Most member engagement strategies were designed around commercial insurance, then adapted for everyone else. That approach misses a structural difference between the populations.
Commercial insurance usually comes with a built-in institution that helps people navigate coverage: the employer. HR teams coordinate enrollment. Benefits administrators explain plan choices. Premiums are deducted automatically. Workplace communications remind employees about deadlines and preventive care.
This system isn't perfect, and not every employer provides meaningful support. But many commercially insured members have an organization with both the infrastructure and the financial incentive to help them stay covered and use their benefits.
Medicaid, Medicare, and Exchange members usually don't have a comparable institution performing that role. The problem isn't simply that these members are harder to reach. They're being asked to navigate more complexity with less built-in support.
Medicaid makes the consequences of missing support especially visible. When states resumed regular eligibility reviews after the pandemic, more than 25 million people were disenrolled. Among those who lost coverage, 69 percent were terminated for procedural reasons, a missed notice, an outdated address, an incomplete form, not a finding that they were actually ineligible.
Georgetown's Center for Children and Families reports Medicaid and CHIP enrollment declined again in 2025, the third straight year of decline. The challenge is set to grow: a significant share of the Medicaid expansion population moves from annual to six month renewals starting in 2027, alongside new community engagement documentation requirements in applicable states.
Traditional outreach can remind a member a deadline is approaching. It doesn't necessarily help that member understand the notice, determine which requirement applies, gather the right information, or complete the process. That's the difference between sending a message and supporting an action.
Medicare members face a different challenge. People entering Medicare must choose between traditional Medicare, Medicare Advantage, prescription drug coverage, and supplemental coverage, decisions that can change as health needs, medications, and available plans change.
Medicare Advantage now covers more than half of eligible Medicare beneficiaries. For 2026, the average beneficiary can choose among roughly 39 Medicare Advantage plans, according to KFF's analysis of CMS plan data. More options create more chances to make a decision that doesn't fit. Medicare members aren't entirely without help, plans, brokers, State Health Insurance Assistance Programs, providers, and community organizations all play a role, but that support is fragmented. Members often have to figure out which source to trust and where to go for a specific decision.
The need here isn't just more information. It's trusted, local help that turns complexity into a clear next step.
Exchange members navigate the individual insurance market without an employer's administrative structure behind them. They may need to compare plans, estimate annual income, understand subsidy eligibility, report household changes, and reconcile financial assistance at tax time, all while potentially moving between Medicaid, Exchange, and employer coverage as circumstances change.
Navigators, brokers, and enrollment assisters provide real support, but access isn't always continuous. A member may get help during enrollment and then have no consistent point of contact when income changes, a notice arrives, or coverage needs to be renewed.
The issue isn't a lack of interest. The system places the burden of coordination on the individual, even when the rules are complicated and the consequences of an error are significant.
Healthcare often describes Medicaid, Medicare, and Exchange members as hard to engage. That framing can make the member sound like the problem.
These members are already connected to organizations in their daily lives: faith institutions, food pantries, workforce programs, housing communities, unions, neighborhood associations. These organizations often know when a family is struggling, when an older adult needs help, or when someone is confused about a notice, relationships no automated message can recreate.
The gap isn't a lack of community. It's that community organizations have rarely been equipped to turn that trust into consistent support for coverage and care.
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CleanCut Health gives healthcare organizations the infrastructure to activate trusted community partners, fund their work, and verify the health actions that drive membership, retention, and preventive care.
