RP Sanjiv Goenka Group

A Hospital Game Plan for Dealing with Medicaid Redetermination

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Medicaid unwinding is eliminating coverage for millions of people. Hospitals must help eligible patients re-enroll and others find appropriate coverage to mitigate serious health and financial consequences

More than 3 million people and counting have lost their Medicaid coverage since April 1, when the Covid public health emergency ended and many states began reviewing their Medicaid rolls. More than 73% of the patients have been disenrolled for procedural reasons, such as not responding to notification letters. While negative consequences will lag this immediate crisis, hospitals are facing major health and financial challenges in the wake of this massive Medicaid unwinding.

Patients losing access to affordable care likely will see chronic conditions worsen when they skip physician appointments and prescriptions. That means expensive emergency department visits will rise, along with readmissions. Hospitals absorbing those costs will see bad debt levels increasing on their P&L statements. That will hurt credit ratings and could prevent hospitals from getting advantageous rates on borrowing for capital improvements and equipment.

On top of that, hospitals will see a large shift in payer mix, resulting in lower revenues. This shift in payer mix has a direct impact on net revenue by increasing the costs of collections and uncompensated care. Troubled financial performance and minimal financial flexibility could hurt hospitals’ ability to care for patients.

To avoid these consequences, hospitals must start now to reenroll Medicaid-eligible patients and educate patients who are no longer Medicaid-eligible about alternative coverage to soften the financial ramifications of redetermination. That will be critical to ensuring hospitals can continue to provide care to all who need it.

Tackling Re-enrollment

While putting effort into re-enrolling Medicaid-eligible patients may seem like an unrealistic goal given healthcare’s current labor shortage, hospitals can make the strategy practical. Here’s how:

  • Target the most at-risk patients first. Logic suggests these are the people who most need access to care and who will suffer the most without continued intervention and monitoring. One way to do this is to review activity within the hospital’s Medicaid population over the last 12 months, further identifying frequency of visits as a potential mark of at-risk patients. Providers should review their consent forms to ensure outreach efforts will be in compliance with those.
  • Launch an omnichannel outreach strategy. Providers’ outreach strategies should include text and email as well as phone. Research indicates many Medicaid patients are digitally savvy and want to use digital devices for health reasons. Data enrichment solutions can help identify patients’ current phone numbers to minimize calling efforts, yet ensure 100% outreach coverage. Mailing letters is likely to be a waste of resources because many Medicaid recipient addresses have not been updated in more than two years. Also be prepared to offer high touch services to the highest risk patients who need help from human agents to navigate the re-enrollment process.
  • Use enrollment delivered as a service. Service providers with a national reach have the personnel and economies of scale to implement re-enrollment strategies quickly. They have the capacity to manage many different types of enrollment channels. Their agents can personally guide high-touch patients through enrollment processes while also offering self-service portals that hospitals may self-brand. In addition, enrollment-as-a-service providers have the reach to keep up with coverage options and sales regulations in specific states to help inform patients about alternative coverage options if they are truly no longer Medicaid eligible.

Acting now

Outreach, education, and application assistance are crucial. Large majorities of patients across demographic groups do not realize their states are allowed to remove them from Medicaid. Most states are not giving providers patient reenrollment dates; however, patients can log into their state’s website to find their reenrollment date, if they know where and how to find this information.

Here are other key steps providers may take now:

  1. Download your state’s unwinding toolkit, if available. This should include the state’s unwinding strategy and possible timelines so providers can stay on top of deadlines.
  2. Set priorities for which Medicaid patient cohorts to include in outreach efforts and create program timeline.
  3. Partner with a third party that is fluent using an omnichannel outreach approach that includes text, email and phone communications.
  4. Find an outreach partner trained and ready to provide application assistance for those patients who are not comfortable with self-service.
  5. Consider other opportunities to educate your Medicaid population such as using flyers at registration and financial assistance offices.

A patient advocacy program supports patient retention, continuity of care, and improved patient experiences and health outcomes. Instead of relying on state agencies, insurers and community organizations to untangle the Medicaid unwinding, providers that proactively work to reach and re-enroll eligible patients will be caring for their patients as well as their organization’s financial health.

With more than 30 years of supporting leading payers and providers and recognized as a leader in Medicaid eligibility and enrollment, we bring the experience and expertise required to help your organization prepare for Medicaid Redetermination and ensure continuity of care. For additional information or questions on how Firstsource can help your organization prepare for Medicaid redetermination please contact Noel Felipe, SVP and Revenue Cycle Practice Leader, Firstsource or Brent Hipp, AVP, Healthcare Provider Solutions, Firstsource.

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