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No More Medicaid Auto-Enrollment? Healthcare Orgs Must Pick up the Slack

Kevin Holst
June 22, 2023
Medicaid auto-enroll

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There is nothing permanent except change.

This quote from the Greek philosopher Heraclitus has been on display during the past few years. The global pandemic brought about a host of changes throughout the United States.

In the healthcare industry, the pandemic forced changes in the way healthcare organizations deal with patients. Medical appointments conducted via video conferencing became the norm. Patients were given more online tools to schedule appointments, pay bills, connect with doctors, and more.

But what it also showed was the importance of government programs aimed at helping citizens through difficult times. Programs, such as Medicaid, became an important lifeline for many Americans during the pandemic. But now that COVID-19 is no longer considered a global health emergency, changes are happening again, including with Medicaid enrollment.

While changes to Medicaid enrollments will have an enormous impact on millions of citizens, all is not lost. Hospitals and healthcare organizations can still help their patients find and enroll in the appropriate health coverage…with the right technology solution.

Everything changed

The traditional procedure relied on individual states regularly checking to make sure that people who receive Medicaid coverage remained eligible. At the start of the COVID-19 pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA). This act included a requirement that Medicaid programs keep people continuously enrolled through the end of the COVID-19 public health emergency (PHE) in exchange for enhanced federal funding.

Thanks to the FFCRA, Medicaid saw more than 19 million new enrollees since early 2020. It also saw enrollment grow more than 27% in just over two and a half years. This was initially tied to the widespread job and income losses that affected millions of Americans early in the COVID pandemic. Fortunately, Medicaid was able to step in and provide health coverage when people lost their income. Without it, millions of additional Americans would have joined the ranks of the uninsured.

As of February 2023, 86.2 million individuals were enrolled in Medicaid. This makes Medicaid responsible for 19 percent of the nation’s health care bill and the third-largest payer behind private insurance and Medicare.

Problems ahead

But when the Biden administration announced the end of COVID-19 public health emergency and national health emergency designations on May 11, Medicaid announced that continuous enrollment, which helped millions of people maintain healthcare coverage, would end on March 31, 2023. Beginning April 1, 2023, states were returning to the regular Medicaid renewal process. As a result, millions of people who no longer qualify for Medicaid lost their Medicaid coverage.

While the number of people who may be disenrolled is highly uncertain, the Kaiser Family Foundation estimates that between 7.8 million and 24.4 million people could lose Medicaid coverage during the 12-month unwinding period. These projections are consistent with estimates from the Department of Health and Human Services (HHS). HHS suggests that as many as 15 million people will be disenrolled, including 6.8 million who will likely still be eligible.

An estimated 380,000 of those who are losing coverage are working adults who won’t be eligible for other health coverage because they make too little to qualify for Obamacare subsidies while making too much to sign up for Medicaid.

Missing out

What’s worse is that many people aren’t aware of these changes. As recently as December 2022, two-thirds of adults in Medicaid households didn’t know the program rules were changing. Individuals who don’t have access to the internet or a newspaper are likely to have missed the announcement. And those who have moved might have missed a termination letter or renewal notice if they have not updated their contact information with the state Medicaid agency.

Also troubling is that many individuals will now be at risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers in the renewal process. These individuals might not know where they can go to enroll in Medicaid. They likely don’t know what type of documentation they need or what the requirements are to qualify. Those affected most include:

  • People who have moved
  • Immigrants
  • Those with limited English proficiency
  • Individuals with disabilities
  • Older adults.

It’s your turn

As healthcare professionals, it is incumbent upon us to help patients sort through their options and find the coverage that fits them best. This is a critical aspect of providing patients with the personalized and human care that they desire.

Everyone benefits from helping patients determine what financial healthcare options they have, including treatment and coverage options. Yet, hospitals and healthcare organizations can only do this if they have the necessary information at their fingertips. The monolithic health information system (HIS) platforms were not designed to support patient enrollment, making it difficult to solve this problem for the patient.

Instead, healthcare staff need the right tool so they can help patients apply for coverage, either early in the process before any treatment begins or even after treatment has been provided. That requires an investment in technology that not only helps humanize the process, but also features centralized automation that gives agents access to all pertinent information instantly. The right solution should also include intelligent workflows to help your staff identify coverage options at whatever point the patient is during their journey, even during the balance follow-up process.

Your true colors

Everyone knows that change is inevitable. Hospitals and healthcare organizations can’t anticipate what specific changes are coming. But the organizations that will best handle change are those that invested in technology solutions that personalize the healthcare experience. This is especially important during stressful times, including when the patient’s healthcare coverage is in flux or has disappeared. This is when you can show your patients just how human your organization can be.

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