This summer, West Virginia will use the U.S. Postal Service and an online account to reach Medicaid enrollees about the expected end of the COVID-19 public health emergency, which will put many recipients at risk of losing coverage.

What West Virginia won’t do is use a form of communication that is ubiquitous across the globe: text messaging.

“West Virginia is not prepared to text its members,” Alison Adler, the state’s Medicaid spokeswoman, wrote to KHN in an email.

In fact, most state Medicaid programs don’t text enrollees, despite the urgency to contact them to update their coverage. A KFF report published in March found only 11 states Said they will use text messages to alert Medicaid recipients about the end of the COVID public health emergency. In contrast, 33 states plan to use regular mail, and at least 20 states will be contacted by personal or automated phone calls.

“It doesn’t make sense when texting is how most people communicate today,” says a little serafipartner at consulting firm Manatt Health.

State Medicaid agencies have been preparing for an end to the public health emergency for months. As part of the COVID relief law approved in March 2020, Congress barred states from removing anyone from Medicaid unless they moved out of the state during the public health emergency. When the emergency is over, state Medicaid officials must reassess each enrollee’s eligibility. Millions of people could lose coverage if they earn too much or fail to provide the information needed to verify income or where they live.

As of November, approximately 86 million people They are enrolled in Medicaid, according to the Centers for Medicare and Medicaid Services. That’s up from 71 million in February 2020, when COVID began to ravage the country.

There are more than 600,000 Medicaid enrollees in West Virginia. About 100,000 of them could be ineligible by the end of the public health emergency, Adler said, because either the state determined they were ineligible or they didn’t respond to requests for updated income information.

“It’s frustrating that texting is a way to meet people and states aren’t adopting it more,” said Jennifer Wagnerdirector of Medicaid Eligibility and Registry at the Center for Budget and Policy Priorities, a Washington-based research group.

The problem with relying on the postal service, Serafi said, is that a letter can be hidden in “junk” mail or undeliverable to someone who has moved or is homeless. She pointed out that if people have accounts, emails can end up in spam folders.

By contrast, surveys show low-income Americans equally possible have a smartphone and cell phone as the general population. Most people use text messages regularly.

In Michigan, Medicaid officials began using text messages to communicate with enrollees in 2020 after building a system with the help of federal COVID relief funding. They say texting is an economical way to contact registrants.

“It costs us 2 cents per text message, which is pretty cheap,” said Stephen White, admissions coordinator for the Michigan Department of Health and Human Services. “It’s a huge return on investment.”

CMS officials told states they should consider texting and other means of communication to reach registrants when the public health emergency is over. But many states don’t have the technology or information about registrants to do so.

Efforts to add texting have also faced legal hurdles, including a federal law that prohibits texting without the consent of others. The FCC ruled in 2021 that state agencies are not bound by the law, but Matt Salo said whether counties that handle Medicaid duties for some states and Medicaid managed care organizations that work in more than 40 states are also being held accountable. The waiver is unclear, said the executive director of the National Association of Medicaid Directors.

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CMS spokesperson Beth Link Said the agency is trying to figure out how Medicaid agencies, counties and health plans can send text messages to enrollees under federal law.

Several states told KHN that Medicaid will help connect enrollees, and they want the plans to use text messaging. However, the requirement to obtain consent from participants before texting may limit such efforts.

That’s the case in Virginia, where only about 30,000 of the more than one million Medicaid enrollees agree to receive text messages directly from the state, said spokeswoman Christina Nuckols.

To boost that number, the state plans to ask enrollees if they’d like to opt out of text messages, rather than asking them to opt in, she said. That way, registrants will only contact the state if they don’t want to receive text messages. The state is reviewing legal options to achieve that, she said.