Health Equity in Reach: Expanding Healthcare Coverage with Personalized Customer Experience (CX) Solutions

Case Story


Helping People Enroll in Health Coverage

The Centers for Medicare & Medicaid Services (CMS) administers a range of health insurance options, including Medicare, Medicaid, and the Federally Facilitated Marketplace created by the Affordable Care Act. Since 2013, as a trusted program partner, Cognosante has delivered critical information to the public about these offerings through outreach efforts and customer experience (CX) solutions. We have helped people enroll in health coverage, resolve enrollment disputes, and provided operational and program support.

The Challenge

Helping People Keep Health Coverage Requires a Human Touch

In 2022, CMS faced an unprecedented challenge – helping people maintain healthcare coverage when the COVID-19 Public Health Emergency and continuous Medicaid enrollment condition ended. That event – called the Medicaid Unwinding – required states to resume annual redetermination of consumers’ eligibility to continue Medicaid or the Children’s Health Insurance Program (CHIP). Those who lose coverage must find it through other sources, like the Federally Facilitated Marketplace. According to CMS, the Medicaid Unwinding represents the single largest healthcare coverage transition since the beginning of the Affordable Care Act.
230,000 people contacted who may lose healthcare coverage
1,000 community outreach events held to drive consumer awareness
1,800 appointments scheduled to assist consumers with options

Our Innovative Solution

A Personalized Approach Meets Consumers’ Unique Needs

To manage this transition, Cognosante was awarded the Enrollment Assistance Program (EAP) for Medicaid Unwinding contract by CMS to implement an EAP similar to one supported during the 2013 implementation of the Affordable Care Act. Through the EAP, our trained local support teams (called Assisters) reach out to those affected – low-income adults, seniors, families, and persons with disabilities – to help them find alternative coverage.

Our approach delivers CX solutions to consumers with a personal touch. Assisters live and work in the communities they serve and use that knowledge to customize outreach programs to meet the unique needs of their communities. In most states, Assisters place outbound calls and text messages, leveraging a CMS database of affected individuals called the Medicaid Assister Community tool. The teams hold community outreach events in libraries, community centers, and other public places to drive awareness of consumers’ healthcare options. In some rural communities, however, outreach is done entirely through community events.

This flexible model enables Assisters to broaden their reach using a variety of communication methods. In individual interactions, Assisters use a standard set of tools and resources, and tailor support to each consumer’s household composition, income, language, and personal needs.

Our Tangible Results

Making a Difference One Consumer at a Time

Now in its second year of operation, the EAP program is making a positive, life-changing difference. To date, Assisters have Initiated over 230,000 contacts to affected people, held 1,000 community outreach events, and scheduled 1,800 appointments to assist consumers.

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