The End of Medicaid Continuous Enrollment: What Can Providers Do?
By athenahealth Marketplace Partner maxRTE |
When the U.S. federal government enacted the Families First Coronavirus Response Act (FFCRA) in 2020, individuals and families with Medicaid coverage gained a huge win. Part of the FFCRA, the Medicaid continuous enrollment policy allowed individuals who qualified for Medicaid to maintain coverage without interruption, ensuring reliable access to health care—regardless of changes in eligibility.
On March 31, 2023, however, the policy came to an end, along with the temporary provisions of the COVID-19 public health emergency. Now, states have fewer than 12 months to return to normal eligibility and enrollment operations.
What does this mean for patients and providers?
This policy change is considered the largest healthcare coverage transition event since the first open enrollment period of the Affordable Care Act. Of the 15 million people affected, approximately:
- 8.2 million will lose eligibility owing to demographic changes.
- 6.8 million will lose coverage due to administrative churning and eligibility redetermination errors (even if people remain eligible).
As coverage gaps disrupt access to health services and increase the risk of uncompensated care, it is important for all patients and providers to be aware of these changes and understand how they might be affected.
The end of Medicaid continuous enrollment means patients seeking to maintain coverage will need to reapply for benefits each year, which can be confusing and time-consuming. For healthcare providers who serve Medicaid patients, the end of Medicaid continuous enrollment could create significant financial challenges if they are not reimbursed for the care they provide to patients who have lost Medicaid coverage.
How can providers mitigate disruptions in coverage and care?
While patients navigate the complex process of re-enrollment, providers can proactively identify patients who have lost coverage and help them reapply for benefits.
Leveraging automated revenue cycle software, providers can mitigate the impact of this wind-down in two ways:
- Verify Medicaid eligibility at every step of the patient journey. Using maxRTE’s Insurance Eligibility Verification software, providers can verify if a patient has active Medicaid coverage—in real time at the point of registration, or via daily, weekly, or monthly batches. maxRTE can help identify which patients need to reapply for Medicaid and get them the assistance they need to navigate the process. Implementing an automated solution also reduces the administrative churning and eligibility redetermination errors that can drive Medicaid coverage losses. With more clarity around enrollment and eligibility, providers will spend less time chasing Medicaid reimbursement for disenrolled patients, and avoid denials and payment delays.
- Detect overlooked coverage for patients who lost Medicaid coverage. For patients who are no longer eligible for Medicaid due to demographic changes, providers can use maxRTE Insurance Discovery to run further coverage checks for unknown insurance. maxRTE can help identify additional exchange plans, Tricare, and commercial coverage (e.g. from a spouse) that may have been overlooked at the point of registration. Insurance Discovery also helps providers avoid unnecessary bad debt write-offs while eliminating manual, time-intensive processes.
The bottom line
Providers should use automated processes at every step of the patient journey to not only re-verify Medicaid coverage, but also help locate active coverage that may have been overlooked. Using maxRTE real-time Insurance Eligibility Verification and Insurance Discovery, providers can identify patients who have lost Medicaid coverage and work with them to reapply for benefits. This can help ensure patients maintain coverage and can access the care they need, while also helping providers receive reimbursement for the care they provide, even in the face of changing policies and regulations.