. How can existing solutions be supplemented with new ways to alert Medicaid enrollees to what’s happening, help them maintain their coverage, and take advantage of the health technology tools available today?

Turning knowledge into action

There are no “black and white” solutions when it comes to access issues, including Medicaid mitigation. But if providers recognize that they’re dealing with shades of gray and explore a more nuanced approach, technology can be used to make a difference, as demonstrated by the three insights and related actions below.

Insight #1: While overall Internet access is limited among Medicaid enrollees, when zoomed in further, it is clear that lack of home Internet connectivity (ie, broadband) is the real problem, with many people able to access online resources using their smartphones (ie, mobile broadband or cellular data).

Online resources that explain how Medicaid enrollees can update their information with their state programs, deal with gaps in coverage, and find alternative sources of care if they lose coverage are extremely helpful—but those platforms should be optimized for mobile viewing rather than assuming that enrollees can view these resources on a desktop. It’s also ideal to use short URLs that are easy to remember and type on the phone’s small keyboard.

Insight #2: The majority of the Medicaid population consists of communities of color, whose trust in institutions such as government and health care professionals is often low. This is disheartening about what is happening with Medicaid as these institutions are currently the main sources of information. But there are individuals within these communities who can help.

Addressing the social determinants of health (defined as “Conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health outcomes and risks, functioning, and quality of life”) is key to improving health outcomes for low-income and disabled individuals. States are authorized to address SDOH through Medicaid. This means identifying resources to address needs around housing, transportation, healthy foods and more.

Community-based organizations that address the needs of the population tend to be led by individuals who have exceptional knowledge of the people they serve and, as a result, have a high level of trust. Community leaders can not only ensure that critical information about maintaining Medicaid coverage is provided to enrollees, but they can also provide broadband Internet access to ensure that digital tools ranging from educational resources to telehealth visits are available to the Medicaid population.

Some companies employ care navigators in low-income communities who come to people’s homes and bring Wi-Fi tablets. This is a very effective strategy for supporting the use of health technology because the Medicaid population can benefit most from Internet-based services such as telehealth, as they tend to have higher rates of chronic disease and poorer health outcomes than the general population, and additional contact with providers through telehealth has the potential to address this issue.

Insight #3: A hybrid approach is not only beneficial when it comes to providing care; it’s also a great way to deliver health-related educational content.

As stated earlier, technology is having a huge impact on opening up access to care, but it is not the “end all, be all” for consumers. One of the many lessons of the pandemic is that the future of healthcare is likely to be hybrid in nature.

For example, telehealth will not replace in-person care, but will remain a pillar in the system that opens up the opportunity for many more touchpoints with patients, especially those with chronic conditions that require ongoing adherence to treatment plans. Educational content should be distributed similarly, supplementing online resources such as Medicaid information centers with newspaper ads, flyers, and events in communities with high numbers of Medicaid enrollees at risk of losing coverage.

In Washington, DC, for example, is launching a public health campaign called “Don’t Wait to Update” and will include grassroots outreach through community events, as well as a toolkit that community organizations can use.

Healthcare stakeholders must continue to work to address the digital divide. However, they must also work within the current system to develop short-term solutions that make health technology tools more accessible, because there is no innovative technology that can compensate for an individual’s inability to access basic care through programs like Medicaid.