During the COVID Public Health Emergency period, the Medicaid Continuous Enrollment Provision was established; under this provision, Medicaid could not disenroll its members, even if they technically no longer met eligibility requirements. As a result, during the pandemic between 2020 and 2022, Medicaid enrollment increased by 25%. But the provision expired on March 31, 2023, and states have begun disenrolling people who are no longer eligible or who are unable to complete the enrollment process.
The Medicaid Continuous Enrollment Provision expired on March 31, 2023 and states have begun disenrolling people who are no longer eligible or who are unable to complete the enrollment process.
To simplify the enrollment process and prevent eligible members from losing coverage during this transition, the Centers for Medicare and Medicaid Services (CMS) is requiring states to provide a plan for renewal review. As part of this plan, states must identify measures they will take to ensure that truly eligible members do not lose coverage during this process due to procedural challenges in the enrollment process, including moving without updating address records or speaking a language other than English.
Operational and Financial Impact to Providers
The US Department of Health and Human Services (HHS) is estimating 15 million individuals will lose coverage and according to a recent Becker’s Healthcare article, Medicaid redeterminations are going worse than expected. States are already reporting several thousand members have lost Medicaid coverage some due to ineligibility and others due to procedural challenges in the enrollment process.
Providers should anticipate the potential impact of this trend on their revenue and operational dynamics. The loss of Medicaid coverage among a significant portion of patients may result in increased uncompensated care and a shift towards patients with other forms of insurance or even uninsured individuals. This can have implications for reimbursement rates, payment collection, and overall financial stability.
As a result, providers can expect to encounter an array of challenges and implications stemming from the increase in patients who are no longer insured with Medicaid. These challenges could include:
Increase in Uninsured Patients
Due to the significant increase in enrollment during the pandemic and the number who are losing coverage during the review, providers may begin to experience a rise in the number of patients who are no longer insured with Medicaid.
Patient Confusion
Compounding the issue, individuals may not be aware their coverage has been terminated and therefore may not provide updated insurance information to their healthcare providers. As a result, patients may be confused if they receive a bill for services that they believe should have been covered by Medicaid.
Significant Rise in Bad Debt
Providers will likely see a rise in bad debt from patients who are unable to pay their bills as a result of losing Medicaid coverage.
Change in Payment Timeline
Patients may take longer to pay bills if they have to contact their provider after receiving a bill to provide updated information or set up a payment plan.
Increased Administrative Burden
Providers may encounter additional administrative tasks related to verifying insurance coverage, navigating different billing procedures, and assisting patients with eligibility determinations.
Changes in Monthly Budgetary Projections
The anticipated changes in revenue necessitate a critical reassessment of providers’ monthly operational budgets. This adjustment process, however, can pose significant financial challenges, particularly for providers who are bound by financial covenants. It is essential for providers to proactively recognize and address these challenges to ensure financial stability and viability in the face of evolving circumstances.
Financial Strain on Revenue
The changes in payor mix, rise of bad debt, and expanded payment timelines can have significant financial implications for healthcare providers. Providers can also incur additional costs to the billing process and fluctuations in staff productivity, as the staff attempts to track down payment for these services.
However, there are things providers can do to help mitigate some of the challenges listed above while supporting patients and also optimizing revenue during the Medicaid continuous enrollment unwinding.
Strategies to Support Patients and Maintain Revenue
1. Know your Payor Mix: What Percentage of Your Business is Medicaid?
To understand the potential impact on your business, it is important to know what portion of your business is currently related to Medicaid revenue. The smaller the percentage of your current business that is Medicaid, the smaller the impact of this particular change. Compare your current Medicaid percentage to 2019, prior to the PHE. It would be reasonable to expect your Medicaid percentage to shift back to the pre-pandemic levels over the next year – unless other significant changes have occurred in your base business, or referral sources, that affect your payor mix.
2. Determine Patient’s Insurance Eligibility Prior to Billing
Insurance Eligibility – Utilizing insurance eligibility verification services prior to billing helps ensure that a claim or bill goes to the appropriate party on the first submission. This reduces your time to collect from the appropriate party. Sending a claim to Medicaid for a patient not eligible for Medicaid benefits slows down your collection cycle.
