Imagine this: a member who has worked for months, met every requirement, and still loses coverage. Not because they were ineligible. Because they never got a form filled out, or never understood they needed to.
That is the real risk with the new Medicaid Community Engagement requirements, and it is already keeping health plan leaders up at night. At the annual America’s Health Insurance Plans (AHIP) meeting in June, a regional Medicaid plan put a number on it: they estimated they would lose 30 percent of enrollment if members did not understand what was being asked of them. Most experts agree that the majority of members will still qualify under the new rules. The coverage losses will stem from something far more avoidable: paperwork that was never filed.
If you run member engagement or communications for a Medicaid plan, this is the moment to act, and here is what you need to know.
What is CMS & What Is It Asking For
CMS, the Centers for Medicare & Medicaid Services, the federal agency that runs Medicaid and Medicare, has introduced new Community Engagement requirements that apply to Medicaid beneficiaries. Under these requirements, most working-age Medicaid members must demonstrate they meet certain work, education, training, or community service requirements, or qualify for an exemption, to keep their healthcare coverage.
CMS has also set a mandate for how plans must communicate this to members. Between June 30th and August 31st of this year, plans must send a mail notification plus at least one additional form of communication explaining the rules. That is not a one-time task. Plans must continue notifying members at least once every six months through 2027 and beyond.
That recurring schedule exists because a member’s situation can change. Someone who is compliant today may need to update their documentation in six months if their job, school schedule, or caregiving responsibilities shift. This means Community Engagement communication has to become part of your ongoing outreach, not a single mailing you send and forget.
Why Mail Alone Will Not Reach Members
Mail has a poor track record with Medicaid populations, and recent data proves it. During post-pandemic Medicaid redeterminations, one large regional plan reported at AHIP that switching to digital outreach cut member disenrollment in half, from 30 percent down to 15 percent.
Most Medicaid members carry a mobile phone and prefer to communicate that way. But a phone call is hard to connect, and the details members need, work hour requirements, exemption categories, and reporting deadlines, are too long to fit in a text message. A short text with a link to a secure, encrypted web page solves both problems. It can explain the requirements in full, collect a member’s documentation, and connect them to the resources they need, without a phone call or a mailed notice that may never get opened.
What Members Need to Understand
Every communication about Community Engagement should cover four things clearly enough for a member to act on without outside help:
- Compliance rules: 80 hours per month of work, job training, education, or community service.
- Exemptions and how to claim them: medically frail members, caregivers, students, and other hardship categories.
- Consequences: coverage will be terminated if compliance or an exemption is not documented.
- Reporting: how and where to submit documentation each month.
If a member misses any one of these details, they risk losing coverage they were actually entitled to keep.
How SmartStory Can Help
SmartStory's digital engagement platform is built for exactly this kind of high-stakes member communication. Here is how it works:
- Patient Journey Navigator: Map out a Community Engagement journey step by step, from the first notification through documentation, exemption claims, and ongoing reporting, and adjust it as CMS guidance evolves.
- Custom Mobile Page Builder: Each message links to a secure mobile web page built for the member’s specific situation, rather than a generic notice.
- Content tailoring: Your teams set requirements based on state-specific regulations. SmartStory draws from a shared library of team-approved videos, documents, and plain-language educational content to support engagement journeys. Your team maintains full control over the content and resources available to members.
- Secure Messaging and Chat: If a member has questions that a web page cannot answer, your staff can step in directly via secure messaging, with a full audit trail of the conversation.
- HITRUST r2 Certification & HIPAA Compliance: Member data stays protected at every step, on infrastructure built for healthcare-grade security.
- Engagement Analytics: Track opens, clicks, and completions daily, so your team can see exactly which members have not yet documented compliance or an exemption and follow up before a deadline passes, rather than finding out after coverage is terminated.
Protect Member Enrollment Through Better Communication
Keeping eligible members enrolled should not depend on whether a letter gets opened. SmartStory’s platform gives your team the tools to reach members through the channel they actually use, track who has responded, and step in personally when someone needs help. That is the same approach SmartStory brings to specialty pharmacy and health plans for medication adherence, and preventative care programs across the country, now applied to Community Engagement.
Get in touch with us today to see how we can help you at this critical time.
