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.

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.

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