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Preparing for a Historic Medicaid Redetermination Surge

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Nathan Allen in The Hospital Finance Podcast discusses how hospitals and health systems can prepare for a historic Medicaid redetermination surge, and best practices to help individuals maintain coverage.

Highlights of this episode include:

  • Who is Firstsource
  • What is Medicaid Redetermination
  • How the pandemic impacted Medicaid enrollment
  • Best practices for educating beneficiaries on eligibility
  • How to help

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance podcast. Since the pandemic and public health emergency began, enrollment in Medicaid CHIP has increased by 12 million or 16.8%. When the public health emergency ends, states will have up to 12 months to return to normal eligibility and enrollment operations. With millions of Medicaid recipients facing redetermination, outdated technologies and labor-intensive processes will be insufficient to meet the challenge. Studies project that more than 15 million individuals could potentially lose coverage if states and healthcare organizations are not adequately prepared. Today I’m joined by Nate Allen, senior Vice President and Eligibility Practice Leader at Firstsource, to discuss how hospitals and health systems can prepare for a historic Medicaid redetermination surge. Nate, welcome to the show.

Nathan Allen: Hey, thank you. I am happy to be here.

Mike: We’re happy to have you, Nate. And so for those that may not be familiar with Firstsource, could you tell us a little bit about what you do there?

Nathan: Yeah, sure. So, Firstsource is a global BPO and a segment of our business is focused on healthcare. We have been in the healthcare industry for over 30 years working both with hospitals and payers doing a variety of different services. On the hospital side, we really focus on end-to-end revenue cycle management. And in my role as SVP, I’m really focused on the Medicaid eligibility and enrollment segment of our business, and the redetermination situation has really been something I spent a lot of time focusing on. So I am looking forward to talking with you more about it today.

Mike: Yeah. Looking forward to digging into this. So, first off, why don’t we begin? Could you explain to us what Medicaid redetermination is and why it will be especially significant this year?

Nathan: Yeah. So when someone gets enrolled in Medicaid, they don’t just stay on the program forever. Typically, states will go through a process called redetermination on a 12-month basis. There are some situations that may require a tap in sooner than that, but generally speaking, 12 months is when this typically happens. And that situation requires for the Medicaid recipient to, basically, reverify that they still qualify for the program. So they’re having to submit updated proof of income, statements, things like that, to prove that they still qualify for Medicaid. It’s a way for states to ensure that someone that maybe had a situation that improved and maybe they no longer qualify for Medicaid do not continue to stay on the program, really focusing it for the folks that generally don’t have the means to pay for private insurance.

Mike: And, Nate, how has the pandemic public health emergency impacted Medicaid enrollment?

Nathan: Yeah, it’s been significant. The numbers that you read are telling. And prior to the pandemic, Medicaid was actually going down, the volume of the Medicaid recipients. Since then, I think you mentioned a 16.8% increase. And looking at those numbers, that ties up to roughly 87 million people as of January 22nd that were on Medicaid, which would represent approximately 25% of the population in the United States. The public health emergency, or PHE as it’s referred to, has been significant to the situation because when that was announced in January of 2020, the federal government basically told states that they were suspending the redetermination. So what’s happened is over the course of the past two-plus years, people that are on Medicaid have not gone through that redetermination period, meaning there could be people that no longer qualify for Medicaid that have remained on because they’ve not been through that process. And it just continues to be extend– as the PHE continues to be extended, that volume of Medicaid recipients just continues to increase.

Mike: So when the PHE does end, how is that going to impact coverage for these people?

Nathan: Well, as you said, 15 million people based on an Urban Institute study towards the end of 2021 are estimated to lose their coverage. As the PHE continues to be extended, that number will only rise. You may have seen that the PHE was recently extended to expire on July 15th. Certainly, that’s a realistic date that we’re looking at, but it’s been extended I think 10 times. So I don’t want to say it’s likely, but it very well could be extended again. There’s a lot of different factors that play into that. So, again, as it gets extended, more and more people stay on Medicaid and it is set to expire on July 15th, and that date does end the PHE. What the federal government has told states is that they will be given a 60-day notice and at that point, the states would need to start engaging with their Medicaid recipients, with their population, their Medicaid population to start notifying them that the redetermination period’s going to start again. And, again right now, that would be scheduled for July 15th. So right around mid-May is when we would expect, if that is going to be the date, that we would expect the federal government to start telling states and giving them that 60-day notice.

Mike: Yeah, we’ll note just for the audience, of course, we record these episodes a bit ahead of time so it’s entirely likely that something could change by the time this airs, but this is the best that we have right now or what we know. Nate, what are some of the best practices available for educating beneficiaries on their eligibility?

Nathan: This is a very interesting topic and it varies from state to state. So I’ll speak more broadly. Typically what you’ll find is that states are engaging with their Medicaid population via hard-copy mail. As we all know, those can be effective methods of communicating, but in today’s day and age, really using a more virtual– or excuse me, a digital strategy is really the best way to do it. And what I mean by that is a multi-channel communication whether it be via text, via phone, via access to a microsite that the Medicaid recipient can navigate to and answer questions. That’s really what we are finding to be the best way to communicate with this population. And as part of that, one of the big concerns is the fact that states haven’t had communication with these folks for two years in many cases. So as we all know, people move around and it can be a transient population. So running contact verification, making sure that the telephone numbers that we have on file are accurate, making sure that their cell phones so that you can digitally engage with these folks, finding ways to obtain digital consent to text. These are all things that we’re working very closely with different hospitals and MCOs to make sure that they are engaging with this population in the right way.

Mike: What can organizations, either providers or payers, do to help individuals maintain coverage?

Nathan: Yeah. Again, it’s going to vary based on state. There are states out there that are allowing MCOs to have a very active approach with their membership [base]. And what I mean by that is there are states that are allowing the MCO to represent that member. So they’re not only educating and outreaching to the member, but also taking a high-touch advocacy approach to helping the member go through the re-enrollment process if they need that. There’s always going to be a segment of the population that’s going to be proactive and do what they need to do. But then there’s going to be folks that just maybe are confused or not sure how to do it. So in states that are allowing MCOs to do that, that’s really the best approach or the best way to ensure that those members and those Medicaid recipients are able to stay on. In other states that you’re not able to do that, you still want to outreach, you still want to digitally engage with these folks, and maybe provide a light touch advocacy. And what I mean by that is have people available to walk them through the process. If you can’t do it for them, then holding their hand through the process becomes vital in making sure that they’re taking the steps necessary to maintaining their coverage.

Mike: Great advice, Nate. And if someone wanted to get in touch with you or find out more about Firstsource, where can they go?

Nathan: Yeah. I would encourage, you can always go to Firstsource.com. But if you’re really specifically looking for information on the redeterminations, if you Google search Firstsource redetermination, it’ll take you to a landing page that has all kinds of literature that we’ve put out about this topic and some of the solutions that I’ve talked through. And I can also be reached directly at: Nathan.Allen@Firstsource.com.

Mike: Nate Allen, thanks so much for joining us today on the Hospital Finance Podcast.

Nathan: It’s been my pleasure. I appreciate you having me, Mike.

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