Under the Same Sky featuring John Frias Morales
John Frias Morales, Analytics Expert, discussed how states and health plans can avoid built-in system bias and protect Medicaid beneficiaries from losing their health insurance coverage.
Medicaid Work Requirements: How States and Health Plans Can Avoid Built-In System Bias and Protect Medicaid Beneficiaries from losing their health insurance coverage
New policies demand more than compliance; they require smarter data strategies and an equity lens to prevent disenrollment and disparities. Abner recently hosted a conversation with guest speaker John Frias Morales, an analytics leader who has spent two decades improving healthcare delivery through data-driven strategies.
Barrier-Driven Disengagement: A Human Story
John shared a deeply personal story about his late grandmother as an example of someone who would have qualified for seven different exemptions under the upcoming work requirements because of her life circumstances. Yet, without thoughtful systems, people like her will face unnecessary administrative hurdles that lead to disenrollment.
This is what John calls barrier-driven disengagement. When systems fail to recognize real-world complexity, vulnerable populations pay the price.
The Promise and Limits of Ex Parte Data
States have an opportunity to reduce burden through ex parte electronic verification, using existing data sources like tax records and school enrollment to confirm eligibility. Pilots in Louisiana and Arizona showthis approach can validate up to 80% of Medicaid expansion beneficiaries. That’s encouraging, but what about the remaining 20%?
Current enrollment systems are built as financial engines, not clinical ones. They don’t capture medical frailty, substance abuse disorders, or other important factors. If we rely solely on claims data, we risk perpetuating multiple disparities due to important missing data.
Avoiding Built-In Bias
John’s warning is clear: if we implement these policies without recalibrating tools and addressing data gaps, we will bake inequity into the system. For example, frailty questionnaires designed for one population may under-identify frailty in others. The same applies to mental health.
What States and Health Plans Can Do
John offered practical steps to get this right.
Fix enrollment churn problem: Stable coverage means better data quality collected from year-round data on an individual.
Improve provider screening: Monitor for frailty and psychiatric screenings on all populations to make sure there are no disparities.
Triangulate data sources: Combine questionnaires, claims, and alternative data to create a hybrid verification model frailty and psychiatric exclusions.
Recalibrate tools: Adjust weights and algorithms to reflect diverse populations and constantly monitor disparities.
The Bottom Line
Cross-agency, cross-stakeholder engagement is critical to working through these challenges. We need to design systems with Medicaid beneficiaries in mind so that they don’t lose their health insurance coverage due to administrative burdens. As John reminded us, this isn’t just about compliance. It’s about fairness, dignity, and the health of our communities.
Join us for the final conversation in the series on Thursday, November 20, at 12:30pm (ET) with special guest Jessica Kahn, Partner, McKinsey, based in Washington, D.C.
