A rural critical access hospital (CAH) sought to establish a Medicaid-funded patient eligibility and enrollment program to help its patients take advantage of Montana’s Medicaid expansion waiver.

Rising to the occasion: Expanding Medicaid

Marcus Day Memorial Hospital (MDMH) is an award-winning rural critical access hospital with 24 acute care beds and 60 providers.

In November of 2015, when CMS approved Montana’s Medicaid Expansion waiver under the Affordable Care Act (ACA) with enrollment effective January 1, 2016, MDMH embraced the program. Consistent with its mission to provide quality, accessible, personalized healthcare, the hospital wanted to enable patients with incomes below 138% below the Federal Poverty Level to enroll in Medicaid.

It was looking to establish its Medicaid-funded patient eligibility and enrollment program. The hospital’s main goal was to help its patients take advantage of Montana’s Medicaid expansion waiver.

Multi-faceted challenges

MDMH recognized that establishing a robust Medicaid Eligibility and Enrollment program posed several patient engagement challenges such as managing enrollment, providing financial advocacy, and enabling adequate access to services for beneficiaries. The hospital partnered with Firstsource to successfully manage the complexity and rapidly deploy a patient-centric solution.

Accelerating patient eligibility and enrollment

Firstsource acted fast, deploying its proprietary patient advocacy solution, a blend of financial guidance, technology-enabled services, and program intelligence. The solution included:

Two-pronged patient communication approach

Firstsource Advocates screen all patients with no medical coverage – those who are inpatient or those with higher dollar outpatient charges. Firstsource’s Patient Engagement Center screens and provides assistance for all other patients, with extended hours and multiple language support and E-signature capabilities.

Customized tech-enabled workflows

In close coordination with the MDMH’s Patient Accounting Department and Social Workers, Firstsource combined tailored workflows with sophisticated technology to optimize Medicaid eligibility identification and enrollment. The tech-infused intelligent workflows, automatically notify Advocates when a patient date of service is covered based on the daily eligibility check of all referred accounts against the state’s Medicaid system.

Solution Synopsis

• Implemented proprietary patient advocacy solution
• Set up a digital patient engagement center to screen patients and offer extended hours support
• Deployed tech-based workflows to optimize Medicaid eligibility and enrollment.