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How Hospitals Can Take a Proactive Role in Preventing Medicaid Churn

June 8, 2023
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Broadly speaking, churn has always been a part of the Medicaid system. Circumstances can change quickly, or states can change Medicaid requirements and people often transition in and out of enrollment. However, in the healthcare finance industry, churn is often used as a negative term, considered something to be avoided. 

“Churn” occurs when people fall out of Medicaid coverage for a short period of time but eventually re-enroll. This is different from a permanent loss of Medicaid coverage, which often occurs when a patient transitions off of Medicaid due to ineligibility and moves onto a new coverage plan, like an employer-sponsored commercial insurance program. 

One of the worst case scenarios surrounding Medicaid churn occurs when a patient does not re-enroll in Medicaid despite remaining eligible. That patient then loses coverage without transitioning to a new type of insurance, leading to a lapse in coverage (and often care) that lasts indefinitely. 

Medicaid churn leads to increased administrative costs and lapses in coverage for vulnerable populations. Healthcare finance professionals often seek to minimize churn as much as possible to ensure patients have coverage for the care they need.

Medicaid redetermination and expected churn

During the COVID-19 pandemic and subsequent Public Health Emergency (PHE), the Medicaid continuous enrollment provision provided extra funding for states on the condition that they did not remove anyone from Medicaid enrollment. By halting disenrollment, churn was effectively also halted from March 2020 to present.

Today, as the PHE expires and we move through the Medicaid redetermination process, we will once again experience Medicaid churn. The question is - just how extensive will it be?

As states begin to disenroll Medicaid recipients who do not renew, an estimated 15 million people will lose coverage. Of those 15 million Americans, an estimated 6.8 million people will lose coverage despite remaining eligible.

Due to social and income barriers, certain groups will likely be at a greater risk for losing coverage during redetermination, including low income families, people of color, chronically ill and disabled populations, children and non- or limited English speakers. 

It will also be challenging to contact and re-enroll patients who have moved and have not kept their address up to date with the hospital during the pandemic. In 2020, 10% of enrollees changed addresses or moved while remaining within the borders of their state, meaning they were eligible for the same state-sponsored Medicaid program but difficult to contact to communicate this eligibility and need for renewal. 

The concern here is twofold: One, how can we as healthcare finance professionals reach eligible populations to communicate the need to re-enroll? And two, how can we minimize “churn” or the time spent between Medicaid disenrollment and renewal - especially for vulnerable populations?

How to prepare for (and prevent) excessive Medicaid churn

A large percentage of Medicaid patients will lose coverage if they do not re-enroll or know to re-enroll in the first place. It’s easier to assist a patient in the re-enrollment process than to have them come in for care and then assist them with an entirely new application. 

New applicants come with a higher cost and delayed reimbursement, so there are financial and ethical incentives for hospitals to take a proactive role in the redetermination process by identifying affected patients and actively assisting them to prevent lapses in coverage. 

Luckily, the tools and partnerships you need to take a proactive role in redetermination exist and are available. Office Ally has been operating in the insurance verification and Medicaid eligibility and enrollment space for more than 20 years. We’re proud to serve as a trustworthy source of information and customizable software solutions to help you navigate through this challenging period.

  1. Comprehensive data
    We provide access to comprehensive data to help you better better understand patient eligibility and coverage options, including
    • Realtime Medicaid eligibility verification: Pre-check the appropriate state database to determine if the patient is currently enrolled in Medicaid and, if available, their renewal date. 
    • Retrospective lookback: Identify patients who have already converted to commercial coverage or who have lost coverage through the redetermination process. If they are no longer enrolled, they can be flagged in the billing workflow for additional financial counseling.
    • Comprehensive Insurance Discovery: Identify available coverage of all types of payers, government and commercial with an exhaustive check. This robust process ensures no dollars are lost due to unknown coverage.
  2. Customizable technology solutions
    We also provide technology solutions to facilitate on-the-job tasks, including:
    • Screening and enrollment solution for Medicaid and Financial Assistance: Office Ally’s MAPS solution offers a rapid assessment tool that quickly and accurately screens patients and identifies potential eligibility and next steps for enrollment in various financial assistance programs, all in around three minutes.
    • Outreach and engagement and patient portal: The MAPS-clear patient portal can serve as an outreach tool to draw patients into the financial counseling process. The portal can also serve a tool to increase communication with the patient through the enrollment process to ensure a final resolution. It has the power to take the place of 1:1 communication that occurs through phone calls, letters and most emails. Portals ease outreach and engagement and give financial counseling teams the opportunity to remind patients to re-enroll and provide clear instructions, next steps and fast assistance. 
    • Automated scoring to prioritize accounts: There are a wide variety of trusted data sources that can be used to assist financial counselors in assessing patients' financial situation. A best practice is to use multiple tools and deploy them in a manner that is consistent with your policies. This process allows patient financial services to prioritize accounts by identifying those most likely to qualify for enrollment or re-enrollment into a reimbursement program, such as Medicaid. Leadership can then define their outreach and engagement flow based on these scores, integrating high touch procedures for valuable accounts and more automated, email-based procedures for low value accounts. 
    • Reporting: The team has the ability to run varying types of reports based on their specific metrics. These reports can measure internal performance, third-party vendor performance and a variety of other customizable metrics.

These tools aren’t far-fetched dreams or inaccessible ideas. They exist, and thousands of providers are using them to navigate redetermination and avoid Medicaid churn by streamlining their workflows, improving processes and better serving patients. 

We’re here to help you navigate Medicaid redetermination from start to finish. Contact Office Ally today to connect with one of our experts for more information.