From Opt-In to Automatic: Review of MFPP Eligbility

Kira Eidson Phillips, J.D. (She/her)

States looking to protect coverage for people falling off the rolls for full benefit Medicaid should automatically consider enrollees for Medicaid Family Planning Program (MFPP) coverage during the initial application and at renewal without requiring the applicant to opt-in. This is a practical, high-impact strategy that keeps people covered, reduces churn, and improves health outcomes.

Federal regulations require state Medicaid agencies to consider a beneficiary’s eligibility for partial benefit programs at redetermination, prior to terminating an enrollee’s Medicaid coverage. Yet ICAN!’s research has uncovered that many states don’t do so for family planning coverage unless an applicant opts in. Removing the opt-in option and transitioning to a cascading application where MFPP eligibility is always considered before denying or disenrolling a person from coverage is the best way to ensure people in search of coverage are consistently paired with the most generous benefits option available to them.

If this change requires significant system and technological upgrades, states can shift to an opt-out application in the meantime, improving enrollment by setting the default application setting to select “Yes” to apply for Family Planning coverage, instead of having the default set as “No” or nothing selected. Illinois just implemented this change in its online benefits application.

This means that more Illinoisians will be connected to partial coverage, if ineligible for full benefits, and will be considered for family planning eligibility during ex parte redeterminations, if they’re found ineligible for full coverage.

Here are a few reasons why automatic review of MFPP eligibility without requiring an opt in is so beneficial!

It protects against coverage loss due to H.R. 1: MFPPs are not subject to H.R.1’s work requirements and 2x/year redeterminations. Thus, people losing coverage due to these changes can keep coverage for basic primary and preventative care services such as annual exams STI testing and treatment, contraception, preconception counseling, cancer screenings and more (the exact scope of covered services varies by state).

It ensures coverage continuity for new moms: When people roll off of their postpartum Medicaid coverage, many might become uninsured unless they qualify for parent/caretaker Medicaid or Expansion coverage. However, with automatic MFPP eligibility consideration, instead of falling off postpartum coverage, individuals can be enrolled in MFPP coverage without having to complete a whole new application, if eligible. This lets new parents maintain coverage that helps them achieve healthy pregnancy intervals, improving maternal and infant health outcomes.

It reduces churn, saving state dollars: Churn is expensive. Disenrolling and reenrolling an individual in Medicaid costs a state $400-$600 dollars per person. Automatic MFPP eligibility review ensures states are not unnecessarily wasting resources disenrolling folks from full-scope Medicaid coverage and reenrolling them into MFPP coverage.

It supports enrollment despite cuts to navigator programs: Enrollment navigator program budgets have been severely cut, leaving the public with fewer resources to support them navigating complicated enrollment processes. Automatic MFPP consideration reduces the need for re-enrollment support, allowing more resources to be spent on supporting new enrollees.

It ensures an applicant’s present needs do not limit their future benefits: People’s needs change. A one-time opt-in at application doesn’t capture new circumstances. If an applicant’s initial opt-in/out choice determines what they’ll be considered for at redetermination, many individuals who don’t need MFPP coverage now, but would benefit from it later face unnecessary administrative barriers to re-enrolling.

Here’s how states can make automatic MFPP review happen:

Step 1: Move to an opt-out application! If your state has an opt-in MFPP application, change the application setting so that the checkbox to apply for MFPP coverage is automatically checked when a person selects to apply for health care coverage. Individuals may still opt-out from having their MFPP coverage eligibility reviewed at the application and renewal, but this is an easy way to improve enrollment and reduce administrative burdens without significant system changes!

Step 2: Transition to a cascading application! Remove the opt-in/out box from the application and make MFPP coverage a normal part of the application cascade for applications and redeterminations. This just means that every time a person applies for medical assistance, they are considered for all medical assistance programs offered in the state. This transition may require larger system updates, thus transitioning to opt-out in the meantime protects coverage while updates are underway.

Don’t forget that implementation is key!

Whether your state moves to an opt-out or cascading model, it’s essential that new MFPP enrollees receive clear, plain language information that helps them identify what services they can get and where. ICAN! can support this work with tailored training, technical assistance, and resources to help patients where to go, who to trust, and that they can afford their sexual and reproductive health care.