Socially Determined Launches Redetermination Risk Solution to Empower Managed Care Organizations to Retain Eligible Medicaid Members as Pandemic-Era Continuous Enrollment Provision Ends

WASHINGTON—-Socially Determined^®, the social risk analytics and solutions company leading the integration of health and social care, today announced a new solution for Managed Care Organizations (MCOs) nationwide. The offering, a Redetermination Risk Roster, empowers MCOs to proactively identify, engage, and assist vulnerable Medicaid beneficiaries in navigating the eligibility recertification process scheduled to resume on April 1.

“For many socially determined reasons, from educational attainment, language barriers, and health literacy challenges to cell phone ownership, broadband access, and frequency of household moves, millions of eligible Medicaid beneficiaries may experience coverage gaps, access challenges, and ultimately disparities in care as a result of this process”

As part of this process, more than 90 million Medicaid beneficiaries nationwide will be required to re-establish their coverage eligibility, following the end of the continuous enrollment provision introduced under the Public Health Emergency in March of 2020. According to the Urban Institute, over the coming year up to 18 million current Medicaid beneficiaries are at risk of losing coverage as part of this process. Of these, estimates suggest that up to 40 percent still meet the Medicaid program’s eligibility requirements, however, they will be unable to navigate the re-certification process successfully due to administrative and social barriers.

“For many socially determined reasons, from educational attainment, language barriers, and health literacy challenges to cell phone ownership, broadband access, and frequency of household moves, millions of eligible Medicaid beneficiaries may experience coverage gaps, access challenges, and ultimately disparities in care as a result of this process,” said Ashley Perry, Chief Strategy & Solutions Officer at Socially Determined. “Beyond the very real human toll of this, MCOs are also at-risk of losing a meaningful percentage of their members, resulting in a significant impact on their business. For these reasons, we’ve deployed our social risk data, platform, and insights to empower MCOs to proactively identify members most likely to benefit from recertification support. By helping our clients identify these people, it allows their outreach teams to proactively engage the people who need it most.”

Socially Determined’s Redetermination Risk Solution is an innovative model that considers factors such as member education levels, preferred languages, frequency of address changes, access to technology, and other community, demographic, and social risk factors to proactively identify members most likely to require support to maintain their coverage. Using a simple member roster, the SocialScape^® platform assesses risk across an entire member population and then delivers a prioritized roster back to plans so outreach teams know with precision which members should be the focus their efforts.

Existing Socially Determined customers are also able to analyze this data in the context of other social risk insights that the SocialScape platform generates, such as Financial Strain, Food Insecurity, Housing Instability, and Transportation Barriers, allowing them to further refine member outreach and support strategies.

Socially Determined built the Redetermination Risk Solution on top of its SocialScape platform, which already provides social risk data, analytics, and expertise to payers, providers, life science companies and risk-bearing entities. These actionable social risk insights and solutions enable organizations to quantify and mitigate the impact of social risk on utilization, costs, outcomes, and equity for their full market and member population. The foundation created by the company’s existing industry-leading social risk data and platform allowed the company to deploy this new solution less than three months after the end of continuous enrollment was approved by Congress as part of the Omnibus bill in December 2022.

For more information on the Redetermination Risk Roster, contact Socially Determined at https://www.sociallydetermined.com/contact-us.

About Socially Determined

Socially Determined is leading the integration of health and social care through social risk analytics. Its SocialScape^® platform, social risk data solutions and industry-leading expertise empower health systems, plans and other risk-bearing organizations to manage risk, improve outcomes, and advance equity – at scale. Headquartered in Washington, DC, Socially Determined has been named as one of the 15 most promising healthcare companies by Fierce Healthcare. For more information, visit www.SociallyDetermined.com.