Medicaid member engagement and the
six-month clock

Summary

• Beginning December 2026, Medicaid expansion adults face eligibility redeterminations every six months. 
• Many members who lose Medicaid coverage lose it for procedural reasons, not because they no longer qualify.
• The members hardest to reach by mail and portal are often the ones who need continuous care the most and have the least help navigating the system.
• Reaching these members where they are, in their language and on the channels they use, is what keeps them covered and in care all year.

Maria had already been on Medicaid for three years when her coverage lapsed. Nothing about her eligibility changed. What changed was her address. After her rent climbed for the second time in a year, she and her two children moved to her sister’s house across town, and her renewal packet went to the apartment she already left. She found out her coverage lapsed when standing at a pharmacy counter, wondering how she was going to pay full price for her medication. In the end, she left without it so she could afford groceries that week.

Maria’s story repeats thousands of times every renewal cycle. Eligible members lose the benefits and care they qualify for, simply because a renewal packet couldn’t find them.

Beginning December 2026, every expansion member faces that risk twice as often. Under H.R. 1, Medicaid expansion adults must have their eligibility redetermined every six months.¹ For plans, every determination is another moment an eligible member like Maria can quietly lose coverage. The Congressional Budget Office estimates this provision alone will add roughly 700,000 people to the uninsured by 2034.¹ 

H.R. 1 is new, but the challenge underneath it isn’t. Reaching members like Maria has always been challenging, and the six-month clock raises the stakes on getting it right.

Why eligible members fall through, and what it costs

The COVID-19 pandemic already showed us how a paper-driven renewal process fails members like Maria. When pandemic-era continuous enrollment ended and states resumed redeterminations, more than 25 million people were dropped from Medicaid and CHIP. Of them, nearly seven in ten lost coverage for procedural reasons rather than eligibility, such as an unreturned form or an address that no longer matched.²

Those losses point to a structural  issue that health plans face. The channels most plans rely on, such as member portals, paper mail, and call centers, were built to record transactions, not reach a member and move them to act. They also weren’t built for the populations that Medicaid and Medi-Cal serve: members who move frequently, often speak languages other than English, work hours that don’t line up with a call center, and are mobile-first. 

Maria fit that description and lost coverage because no one reached her in the channels she actually uses. The same failure now plays out on a shorter, fixed cycle, making Medicaid member engagement more critical than ever. 

When a member loses coverage over a missed notice, they lose the medications, checkups, and chronic-condition support their plan exists to provide. For health plans, that lost member also means lost capitation, the administrative cost of re-enrolling and re-engaging them later, and disruption to quality measures like HEDIS and Stars. 

Renewal is the most visible moment, but not the only one

A member a plan can’t reach for renewal is just as hard to reach for a checkup, a refill, or a follow-up. Maria’s out-of-date address means she also missed a mailed reminder to schedule her yearly mammogram. Her language barrier also stopped her from booking an appointment for her son’s asthma. While renewal is the most visible moment, the cost of failing to reach members and guide their next action adds up every day.

For Medicaid populations, that challenge is heavy. These members are often managing chronic conditions, coordinating care for their kids, and stretching limited time and financial resources to stay healthy. And when outreach finds them, transportation and language barriers can prevent them from taking the next step.

Plans serving these populations are working to keep members healthy and covered. Increasingly, whether they can do that comes down to a simple operational question: can they reach their members and move them to act, throughout the entire year? 

What Medicaid member engagement really takes

Closing the Medicaid member engagement gap takes more than call centers, mailed notices, or portals that members forget to log into. It takes infrastructure that reaches members through the channels they already use, in the languages they speak, and makes it easy for them to take the next best action, whether that’s a renewal, a follow-up appointment, or a refill. 

This is what League gives Medicaid plans: one digital front door where benefits, care navigation, and health engagement all live together, rather than scattered across a renewal tool, separate portal, and care app. The League platform is purpose-built for healthcare and proven at scale. Because it reaches members where they are, they can respond to a renewal notice, close a care gap, or activate a benefit without a phone call, paper form, or login to remember. 

For Maria, this changes how her renewal plays out. The reminder reaches her in a channel she uses, in the language she speaks at home, guiding her through exactly what she needs to do and closing the loop. In this scenario, she gets a real chance to stay covered and keep her family engaged in their care.

The payoff, for members and plans

The ability to reach and guide members pays off the entire year. The channel that carried Maria’s renewal reminder can also prompt her overdue mammogram or check in after she starts a new medication. When she’s unsure whether a specialist visit for her son is covered or what her plan includes, she can ask League’s Benefits Navigation Agent Team and get a clear answer instead of making a call and waiting on hold. Renewal is just one of several moments throughout the year where reaching and guiding her matters.

Santa Clara Family Health Plan put this into practice. The Medi-Cal plan brought its members’ benefits and care into a single front door with seven languages supported natively, and saw 3x digital activation and a 68% member satisfaction score.³

Keeping eligible members enrolled and engaged also eases the cost pressure of H.R. 1. A member who stays covered isn’t a member the plan has to find, re-enroll, and re-engage later. The savings compound from there. One regional Medicaid plan stood up its member experience with League at roughly one-sixth of the cost and one-third the time of building in-house, modeling $10-16M in annual operational savings for every one million members over five years.⁴ At scale, each moment adds up to meaningful savings and a plan that can keep serving its members well.

And once a plan can reliably reach its members, that same foundation enables more proactive support over time, including AI agents that can anticipate what members need and guide them to take the right action.

The plans that move this cycle will be ready

December 2026 is fixed. The plans that will be ready for it are the ones building now, while there’s still time to have the infrastructure in place before the first six-month cycle arrives. The ones that wait will keep absorbing preventable losses every renewal cycle, in a population that can least afford to lose coverage.

Behind every one of those losses is a member like Maria: someone managing a chronic condition, raising a family, and doing her best to stay healthy, without anyone to help her navigate the system. She’s counting on her plan to reach her. So the question for every Medicaid plan is a simple one. When the six-month clock starts, will your members be within reach?

Sources

1. KFF, Health Provisions in the 2025 Federal Budget Reconciliation Law, August 2025.
2. KFF, Medicaid/CHIP Monthly Enrollment Tracker, July 2026.
3. League customer data, Santa Clara Family Health Plan. Approved for external use.
4. League customer data, blinded regional Medicaid plan. Approved for external use.