Uninsured Eligibility: Updates and Changes Q3 2020

As COVID-19 stretches into the fall, we continue to see the effects of the pandemic on public and private benefit programs. With more changes than ever, including changes to eligibility, the introduction of new programs, and Medicaid expansions, an increasing number of patients are eligible for coverage.


In Q2 of 2020, we saw 2,485 changes impacting 737 programs, a record high compared to the last several years of data. By comparison, in Q3 of 2020, we saw 2,551 changes impacting 469 programs across the country. More changes to fewer programs mean that there is an abundance of new information for enrollment teams to track. PointCare is here to help. 


These are a few highlights:


  • 485 eligibility requirement changes
  • 573 changes to program applications 
  • 57 new programs


Three Important Factors Affecting Eligibility

First, with many patients losing their employment-based healthcare coverage, uninsured rates are rising across the country. According to the New York Times, 8 million people have fallen into poverty during the pandemic crisis. This represents more patients eligible for programs like Medicaid. 


In addition, there are other legislative factors affecting enrollment. Missouri, Nebraska, and Oklahoma are expanding Medicaid, with Nebraska’s expansion taking place on October 1st, 2020, and Oklahoma and Missouri on July 1st, 2020. This means historically excluded groups, like childless adults, will now be eligible for Medicaid coverage in these states. 


Finally, it is important to note that most patients, even if they do not qualify for Medicaid, do qualify for additional programs. 78% of patients in non-expanded states and 67% of patients in expanded states qualify for additional programs.


With so many patients eligible for coverage, there are many opportunities to gain financial compensation for health visits. Finding the best and most accurate coverage options leads to more approvals. More approvals mean more covered visits and more revenue captured. 


Social Determinants of Health

In addition to coverage options, PointCare’s Qualify screens for programs that address health outcomes related to Social Determinants of Health (SDoH). These programs aim to assist patients with other resources that directly affect health and wellness, like help with food scarcity. SDoH are recognized as an increasingly important part of the patient satisfaction experience. 


How Does PointCare Help?


We are the most rapid decision engine for qualifying uninsured patients, designed to be used at point-of-care in the ED setting where time is of the essence. PointCare ensures a standardized and data-driven qualification process. Using our nationally curated database of all insurance and benefit programs nationwide, screeners know that they are sharing up-to-date information with patients. Once this 90-second screening is complete, the patient can receive results via email, text, or print. 


PointCare Qualify API is now available as a stand-alone product or as part of the Total Enrollment Management platform. Learn more about Qualify API.


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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