With 47 states expected to complete most of their Medicaid redetermination activities by August 2024, health insurers and providers are calculating the costs of losing millions of Medicaid members. Of the 94 million individuals enrolled in Medicaid as of March 2023, 24.2 million (26%) had been disenrolled as of mid-July 2024, according to the Kaiser Family Foundation tracker. Another 16.3 million (17%) had yet to go through the re-enrollment process so their ultimate status is uncertain. Meanwhile, several large managed Medicaid plans are reporting remaining patients are sicker, so their treatment costs are higher (https://kffhealthnews.org/news/article/medicaid-unwinding-insurer-revenue/). They are lobbying states to increase reimbursement rates. Some hospitals and health clinics are seeing double-digit drops in their Medicaid populations and are cutting back services.
The post-pandemic Medicaid re-enrollment campaigns that some providers launched have established best practices to apply to ongoing Medicaid enrollment activities. Implementing these should enable providers to protect and even grow their potential Medicaid revenues and most importantly, help ensure ongoing access to care to improve population health and reduce medical costs and bad debt expense.
The case for being proactive about Medicaid coverage
It’s easy for healthcare providers to calculate their Medicaid revenue at risk. First, calculate the net revenue rate on gross Medicaid charges. Compare that to the percentage of charges recovered from self-pay patients. That’s usually 1% to 2%. Then apply a state procedural disenrollment rate to the provider’s state Medicaid population. That result indicates how many individuals might have become self-pay patients (or still may, depending on whether a state still has to complete redetermination for any patient cohorts). From there, a provider can estimate the impact of increased uncompensated care resulting from an overall reduction in Medicaid-enrolled patients.
These numbers should provide justification for implementing proactive Medicaid enrollment efforts. Growing numbers of uninsured patients and uncompensated care must be addressed. One provider that did so even before redetermination began helped 500 patients enroll in Medicaid and secured $400,000 that otherwise would have been written off as bad debt.
Best practices for ongoing Medicaid enrollment
Some individuals dropped from state Medicaid rolls may now have coverage via the health exchange or employers. But as many as 69% of recipients lost coverage for “procedural” reasons, meaning they didn’t respond to an initial contact, missed a deadline, filled out a form incorrectly, etc. These patients may still be eligible for Medicaid coverage. Further, as many as 25% of “nonelderly” individuals now uninsured are Medicaid-eligible, according to the Kaiser Family Foundation. Implementing the following best practices honed during redetermination can help providers reach and help enroll these individuals.
- Connect in person at the point of care whenever possible. An ideal time to check eligibility and enrollment status is when a patient is in a provider facility. Enrollment counsellors in emergency departments or urgent care clinics may meet with patients after they are stabilized to determine their eligibility and begin the application process before they leave the facility. This helps relieve financial stress on the patient as well as the provider.
- Augment in-person connections with multiple channels of digital outreach. When it’s not possible to meet directly with a patient, digital outreach has proven to be effective. Research shows Medicaid recipients of all ages are comfortable with and want to use email, text, web portals, QR codes, etc. The key to success here is to link the channel to action. A text may include a QR code to a state’s Medicaid enrollment site as well as a “need more help” link for patients who need more assistance in completing their form. Providers can use analytics data from these channels, such as the best days, times and techniques to reach different patient cohorts, with other outreach programs.
- Update patient contact information. While some records may be updated by reviewing recent utilization, working with a contact list enrichment vendor is the most efficient way to secure the most recent contact data. Make certain the vendor includes an insurance discovery check. That will enable providers to eliminate individuals who gained alternative coverage from Medicaid enrollment efforts.
- Partner with Medicaid enrollment experts. Given continued staffing pressures, providers may choose to work with eligibility and enrollment professionals who act as extensions of their staff and brand. These experts can work onsite at provider locations as well as provide enrollment assistance to patients engaged via digital channels. When regulations permit, these individuals can even act as patient advocates with state Medicaid agencies, managing appeals.
Continuing Medicaid enrollment efforts as redetermination concludes helps ensure patients receive coverage for which they are eligible and that providers are properly compensated for the care they deliver. Secure coverage helps encourage access to care that can help improve outcomes and reduce costs. That makes ongoing enrollment programs a healthy practice.
