Modernized member communication remains a priority after Trump reconciliation bill

By Noah Tong / July 11, 2025

Tucked inside Republicans and President Donald Trump’s controversial bill incorporating Medicaid work requirements is a provision that could weaken restrictions around texting members.

Abner Mason, chief strategy and transformation officer for GroundGame.Health, said the inclusion in the “big, beautiful bill” was a flicker of good news for a law he overwhelmingly opposed.

“I was not supporting the implementation of work requirements,” he said in an interview. “But given that the bill was moving forward, my thinking was ‘How do we make sure this bill does the least harm and the most good?’”

Under a law from the early 1990s, managed care plans were effectively banned from texting enrollees because Medicaid members are traditionally assigned a health plan by a state or county. Therefore, enrollees cannot opt in and implied consent is not present, unlike in other lines of business in the insurance market. Plans are also not allowed to text members, according to rules from the Federal Communications Commission (FCC).

Mason recently met with trade lobbies America’s Health Insurance Plans and the Medicaid Health Plans of America to discuss the topic, a longtime priority of the organizations. Health plans believe modernizing communication with enrollees will ensure it is easier for members to stay enrolled in coverage they are eligible to have.

The bill says states are required to inform Medicaid enrollees about work requirements—and how to comply—by the end of 2026. A notice “shall be delivered” by mail or email and in an additional form. Those additional options include a phone call, text message, a website, “other commonly available electronic means,” or “other forms as the Secretary deems appropriate.”

In other words, as new technology and forms of communication evolve, they too will be options for states to utilize. It’s unclear how the texting provision is affected if future policymakers roll back work requirements.

The Centers for Medicare and Medicaid Services are now tasked with writing the regulations to fulfill Congress’ wishes, said Mason. Codified FCC guidance allowing managed care plans to conduct texting outreach was not included in the bill. 

Mason interprets the law as good news for Medicaid insurers, though conceding the "devil is in the details" about how future regulations are written. Medicaid programs are administered through contracts from the states to managed care plans. 

"In my opinion, all we need to do here, through the intent of Congress, is for CMS to say, 'this is normal, this is the way it works,'" said Mason, hoping Medicaid plans will have more leeway now.

Other onlookers view the provision less favorably for insurers, including Marsha Simon, a consultant and former Senate health policy staffer.

"As I understand it, the state government entities can text at any time," she told Fierce Healthcare. "That's not the issue. The issue is contractors, so I don't think the language works."

She said another section in the bill might throw cold water on the plans' options. The bill's language restricts managed care plans or contractors from determining beneficiary compliance to reduce conflicts of interest.

"In my opinion, this is saying that the ultimate responsibility for saying this person is in compliance has to be with the state, but the state can collect information from all sorts of data sources," said Mason. "I believe this doesn't exclude information collected from managed care plans, if the state has confidence in them."

Mason hopes to work with the CMS to maximize the impact of the law, noting promulgation must come quickly for states to carry out work requirements by 2027.

Millions are expected to lose healthcare coverage from Trump’s bill due to not correctly filling out work requirement documentation.