The Unwinding dominated meeting topics this time last year as the public health emergency (PHE) ended in April 2023. Now, 12 months and over 15M terminations later, what can we expect from Medicaid terminations?
Actually, more of the same. While the Unwinding is an ear catching term, in reality, we are just going back to normal.
The Normal:
What is normal with regard to monthly terminations? Ask AltaMed.
“We've been working with PointCare since 2017 to manage coverage every month for our Medi-Cal population. Leading up to the PHE, approximately 7,000 AltaMed patients were losing coverage every single month. Our lapse rate has dropped slightly since the Unwinding began and still we are averaging a 1.78% lapse rate every single month, or over 6,000 patients being terminated every month. This exceeds what we see on our redetermination lists. We expect this to continue and will manage coverage for our patients proactively. Managing coverage is a worthwhile service for our patients, reduces our self-pay visits, and lessens resource constraints.” Dr. Robert Young, VP of PFS at AltaMed.
Dr. Young has been with AltaMed for 15 years. The monthly termination rate he is referring to is primarily due to procedural terminations, or when a Medicaid member doesn't get through the redetermination process or is unaware they lapsed, requiring assistance to get re-covered. This is where PointCare comes in to help, re-covering up to 49% of procedurally terminated patients within 90 days of a lapse. This keeps the patient in the same health plan and anchored with the same provider.
State of Unwinding:
Unwinding the PHE has proven to be easier said than done. Since the Unwinding began in April 2023 only 11 states have completed the process while others have had to extend their timelines into early 2025.
By February 2024, half of the individuals expected to be enrolled in Medicaid and similar programs impacted by PHE were redetermined. The unfortunate consequence of this arduous process has been a steady rate of disenrollment from Medicaid due to procedural reasons. In many cases, patients who are still eligible for Medicaid coverage have lost their coverage due to clerical errors or delayed paperwork filings. As it stands, recent Kaiser Family Foundation reports show that the majority, 70%, of Medicaid terminations were due to procedural reasons as of March 2024. This means there is still work to be done to ensure Americans remain covered under their appropriate health plans.
Beyond Unwinding:
Why are procedural terminations averaging 73% nationally despite all the education, marketing, and awareness campaigns leading up to the Unwinding? It's a function of data quality at the state level.
“While the Unwinding placed a spotlight on the challenges of Medicaid eligibility redetermination, the issues existed well in advance of the Public Health Emergency. As we return to “normal”, we recognize that Medicaid members have always dropped from coverage unexpectedly, and unfortunately, redetermination lists are historically inaccurate.”
Salliann Alborn is the CEO of MCHS, an IPA in Maryland with close to 80,000 Medicaid members.
She goes on to say, “We found that PointCare identified 5x more Medicaid terminations each month than we received on our redetermination lists. This led to improved engagement and rapid re-coverage. We are working to bring coverage management to our patient population as a standard service, in partnership with our payers and providers. Keeping members covered is critical to effectively managing care and enhancing re-coverage efforts will only improve clinical outcomes and cost management over time. Embracing a Coverage Management concept is a necessity because data indicates members are often unaware of the need to redetermine Medicaid eligibility risking a lapse in coverage and care. PointCare’s ability to both identify lapsed members and facilitate re-enrollment using the “VANCE” tool helped mitigate our average 2.16% lapse rate each month."
PointCare deployed VANCE, a digital Medicaid navigator allowing the patient to rapidly enroll in Medicaid, in 2022. Its multilingual capability has excellent feedback from patients taking re-enrollment into their own hands and sometimes with the help of PointCare.
Everett Lebherz, Co-founder and CEO of PointCare has been delivering Medicaid enrollment solutions to the market for over a decade.
“We noticed patients were re-enrolling multiple times every year even though Medicaid was supposed to last for 12 months. Digging into it and talking to our customers, we learned the data was accurate. Patients were dropping randomly throughout the year well in advance of the PHE. Lapse rates haven't changed much from pre-PHE, it just feels like they have because no one dropped coverage for 3 years. Thanks to our partnership with AltaMed, we built the capability to identify coverage events and act on them instantly in advance of the Unwinding. We invested knowing terminations are a perpetual issue that trickles down to the patients and providers. This is why we are seeing more and more providers offer our Coverage Management services to their patients. Anyone who has been involved in Medicaid coverage prior to 2020 knows terminations are a perpetual issue.”
Contact PointCare if you want to keep your Medicaid patients covered in perpetuity.
Want to hear more? Join us for our webinar What's Next After the Unwinding? on Tuesday, April 23, 2024, at 9 AM PST where we sit down with Everett Lebherz, Dr. Young, and Salliann Alborn.