Medicaid Eligibility: Updates and Changes Q1 2020

Due to the COVID-19 pandemic, resulting job loss and healthcare crisis, coverage has never been more important to patients and the facilities that see them. Coincidence with these current events, PointCare has tracked the highest number of changes to Public, Private, State, and Federal level programs in the last two years. In the first quarter of 2020 there were 2,366 updates, including changes to applications, websites, contact information and more.

PointCare makes it easy to manage self-pay patient enrollment, even in these chaotic times. When you convert self-pay patients you have more covered visits resulting in additional revenue. This can only happen if enrollment teams have current information on programs and eligibility. Here are some of the most important updates to share with your enrollment team:


Q1 Updates: January 1, 2020 - March 31, 2020

We compiled 2,366 program changes on our platform. Highlights include:

  • 628 applications updated
  • 472 modifications to eligibility requirements including income, age, or asset limits
  • 70% of all programs nationwide implemented changes

These shifts make staying current with enrollment information challenging, especially when you add in the fact that 22% of programs made URL adjustments and there were 1,098 updates to program contact information.

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Identifying Opportunity

We track these changes and consistently update our software so that your enrollment team has the best information when working with a patient. Why is this so important? 

There is a significant opportunity to convert self-pay patients to covered visits. Our research shows that 81% of self-pay patients qualify for Medicaid in expanded states and 50% in non-expanded states. 


Managing Your Self-Pay Population

Both patients and enrollment teams are challenged by the constant shifts in eligibility.

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With opaque coverage systems, patients may come to appointments or visit an emergency room unaware that their coverage has lapsed or that they may qualify for state or federal programs. The constant changes to eligibility and redetermination requirements make finding and maintaining coverage challenging for patients as well as enrollment teams. 

Historically there were three solutions: help the patient apply to programs, write-off costs as charity or use a sliding fee scale. 

All of these situations result in high costs to your facility as your staff tries to navigate complex programs. With time at a premium and resources stretched, it is important to be efficient and accurate when enrolling patients. 


Converting Self-Pay Patients

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How can you find coverage for your patients?

When information is hard to find, enrollment is complicated and difficult to manage. In many cases your enrollment team is investing time and resources in helping patients apply, only for the patient to be denied. Reporting is often done on spreadsheets and takes hours to find data that quickly goes out of date.

There are constant changes to qualifying rules, and the key is having a user-friendly system that qualifies, enrolls, and verifies your health system’s coverage journey - we call this the Enrollment Cycle. 


How Does PointCare Help?

PointCare makes the Enrollment Cycle simple, user-friendly, and up-to-date. You can qualify patients for coverage in 90 seconds, track applicant statuses, and help prevent future lapses in your patients’ coverage. The qualification process is dynamic and include social determinants of health. The results are a personalized list of programs, leading to higher qualification, submission and approval rates.

Data indicates that when you use PointCare on all self-pay patients, approval rates increase 53%! That means your enrollment team is using their time efficiently to convert more patients and capture more revenue.

Whether you simply want to do better identifying enrollment opportunities or replace your enrollment process with PointCare's TEM we have options to suit clinics, hospitals and Revenue Cycle Management (RCM) organizations.

Want to learn more about PointCare's Best Practices? Check out our website,

Note: Our Customer Success Advisors have implemented PointCare in over 600 health system sites nationwide who have decided to simplify their enrollment cycle. We are now providing free enrollment cycle assessments for those who qualify. Schedule a call with our team to learn more.

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