Swaay.Health sat down for an in-dept discussion on this issue with Abner Mason, Chief Strategy and Transformation Officer at GroundGame.Health. Mason has been a tireless advocate for improved care access, SDOH, and better patient experiences for over decade.

Here is his take on the situation.

The Telephone Consumer Protection Act (TCPA) requires organizations to get prior consent before sending texts—a reasonable protection when it comes to spam, but a roadblock for Medicaid.

“This old 34-year-old law prevents health and managed Medicaid plans from using texting as a way of communication for Medicaid members, even though that’s the primary way that Medicaid members want to communicate,” explained Mason. “In many instances, texting is the only way they are going to communicate.”

Unlike Medicare Advantage or commercial plans, Medicaid members don’t choose their plan, which makes obtaining that consent legally murky. The result? Many health plans are afraid to hit “send,” even for basic messages like appointment reminders or preventive care nudges. And with potential fines reaching $1,500 per violation, the legal risk is too steep for most to ignore.

This isn’t just a theoretical problem—it’s about to become a real crisis. Under new federal rules, people on Medicaid must now prove their eligibility twice a year and verify their work status every month to keep their coverage.

“Many people will lose their health insurance, but not because they’re not qualified, not because they don’t meet the requirement, but because they have to fax in their monthly information,” stated Mason. “Who has a fax machine nowadays?”

The state of Arkansas implemented Medicaid work and reporting requirements from June 2018 through March 2019. During that time, 18,000 people lost coverage primarily due to “failure to regularly report work status or document eligibility for an exemption.”

According to Mason, there is a fix: “It’s a very simple thing. Exempt plans and states and counties from the Telephone Consumer Protection Act. It is very narrow, very simple, very clean. And that would solve the problem for Medicaid.”

This isn’t about marketing. It’s about helping people keep their coverage, attend appointments, or verify eligibility under new federal work requirements. An exemption would empower Medicaid plans to engage patients where they are—on their phones—without fear of lawsuits.

Mason puts it eloquently: “What this is really about is modernizing communication. There has been interest from this administration about treating American citizens more like a consumer and modernizing the way the government interacts with them. If we want to implement work requirements in a way that makes sense, then we ought to use a more efficient way to communicate that is actually cheaper and easier to track for fraud and abuse.”

This Juneteenth, as we reflect on the unfinished work of equity, we should ask ourselves why the most vulnerable patients are stuck with the slowest, most inaccessible forms of communication? Modernizing Medicaid communication rules won’t solve every healthcare problem—but it’s a concrete step toward fairness, access, and dignity. And it’s long overdue.

If this issue resonates with you, Mason encourages you to call your state senator and ask them to support modernizing communication in Medicaid. “Please support modernizing communication in Medicaid,” he says. “It’s a simple fix that can make a big difference.”

For an excellent, well-researched write-up on the TCPA and its impact on Medicaid, be sure to read this article from Jane Sarasohn-Kahn: How Texting Is a Lifeline for Health Access and Equity – Time to Address the TCPA is “Now”

Learn more about GroundGame.Health at https://www.groundgame.health/

Connect with Abner Mason on LinkedIn at https://www.linkedin.com/in/abnermason/