Medicaid, the US government-run health insurance program for low-income individuals and families, is a critical resource for millions of Americans. Despite the crucial role it plays in delivering healthcare, Medicaid has faced political and financial instability. Numerous measures have been taken to strengthen the program, notably the expansion of Medicaid under the Affordable Care Act (ACA). By the summer of 2023, 41 states and the District of Columbia had expanded Medicaid coverage.
It further gained stability during the COVID-19 pandemic with the enactment of the continuous coverage provision under the Families First Coronavirus Response Act, which prevented states from terminating coverage for Medicaid patients. However, with the end of the Public Health Emergency (PHE) declaration this spring, those safeguards dissolved forcing states to reevaluate eligibility for American Medicaid recipients. As a result, over 10.6 million patients lost their Medicaid coverage since the start of the process.
In these changing times, hospital revenue cycle leaders face the challenge of navigating Medicaid redetermination, aiming to safeguard both patients and healthcare institutions. For hospitals, as well as academic medical centers like Kansas City’s University Health, Medicaid is a significant payor. For University Health, it accounts for 44% of their payor mix, making it the largest single source of funding.
In response to the demands of Medicaid redetermination, University Health developed a four-fold strategy:
Patient Engagement – The Financial Counseling Center (FCC) at University Health has a track record of helping patients navigate Medicaid coverage. Leveraging the FCC’s expertise, they have proactively reached out to patients, providing support through various means and ensuring they were equipped to handle the termination of PHE.
Collaboration with Managed Care Payors – Hospitals and payors, despite their differences, share a common goal in maintaining patient enrollment in Medicaid. Collaboration involves joint outreach efforts and shared data analytics to enhance the redetermination process.
Leveraging Analytics – University Health uses data analytics to keep track of Medicaid patients during the redetermination process. This proactive approach allows rapid response to potential issues to prevent a sudden surge in uninsured patient visits.
Financial Assistance Policy Review – Anticipating that some patients will lose coverage, University Health revised its financial assistance policies, and made adjustments to better meet the needs of these patients, ensuring they knew their options and aid compliance regulations.
The strategy has shown positive results with 85% of the university’s Medicaid patients able to maintain their eligibility. This approach represents not just an organizational win, but a necessity for ensuring low-income individuals’ continued access to quality care without excessive financial concerns. Hospital revenue cycle leaders must prepare for Medicaid redetermination. This entails investing in their organization’s long-term sustainability, preventing sudden uninsured patient influx, and upholding the healthcare safety net for those in need.
