The End of the PHE: How Providers Can Cope With the Impact of up to 15 Million Medicaid Enrollees Losing Coverage

As the expiration of the COVID-19 public health emergency (PHE) draws near, healthcare providers face a storm of uncertainty. Already grappling with staffing shortages and overwhelmed emergency departments (EDs), providers need practical strategies to help them manage fallout from the end of the PHE — namely, fast and accurate ways to help a large volume of eligible patients to re-enroll in Medicaid without additional administrative burden.

Where We Stand Today

Because states were not allowed to disenroll anyone from Medicaid during the PHE, the percentage of insured Americans has really grown. “The U.S. Department of Health and Human Services (HHS) recently reported that the national uninsured rate reached an all-time low of 8%1 in early 2022,” says Juli Smith, revenue cycle expert and director at ZOLLâ Data Systems. “With 5.2 million people gaining coverage since 2020, healthcare providers have seen the benefits of the highest number of insured patients in history.” 

The PHE was extended on January 11, 2023, keeping it in effect until April 11, 2023. The Consolidated Appropriations Act, 2023 that was enacted at the end of December untied redetermination from the end of the PHE and established the first date that states could disenroll a beneficiary for no longer meeting the guidelines. States can resume Medicaid eligibility redeterminations as of April 1, 2023.  

“If providers are to avoid finding themselves in a reactive position due to state or federal laws,” Smith notes, “they must be prepared to handle the reality of how Medicaid redetermination will impact their patient population in the near future.”

The Ripple Effect From Redetermination 

The HHS projects that 15 million, or 17.4%2, of enrollees will lose healthcare coverage at the end of the PHE. The Kaiser Family Foundation’s estimates are lower, but equally alarming, projecting between 5 and 14 million people3 will lose coverage. Some states will aggressively attempt to contact people and provide easy access to redetermination, while other states will do the minimum. Regardless of state processes, experts predict there will be a significant drop in Medicaid-covered enrollees nationwide. 

“There’s no doubt that redetermination will negatively impact the payer mix for healthcare providers,” explains Smith. “More people will be uninsured, and more people will experience a coverage gap when they should be insured. My best advice to providers is to build their data technology tool kit to maximize reimbursement levels and stay on top of the churn.”

Automated Healthcare Data Technology Can Help Providers Assist Patients  

Antiquated state eligibility systems and processes will profoundly impact providers. State data on Medicaid patients is often outdated and inaccurate, which means providers need to find alternate, modern solutions to confirm eligibility and coverage status at the time of the patient encounter. 

“Third-party data partners can be invaluable for enhancing demographic data, as well as for better understanding the behavioral and financial background of enrollees, as it pertains to their healthcare,” says Smith. 

The best automated data solutions can access multiple data sources in real time to find, verify, and correct patient information. For example, automated demographic verification and retroactive Medicaid eligibility tools can help providers determine current coverage and encourage patients to pursue re-enrollment through the state, if appropriate. Self-pay and propensity-to-pay tools, coordination of benefits technologies, and technologies that facilitate stronger patient engagement can ease the pain of transition for patients who are no longer eligible for Medicaid and must find other options.

For example, if a patient had Medicaid coverage during pregnancy but didn’t maintain enrollment, she may only learn she has lost her coverage during redetermination when she finds herself in the ED, after giving birth, to treat her baby’s high fever. Automated tools can help providers to assess whether encouraging the patient to go through redetermination is worth her effort. If the patient is unlikely to meet the requirements, the provider can point them in another direction, such as the exchange, or (if they are uninsured and will be paying out of pocket) screen them for charitable discount eligibility.

Healthcare providers can successfully manage the impending downstream impact of mass Medicaid eligibility redetermination with labor-saving healthcare data solutions, such as the ZOLL® AR Boost® solution suite. Using these tools strategically can put providers back in the driver’s seat, enabling them to fulfill their mission of providing quality care to all — including the most vulnerable and at-risk populations — while maximizing reimbursement, protecting administrative staff from undue burden, and partnering with patients to improve their financial experience, whatever their situation.

References

  1. “New HHS Report Shows National Uninsured Rate Reached All-Time Low in 2022.” HHS website, Aug. 2, 2022, https: //www.hhs.gov/about/news/2022/08/02/new-hhs-report-shows-national-uninsured-rate-reached-all-time-low-in-2022.html Accessed Jan. 6, 2023.
  2. “Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches.” ASPE website, Aug.19, 2022. https://aspe.hhs.gov/sites/default/files/documents/404a7572048090ec1259d216f3fd617e/aspe-end-mcaid-continuous-coverage_IB.pdf Accessed Jan. 6, 2023
  3. Tolbert, Jennifer and Ammula, Meghana. “10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Requirement.” Kaiser Family Foundation website, Dec. 8, 2022, https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-requirement/ Accessed Jan. 6, 2023.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.