Insurance Identification – In addition, assuming because a patient is no longer enrolled in Medicaid that they are uninsured when they have insurance can also slow down the collection cycle. It is important to utilize tools that can not only verify the insurance provided is correct, but if incorrect help identify if the patient has updated insurance prior to billing.
3. Monitor Referring Client Profitability
Identification – Identify referring clients who may not be as profitable due to the changes in patient payor mix. Providers can leverage analytics covering the full transaction cycle, order-to-cash, to determine actual client profitability and to determine the root cause of positive and negative fluctuations in revenue.
Education – Once identified work with those referring clients to educate them on obtaining accurate insurance information or providing patients with estimated patient financial estimates. Patients are more likely to pay for or decline services they can’t afford if they are aware of the cost of the service.
4. Promote Self-pay Payment Options
Educate uninsured patients on the options they have for settling their bills. Some items to consider:
Financial Assistance Options – If you provide financial assistance options based on financial hardship, make patients aware of this quickly. Consider including information about access to financial assistance on your patient statements and the website where your patients pay their bills or contact your billing team.
Prompt Pay Discounts – You may also offer a prompt-pay discount to pay in full with the initial bill. Whatever you decide, confirm that members of your staff who take patient phone calls are aware of all the options you offer so that messaging is clear and consistent.
Payment Plans – Consider offering payment plans to your patients, allowing them to pay a designated amount over a defined time period. In these payment plans, you might consider a maximum length of the plan and/or a minimum required monthly payment plan to ensure your cost to collect isn’t unnecessarily high compared to the balance.
Patient Statement Cycles and Method – Evaluate the method and frequency for delivering patient statements to accelerate patient patients. For example, as described in The Latest Trends in Denials and Appeals Management white paper, XiFin customer data shows an increase in patient payments received in the first 30 days of the cycle after integrating texting and automated calls into the traditional process.
5. Offer Enhanced Patient Access Solutions
Offer options that make it convenient and easier for patients to pay their bills, update their information and personalize their experience.
Patient Education – Patients may have questions about their bills. Enhance the language on your patient portal or bill payment website to provide clarity to these patients regarding the services that you provide and why patients may have received a bill.
Online Patient Statements – Consider reviewing and revising the content of your patient statements to clarify and explain services rendered. Patients should also be able to access online invoices that provide all the relevant detail in an easy-to-understand format. Providing patients with a summary of their statements and outstanding balances helps patients manage multiple bills at once.
Multiple Payment Option – Offer solutions that make it easy and convenient for patients to pay their bills in a manner that suits their circumstances. Patients seek access to digital payment options, including credit card payments and PayPal, along with real-time support. Update Insurance Information: Patients should be able to update their insurance and demographic information online.
Utilize Patient Responsibility Estimator – Patient estimation tools can assist the patient in understanding the out-of-pocket expense before the test is performed. Leveraging a patient out-of-pocket estimation tool, can proactively educate the patient and help them understand their out-of-pocket cost.
6. Educate Patient Service Representatives
During this critical period of post-pandemic changes, a customer service team that possesses a comprehensive understanding of the concluding Public Health Emergency (PHE) and its profound impact on your patients is not merely advantageous but imperative.
To effectively navigate the anticipated rise in the uninsured population during this process, it is paramount to thoroughly evaluate all conceivable touchpoints through which your patients may engage with your business, encompassing the call center, customer service, patient portal, website, and referring providers. By identifying and seizing opportunities to provide uncomplicated and transparent information across these channels, you can profoundly augment your patients’ overall experience. Empowering your patients with a clear comprehension of their bill and payment options not only diminishes confusion but also elevates satisfaction levels, all while streamlining the collections process and minimizing any potential delays. Consequently, by proactively addressing these essential elements, you fortify your organization’s ability to navigate the evolving healthcare landscape with greater resilience and ensure the ongoing well-being of your patient community.
In conclusion, the anticipated rise in the number of patients no longer insured with Medicaid presents a significant challenge for healthcare providers. By adopting proactive strategies, enhancing patient education and financial counseling efforts, fostering collaboration, and staying informed about policy changes, providers can navigate this transition period and continue to deliver quality care while maintaining financial stability.
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