From the Desk of Everett Lebherz, CEO & Co-Founder of PointCare

Despite the ongoing efforts of the Unwinding of the Public Health Emergency (PHE), we’ve observed procedural Medicaid terminations remaining a constant burden to providers and patients throughout the start of 2024. Rather than a noticeable decline in Medicaid terminations in the first quarter of 2024, the data shows a 34% increase in procedural Medicaid termination rates nationwide compared to Q4 2023.

Early data shows that as the Unwinding continues and we begin to return to pre-pandemic normal operations, we will likely continue to see an increase in procedural lapse rates. One of the primary driving factors for this continued increase in procedural terminations is the quality of the data, which has proven to be inaccurate. In short, the Unwinding has highlighted historical inaccuracies that were present in the Medicaid redetermination process preceding PHE. Without action, inaccurate data sets will inevitably continue to yield inaccurate results, to the detriment of both Medicaid members and FQHCs.

The Work Continues

PointCare continues to work to reduce procedural termination rates with our Coverage Management solutions, which provide proactive identification and resolution of coverage issues to ensure continuity of care while enhancing the member's coverage experience. This January, we proudly launched the latest addition to our Coverage Management solution toolkit: RECOVER+. This full-service Medicaid Coverage Management solution combines the key elements of our platform in one streamlined product offering designed to help get your patients covered and keep them covered, while providing you with insight and clarity at every step.

In Q1 2024, PointCare helped our customers recover nearly 6,000 Medicaid members who were terminated for procedural reasons for a 32% effective lapse recovery rate. We’ve come a long way but we’re just getting started.

Contact PointCare if you want to keep your Medicaid patients covered in perpetuity. 

Want to hear more about what to expect after the Unwinding of PHE? Make sure to join us for our webinar, What’s Next After the Unwinding, on Tuesday, April 23rd. I’ll be sitting down with Salliann Alborn, CEO of Maryland Community Health System, and Dr. Young, VP of Financial Patient Services at AltaMed, to discuss how the Unwinding is impacting Medicaid Members and care providers and what trends we can expect to see throughout the rest of 2024.