Man standing outside, texting. (Photo by Edward Berthelot/Getty Images)
A heated debate is ongoing regarding the impact of the One Big Beautiful Bill on Medicaid beneficiaries. Despite House Speaker Mike Johnson’s assurance that millions will not lose their Medicaid unless they choose to do so, the reality is that the bill’s work requirements will pose administrative obstacles leading to coverage losses for ill-informed Medicaid beneficiaries. These communication challenges can be tackled through adjustments to the Telephone Consumer Protection Act.
The TCPA, a long-standing law overseen by the Federal Communications Commission, prohibits automated text messages without prior consent. This law has instilled a sense of confusion and risk aversion in healthcare administration. While healthcare administrators, legal professionals, and compliance officers perceive text messaging as a legal minefield, patients and families rely on digital messaging for their everyday communication needs.
This disparity highlights a significant gap: individuals of all demographics, including Medicaid beneficiaries, use text messaging extensively, yet Medicaid managed care organizations and state agencies remain reliant on outdated communication methods due to apprehensions about TCPA regulations.
The FCC has issued guidance allowing digital communication for Medicaid eligibility and enrollment. However, this guidance must be expanded to establish a clear, unambiguous exemption for all Medicaid programs and related services. Such clarity will empower authorities to prevent unnecessary coverage losses resulting from communication breakdowns and foster alignment between healthcare agencies’ communication methods and individuals’ preferred communication channels.
With impending work requirements, we face a choice: continue prioritizing risk mitigation uncertainties over beneficiary communication needs, or adapt our strategies to align with the digital platforms that people utilize and favor.
Speculation about the repercussions of inadequate communication with beneficiaries is unnecessary, as recent events have demonstrated. During the 2023 Medicaid redetermination process, individuals were required to re-enroll to confirm their eligibility. The issue was not eligibility itself but rather communication. According to Kaiser, half of Medicaid enrollees were unaware of the process or had limited knowledge about it. Millions lost coverage not due to ineligibility but because they were unaware of re-enrollment deadlines or struggled with bureaucratic documentation requirements. Many only discovered their coverage loss upon seeking medical treatment. These coverage losses could have been prevented with more effective and efficient communication.
Having served a patient population consisting of 90-95% Medicaid beneficiaries for 25 years, I recognize that these individuals are busy juggling multiple responsibilities. The majority engage in gig economy roles, minimum wage jobs, or positions without affordable health insurance. Many hold multiple jobs and predominantly communicate through text messages. When Medicaid agencies stick to outdated methods like mail and email, crucial information gets lost. Text messaging presents a practical and accessible solution to address these communication inefficiencies, yet there is reluctance to leverage it.
To overcome texting limitations and enhance communication with the Medicaid demographic, Abner Mason, a digital health entrepreneur and longstanding advocates for text messaging in healthcare, aims to establish the Medicaid Texting Coalition. This coalition will collaborate with and advise federal agencies on exempting Medicaid from TCPA restrictions.
“Text messaging is the primary and preferred mode of communication for all Americans, including Medicaid beneficiaries,” Mason asserts, “and we must leverage it to enhance health outcomes and, if necessary, facilitate efficient communication to verify work status.”
If we are committed to mitigating the impact of the Big Beautiful Bill on Medicaid enrollment, a clear and politically viable strategy is to promptly exempt Medicaid programs from TCPA restrictions. The technology is available, and the solution is evident. Medicaid urgently requires a TCPA exemption because the freedom to text represents one of our best chances to minimize the avoidable consequences of potential work requirements.
