As we individually reflect and reevaluate at the turn of the year, so too must states in regard to their plans for unwinding the COVID-19 public health emergency (PHE) and corresponding Medicaid protections. As a reminder, states have been prevented from terminating people’s Medicaid coverage during the public health emergency in exchange for an increase in their federal match rate. States have already begun planning ways to expedite back-to-normal Medicaid redetermination routines during still-not-normal times. Such plans will undoubtedly kick many eligible Medicaid enrollees off of their coverage for critical health services.  

Massachusetts, on the other hand, has made thoughtful investments into outreach, education, and access by allocating Massachusetts’ Health Care for All (HCFA) $5 million to conduct a community-based Medicaid redetermination and vaccination campaign targeted in communities disproportionately impacted by the pandemic. The funds are part of an American Rescue Plan Act (ARPA) spending package and demonstrate an exceptional use of ARPA dollars, as the Urban Institute  among other sources  projects there will be unprecedented Medicaid disenrollment numbers once the protections currently in place end.  

HCFA has a history of conducting large campaigns to educate communities in a way that is multilingual and multicultural. For example, during their ACA campaign in 2015, HCFA supported Massachusetts Medicaid enrollees in navigating a new requirement to resubmit their Medicaid applications in order to maintain coverage. There are several parallels between HCFA’s 2015 ACA campaign and their current campaign, as enrollees undergoing the redetermination process will face an unfamiliar application cycle that may require assistance or discourage the enrollee from reapplying altogether. The lessons learned from the 2015 campaign can inform efforts for their current campaign and for other state advocates seeking cross-state learning opportunities 

  • Establish good relationships with your state Medicaid program and state legislature (if possible). HCFA has a longstanding relationship with Massachusetts’ Medicaid program, MassHealth, and the state’s marketplace, the Health Connector, through past campaigns and continued collaborations. HCFA obtained the recent funds because these programs recognize the important work that HCFA does and saw the benefit of their network and resources for outreach to enrollees who may be considered hard to reach.  

Additionally, it’s important to seek out strong Medicaid champions (this may be especially important in states where key Medicaid features may be at risk) and encourage them to highlight the consequences if their state rushes the redetermination process, through elevating the stories and experiences of Medicaid enrollees. 

  • Utilize data to inform campaign efforts. Data, particularly data directly from state Medicaid programs, can inform where individuals speaking any particular language may be residing, which populations face greater likelihood of redetermination, and what mode of communication works best for certain communities. HCFA bases their campaign strategies and planning on this data-driven approach. 

  • Build trust with communities. HCFA has built trust over a long period of time, not just when campaign opportunities arise, but by working and engaging with community leaders and community organizations on the ground on a consistent basis. A key feature of HCFA’s trust-building process is investing in communities and community groups. Oftentimes, community groups are tasked with rallying up their communities for little to no compensation. HCFA steers away from this inequitable model and ensures that fair and reasonable funding is provided to the groups for which they collaborate. Notably, these community groups are not only at the table as HCFA designs their campaign, but they are also leading the charge for how to communicate with their own community members.  

  • Utilize various modes of communication. These include community leaders, community-oriented media, one-on-one communication that is linguistically and culturally appropriate, WhatsApp messaging groups, mainstream media, partnerships, and providers.  

  • Use consistent messaging. Medicaid enrollees are likely receiving mixed messages as they receive renewals in the mail but are informed that their coverage is protected during the public health emergency. HCFA’s campaign will focus on answering questions and providing consistent guidance that communicates the need for enrollees to update their information, specifically mailing addresses. As such, enrollees can ensure that they are receiving all Medicaid notices and information.  

  • Recognize opportunities for dual work. HCFA sees that this campaign as an opportunity to couple the extensive outreach with continued vaccine equity work recognizing the dual importance of ensuring people stay covered and have equitable access to vaccines 

  • Connect people who are no longer eligible for Medicaid to Marketplace coverage. This will ensure that people have access to health care coverage with premium tax credits, making coverage more affordable (thanks to the American Rescue Plan!). 

HCFA’s model for tackling the unwinding of the Medicaid protections considers how to reach out to and educate those whose coverage is likely to be impacted. People depend on their Medicaid coverage to navigate medical conditions and medical care, particularly during uncertain times, and we should ensure that eligible people can maintain their coverage after the continuous coverage protections end. We hope that such measures can be taken in other states and we applaud Massachusetts for this investment.  

A special thank you to Hannah Frigand, HCFA’s Director of Education and Enrollment Services, and María Rosario González Albuixech, HCFA’s Director of Communications and Immigrant Health, for sharing their campaign strategies ahead of their important campaign!  

How is your state planning to unwind PHE protections? Email me at to let me know.