4 days ago
Why Medicaid Needs A Text Message Exemption Now
Man standing outside, texting. (Photo by)
A fierce debate rages over the Big, Beautiful Bill (BBB) and its impact on Medicaid beneficiaries. While House Speaker Mike Johnson recently claimed millions "will not lose their Medicaid unless they choose to do so," the reality is the bill's work requirements will create administrative barriers that will result in coverage losses due to poorly informed Medicaid beneficiaries. These communication barriers can be addressed by modifications to the Telephone Consumer Protection Act (TCPA).
The TCPA, a decades-old law governed by the Federal Communications Commission (FCC), prohibits automated text messages without prior consent. The law has created a culture of confusion and risk aversion in healthcare administration. Healthcare administrators like lawyers and compliance officers view text messaging as a litigation minefield, while patients and families who need timely, accessible communication freely use digital messaging for everything else.
This creates a glaring disconnect: people communicate through text messaging across all demographics, including Medicaid beneficiaries, yet Medicaid managed care organizations and state agencies continue relying on antiquated communication methods because they fear litigation from murky TCPA regulations.
The FCC has already provided guidance permitting digital communication for Medicaid eligibility and enrollment. However, this guidance needs to extend further and establish an explicit, indisputable exemption for all Medicaid programs and Medicaid-related services. This clarity will provide authority that helps prevent unnecessary coverage losses due to communication failures. It will also lead to a welcome alignment between how health agencies communicate and how people want to communicate.
As new work requirements loom, we can either continue prioritizing risk management gray areas over beneficiary communication needs, or we can adapt our approaches to align with the digital channels people use and prefer.
We don't need to speculate about the impact of poor communication with beneficiaries because we witnessed it recently. During the 2023 Medicaid redetermination process, people were required to re-enroll to demonstrate their eligibility. The problem wasn't eligibility; it was communication. According to Kaiser, half of Medicaid enrollees were unaware of the process or knew little about it. Millions lost coverage not because they were ineligible, but because they didn't know about re-enrollment deadlines or couldn't navigate the bureaucratic documentation requirements. Many only discovered they'd lost coverage when they showed up for medical care. These coverage losses were avoidable with better, more efficient communication.
After 25 years serving a patient population that is 90-95% Medicaid beneficiaries, I understand these are busy people juggling multiple responsibilities. The majority work in gig economy jobs, minimum wage positions, or jobs that don't provide affordable health insurance. Many work multiple jobs and communicate primarily via text message. When Medicaid agencies rely on outdated methods like snail mail and email, critical information gets lost. We have an excellent, accessible tool to address these communication inefficiencies. It is text messaging and we are afraid to use it.
To address texting limitations and improve communication with the Medicaid population, Abner Mason, a digital health entrepreneur and longtime advocate for text messaging in healthcare, aims to establish the Medicaid Texting Coalition. The coalition will collaborate with and advise federal agencies to exempt Medicaid from TCPA restrictions. Mason says, "Texting is the primary and preferred mode of communication for all Americans, including Medicaid beneficiaries, and we must use it to improve health outcomes and, if the time comes, to allow efficient communication to verify work status."
If we care about reducing the impact of the BBB on Medicaid enrollment, an obvious and politically feasible strategy is to exempt Medicaid programs from TCPA restrictions immediately. The technology exists and the solution is straightforward. Medicaid needs a TCPA exemption now because the freedom to text is among our best hopes for minimizing the unnecessary impacts of potential work requirements.
