How to Mitigate the Impact of Medicaid “Unwinding”
By Heather Smith CHAM, CHC, Vice President Eligibility & Enrollment Services, Conifer Health Solutions
Twitter: @coniferhealth
The Department of Health and Human Services (HHS) estimates that more than 8 million Medicaid recipients, 5.4 million of whom are children, will lose Medicaid/CHIP coverage with the phase-out of the Families First Coronavirus Response Act (FFCRA). The program was implemented during the COVID-19 pandemic to ensure recipients were continuously covered throughout the public health emergency.
The potential for patient confusion and gaps in care
While states have 12 months to complete the “unwinding” that began on April 1st, there is no federally mandated process for them to follow. It is up to each state to create its own processes for the recertification process. This is expected to create confusion among enrollees who may not understand the changes to their coverage. It is unclear what, if anything, states are doing to make it an easier transition for enrollees.
For those losing coverage entirely, the consequences could be dire if they fail to find new coverage quickly. We know individuals without coverage can be more likely to put off care or stop taking medications due to costs. This can be dangerous for people with chronic conditions like heart disease or diabetes.
Provider impact
Many hospitals are already operating on razor-thin margins. The impact of the unwinding could make matters worse as the number of uninsured patients increases. This is especially true for hospitals that see a lot of individuals using the emergency department for situations that would be better treated in a physician’s practice or an urgent care facility.
Providers may find it challenging to predict and protect revenue throughout the unwinding process, especially for those with volume-based payer contracts. At the same time, they are likely to experience a spike in denials as it becomes difficult to verify new coverage and determine changes in eligibility. They should also anticipate that self-pay collections may become more challenging as well.
The good news is that there are steps providers can take now to help mitigate the impact of the unwinding.
Leverage automation
By leveraging automated technology, processes like coverage discovery and eligibility verification can become more accurate and more effective. Technological innovations like artificial intelligence (AI) and robotic process automation (RPA) can help patient access staff collect accurate demographic information and detect secondary and tertiary coverage with less manual effort. This can help reduce denials from errors in coverage and eligibility data, as well as write-offs.
Provide patient financial responsibility estimations
As coverage changes for so many individuals, they are likely to be confused about their new plan, including co-pays and deductibles. By offering payment estimations, providers can educate patients about their plans and what they owe. Patients will appreciate having the information they need to make better decisions about how to pay for their care. Estimations help providers, too, by providing them an opportunity to collect earlier in the encounter.
Use propensity-to-pay tools
Propensity-to-pay analytics give providers insight into which patients are more likely to pay and which may need help finding alternative financing sources. It’s a waste of time and money to send statement after statement to patients who can’t pay only to turn an account over to an agency several months later for just pennies on the dollar. Getting a more accurate picture of a patient’s financial circumstances allows providers to better personalize the financial experience. This should include helping patients who qualify to apply for financial assistance or charity care.
Offer tools that make it easier for patients to pay
If providers haven’t already, they should implement digital payment tools and flexible payment plans to help make it easier for patients to pay. Offering payment tools like easy to use payment portals and mobile payments alongside traditional payment methods elevates the convenience for patients and provides a better financial experience. Flexible payment plans can also help by enabling patients to make monthly payments that fit into their budgets. Plans should include the ability to add new charges or charges for family members to the payment plan. Making a single payment each month is much more manageable than trying to keep track of and pay multiple payments.
Find a partner to help
It is more crucial than ever that hospitals have the ability to accurately determine a patient’s eligibility for public health programs like Medicaid or CHIP. But not all hospitals have the technology and resources with which to screen all self-pay patients. For many, working with a partner that already has the latest technologies, tools, and a team of revenue cycle experts in place is the way to go.
One of the most significant ways a partner can help is by assisting a hospital’s patients through the eligibility and enrollment process. Understanding insurance can be difficult for patients. Terms like benefit levels, drug tiers, co-payments, deductibles, co-insurance, covered benefits, coverage limits, and out-of-pocket maximums can be confusing. Even the process of signing up for coverage can be overwhelming. Partners can help alleviate the stress and confusion by educating patients about their options and simplifying the enrollment process. Once a patient is identified as eligible, partners can help get the patient enrolled immediately.
By helping patients navigate this process, partners can improve patient loyalty and increase word-of-mouth referrals for the hospital. Making sure patients are able to get the care they need through the appropriate coverage can also help improve outcomes and care plan compliance.
Hospitals should be careful to choose a partner that embraces their corporate culture and that understands the importance of each patient encounter. The right partner will enhance the patient experience and elevate the hospital’s brand reputation, and add value from the very first day.
The bottom line
These are challenging times for providers and patients alike. By helping patients get the care they need throughout the unwinding and beyond, providers will also be helping themselves to strengthen their bottom line and build patient loyalty.
