What does it mean when a patient falls out of coverage? Practically speaking, we understand the nuts and bolts operationally of what that means. In our recent blogs we covered the financial burden redeterminations have on clinics and one of the primary causes clinics and patients are caught unaware. But when we get to the heart of the matter, the loss of Medicaid is more than percentage points and lost clinic revenue. It is something that impacts the most vulnerable communities in all of our backyards.
We’ve covered the financial implications on clinics of their patients falling out of coverage, but the loss of Medicaid coverage can have a very real financial burden for patients as well. The majority of people who fall out of coverage experience a period of uninsurance following disenrollment. Roughly 79% of lapsed patients were uninsured before they were re-enrolled in Medicaid. This forces patients to make hard decisions - funding their health or other elements of life, such as rent, childcare, commute, etc. As we know, gaps in Medicaid coverage can jeopardize patients' access to health services or can even impact their financial security if they incur medical bills for treatments they cannot postpone. Simply put, procedural terminations often put patients between a rock and a hard place.
Converting to Self Pay or Forgo Coverage Entirely
Recent studies have shown that in 2022, 28% of adults chose to forgo medical care because they couldn’t afford it. Patients who lapse from Medicaid coverage are forced to pay out-of-pocket for medical services, which can sometimes be significantly more expensive than the copayments and deductibles associated with Medicaid. This means lapsed patients often choose to forgo annual exams or screening that could provide early detection for serious health complications to avoid out of pocket fees.
Potentially Life-Altering Consequences
Unsurprisingly, when patients lose coverage they are more likely to cancel or skip their appointments. For some Medicaid patients, like Antonio Abundis from California and the Maron family in Florida, who have serious, life-altering illnesses that require medical intervention, lost coverage due to procedural reasons can be a severe risk. Patients in these scenarios are sometimes forced to decide if they are able to take on higher levels of medical debt from self-pay services. Procedural terminations wipe out the safety net that Medicaid provides, forcing families to make difficult choices - face the financial burden of paying for care out of pocket or forgo care - which could very well mean the difference between life and death.
Unexpected Loss of Access to Non-Medical Benefits
Access to health services is not the only thing that a lapse in Medicaid can jeopardize. In some states, Medicaid benefits are not only tied to health coverage outcomes, but also SNAP benefits as the same staff processes the paperwork for these services. In situations where Medicaid renewal has not been processed, patients also lose SNAP when their benefits ends - cutting yet another layer of assistance. This is particularly concerning when of the nearly 10 Million who dropped from Medicaid within the last year, 4 Million of them were children. This means that lapsed health coverage can trigger cascading issues in accessing various assistance programs, particularly for more vulnerable populations.
For clinic staff, the loss of Medicaid coverage is no walk in the park either. For those staffing FQHCs, assisting the large number of patients who have lost coverage due to procedural reasons is a daily struggle.
Time
Did you know that on average, most clinics spend 30 minutes to 1 hour per Medicaid enrollment? When 70% of Medicaid lapses nationally are procedural, the numbers can stack up exponentially. Who has time for even more paperwork on top of existing workloads? The answer is typically, nobody. Since enrollment is a 1:1 process it creates backlogs when multiple members lapse. This can be catastrophic to teams who were already struggling to keep up with renewal and application paperwork prior to the Unwinding.
Staffing
In addition to bearing the brunt of the burden of extra taskwork associated with the re-enrolment process, clinics are often operating with less staff than they need to keep up with their current patient base. Since clinics receive monetary assistance from the government for each of their Medicaid patients, procedurally lapsed patients reduce the net operating revenue clinics have access to. This has caused some to scale back staffing- leaving more work for fewer people. Adding patient re-enrollment to the mix, especially as the procedural lapse rate remains at 70% nationally is unsustainable.
Patient Reach
When it comes down to it, less revenue for clinics means less effective care for their existing patient base. One clinic in Texas expressed their concerns with procedural terminations impact on operations stating that Medicaid payments are “the lifeblood of our health centers and their ability to serve.” The financial impact of procedural terminations for FQHC is a line item on their budgets - it impacts their ability to provide more robust care options to their communities and vulnerable patients.
Coverage management is a never-ending problem. Fortunately, there are practical solutions to course correct and reduce the likelihood of future procedural termination rates and easily re-cover patients who lapsed. Maximizing ex parte renewals through the use of Coverage Management tools and working alongside companies like PointCare who specialize in the Medicaid re-enrollment process.
PointCare provides comprehensive Medicaid coverage management solutions with a low-risk value-challenge guarantee. If we won’t deliver, you don’t pay. It’s that simple.
Ready to let us take the complexity out of Medicaid enrollment for your clinic? We can ensure your Medicaid patients remain covered and your clinic thrives. Contact PointCare today to learn how we can help you maintain continuous coverage for your patients and secure your clinic's financial health.