Coverage-loss exposure & retention-ROI calculator
Under H.R.1 work requirements — and the new six-month renewals — eligible members will fall off coverage for paperwork reasons. Model your premium at risk, then see the ROI, payback, and net benefit of a retention program built around your numbers.
Your plan
Your expansion-adult population in affected states.
Average monthly premium you receive per enrolled member.
The margin you keep on a member's premium. ROI & payback are computed on margin — not gross premium — so they're defensible.
Disenrollment assumptions
Share losing coverage for paperwork reasons each redetermination. Arkansas hit ~25%.
OBBBA cut expansion-adult renewals to twice a year — more chances to fall off.
How long a disenrolled member stays off before re-enrolling — the window of lost premium.
Admin cost to reprocess a churned member (set 0 to ignore).
Your retention program
Share of avoidable loss a plain-language, multilingual, exemption-focused program can stop.
Estimated annual cost of the retention program. Adjust to a real quote.
Of your at-risk premium, what a retention program protects:
Sensitivity — premium at risk & net benefit by disenrollment rate
| Scenario | Disenroll. rate | Members lost / yr | Premium at risk / yr | Net benefit / yr |
|---|
Illustrative estimate for planning only, from your inputs and publicly reported outcomes of prior work-requirement programs (e.g., Arkansas). Premium at risk = members lost × PMPM × months off coverage; with two redeterminations a year the effective annual loss rate is 1−(1−rate)². Not a guarantee of results. We'll build a defensible, plan-specific model with you in a Readiness Audit.
Get a personalized business case
We'll send a leadership-ready business case built around your numbers — plus the editable deck — so you can take it straight to your decision-makers.
On its way. In the meantime, grab the report, toolkit & editable deck.
Common questions
What is procedural disenrollment?
Procedural disenrollment is when an eligible person loses Medicaid for paperwork reasons — a missed notice, a language barrier, or an unclaimed exemption — rather than because they no longer qualify. Under work requirements it is the dominant cause of coverage loss.
How much premium does a Medicaid health plan lose to procedural disenrollment?
Every procedurally-disenrolled member is lost capitation premium each month. As an illustration, a plan with 100,000 subject members at $450 PMPM and an 18% procedural disenrollment rate has roughly $100 million in annual premium revenue at risk. Use the calculator above to model your own exposure.
How is premium-at-risk calculated?
Premium at risk = members lost x PMPM x months off coverage. With the OBBBA six-month redetermination cycle there are two renewal touchpoints a year, so the effective annual loss rate is 1-(1-rate)^2. The calculator also estimates the operating margin a retention program protects, its ROI, and payback.
How can an MCO reduce procedural disenrollment?
Reduce avoidable, procedural loss with plain-language, multilingual member notices, exemption education so eligible members claim the exemptions they qualify for, and managed omnichannel outreach (mail, SMS, IVR) sequenced to stop the moment a member responds.