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Medicaid Redetermination Solutions for Members Deemed to Lose Coverage From PHE Expiration

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Nathan Allen, Senior Vice President – Healthcare Provider Solutions at Firstsource, discusses Medicaid Redetermination for those who are Medicaid members, but are deemed to lose their coverage due to the upcoming expiration of COVID-19’s Public Health Emergency.

In this first part of a two-part video series, Nathan Allen, Senior Vice President – Healthcare Provider Solutions at Firstsource, discusses Medicaid Redetermination for those who are Medicaid members, but are deemed to lose their coverage due to the upcoming expiration of COVID-19’s Public Health Emergency. Allen also set a scope on populations in rural settings and how they could be affected. However, there is hope through tech-based solutions and a proposed rule by CMS to prevent facility closures and preserve access to care.

How will the Public Health Emergency expiration have a significant impact on critical access hospitals and patients?

0:10: Yeah, I mean, I think it’s going to have well, it is having an impact on everyone right now, especially rural hospitals. Just because a lot of those hospitals, when you look at their Medicaid revenue to net patient revenue, generally it’s might be a little bit of a higher percent than then some other hospitals. So, what’s what’s happening is over the last two and a half years, Medicaid has not gone through redetermination process, meaning everyone is staying on Medicaid through the public health emergency. When that is lifted, an estimated 15 million people are at risk of losing their Medicaid coverage. So, if you are at a critical access hospital that has a high percentage of Medicaid in your patient population, it’s going to definitely impact you in some way shape or form.

1:00: The hard part with this is the timing has continually been pushed back. So you know, depending on when this airs, it could still be in effect, right now as we speak. It’s early August; it’s set to expire on October 13. CMS has told states that they will give them a 60-day notice for they would put this process into place through different conversations that we’ve had with states, with hospitals with different consulting groups.

1:28: I think by and large, everyone expects this to continue, the public health emergency to continue through the end of the calendar year. Beyond that is question mark. I saw earlier this week, the American Hospital Association and the Federation of American hospitals is pushing HHS, HHS to extend the PHE even further. So it’s really a fluid situation and as I stated a little while back, each state is handling it differently. So depending on the state that you live in, or if you’re a Medicaid recipient, or hospital, the way that your state handles it might be different than another state. So just doing everything we can to make sure that you are educating yourself and made aware that you know what the outreach is going to look like and how critical it is that you have a high percentage of Medicaid population coming through your hospital that you’re doing something to ensure that those people stay on is how I would, wrap that up.

Can you explain the need for multi-channel communication (texting, phone calls) to reach the Medicaid population to stop the pending disaster of millions losing their coverage?

2:38: States handle redeterminations differently. So this is not a one size fits all response for every state. But historically, a lot of the notifications that have gone out to Medicaid recipients has been via paper mail. And as we all know, in today’s day and age, not everyone always opens up letters and reads those statements or letters and mail. So you know there’s a risk of them not even being aware that their Medicaid is going to be coming up for expiration. So using an omni channel approach, text messaging, email, in addition to letters, phone calls, it’s critically important not only to make sure that they’re aware of what’s happening, but I would even take it a step further and attempt to offer some type of advocacy or assistance and making sure that they know the steps that need to take place so that they are able to maintain their coverage and in some cases even help them go through the process if they need help going through the application and the paperwork that’s required through that registration process.

Next article: Part 2, How Tech-Driven Solutions, CMS Proposed Rule Can Save Rural Medicaid Members

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