The 78th Primetime Emmy Awards air September 14, 2026, and The Pitt — HBO Max’s Pittsburgh ER drama — leads the field with 25 nominations. The show, a medical drama known for its ultra-realistic portrayal of the Emergency Department at a major hospital, has earned that attention partly by staying close to real policy pressures hitting the healthcare space right now.

In season 2, episode 13, “7:00 P.M.,” a boy named Grady is rushed into the ER mid-asthma-attack, not responding to albuterol. His mother explains why: Grady stopped taking his prescribed inhaler and asthma medication two months earlier, after the family lost Medicaid coverage. Not because anyone became ineligible — because their redetermination letter went to an old apartment, and it’s taken months to sort out. It’s a small part of the larger episode, but highlights a real situation that many Medicaid beneficiaries face.

Grady’s story is fiction, but the failure mode isn’t. We’ve heard this story at Relay many times over – health payers struggling to reach their Medicaid population with information about redetermination because of things like frequent address changes. Procedural disenrollment impacts a staggering number of the Medicaid-eligible population, and under the One Big Beautiful Bill Act (OBBBA), it’s about to happen more often.

Health plans aren’t managing one redetermination hurdle anymore — they’re managing two, on the same members, at the same time.

Starting with renewals due on or after January 1, 2027 (a small number of states move sooner), the ACA expansion population shifts from annual to six-month redetermination. On that same population, a federal work requirement now applies: non-exempt expansion adults ages 19–64 must document 80 hours a month of qualifying activity — work, school, job training, caregiving, or community service — at enrollment and every six months after.

These are two separate compliance mechanics with two separate failure points, not one process running twice. A family like Grady’s already struggled to catch one letter a year at the right address. Making that twice a year — and adding a second, unrelated paperwork requirement on top — doesn’t just double the risk. It compounds it.

Post-PHE unwinding disenrolled more than 25 million people, and 69% of those disenrollments were procedural — a missed form, not a change in eligibility, according to KFF data. A recent JAMA Health Forum study found that 8% of dual-eligible members — 13 million people enrolled in both Medicaid and Medicare — lose coverage for at least a month every year, mostly for the same reason. That population is older and sicker on average; a coverage gap for them isn’t an inconvenience, it’s a disruption in care. It’s exactly the situation that put a fictional kid in an ER bed on primetime TV — and it’s already happening to real families.

Twice-a-year redetermination plus a new documentation requirement means more of these moments, per member, every year, indefinitely. Gartner’s take on how to prevent a repeat of 2023 isn’t “outreach harder” — it’s the same discipline that wins every other high-stakes member interaction:

Relay’s HIPAA-compliant channel platform — a text message notification paired with a secure scrolling content Feed — meets members where they already are: on their phones, with no app, login, or portal to navigate. A BCG study found that 96% of Medicaid members use a smartphone to access the internet, and more than 2.4 million Medicaid members are already active on Relay Feeds today.

Gartner points the same way: plans need tools that are multi-experience — “you cannot rely on members to download an app or log in to a portal” — and that adapt content, language, and reading level to the member. Relay’s Spanish-language Feed gives Spanish-speaking members that same equal access, and Relay Messenger adds compliant two-way chat inside the Feed itself, so a plan can answer a member’s question without routing them to a call center.

This is the gap that put Grady’s family in the position they were in — a letter that couldn’t find them, and no way back into the loop once it went missing. For the OBBBA moment specifically, Relay’s channel does more than remind members to renew: it’s where a member gets notified about their work requirements, uploads a pay stub or enrollment letter as proof, and gets a confirmation that writes back to the plan’s system of record — all without a phone call or a letter that can go to the wrong address. Every step is timestamped and auditable, which matters given how contested the exemption rules currently are.

Relay has already helped Medicaid plans get more eligible members through redetermination without losing them to paperwork:

One Relay client achieved the highest Medicaid renewal rate of any MCO in its state, post-PHE

81% of members clicked to renew directly from a redetermination message in their Relay Feed

2x engagement on redetermination reminders within hours of receipt, compared to outbound phone calls

Imagine if Grady’s mother had gotten that renewal message on her phone, through a channel she already trusted, instead of a letter mailed to an address she’d left months earlier. It wouldn’t be a plotline anymore — it would be a family that stayed covered and did not end up in the costly ER.

Redetermination isn’t the finish line; it’s one recurring high-stakes moment in a much longer member relationship. Relay clients use the same channel across the member journey: digital welcome kits and benefits education at onboarding, preventive care and medication adherence reminders, and care management outreach that connects members to health coaches. The same trust that gets a member to renew is what gets them to show up for a screening, refill a prescription, or answer a call from their care team.

As redetermination gets more frequent and more procedurally demanding, health plans can’t afford communication that reaches members but doesn’t move them to action. Relay gives plans a way to guide members through both new compliance clocks — and to keep that trust intact well past the renewal date.

If you would like to experience a Relay Feed for yourself, use the link below to get a feed sent to your phone.

To learn more about how Relay can support your team in their redetermination efforts, reach out to sales@relaynetwork.com. 

Read more about Relay’s success with redetermination:

Want to read Gartner’s full article, “Quick Answer: How Can Medicaid Redetermination Optimize the End-to-End Member Experience?” Click the link below to download.