More than a year after the Unwinding, navigating Medicaid coverage management has only become more complex. In a recent study, FQHCs reported that 1 in every 4 of their Medicaid patients are experiencing lapsed coverage—most without even realizing it. As of May 2024, the largest percentage of Medicaid terminations, 70%, were procedural - which means patients who could still qualify for Medicaid benefits are being dropped from coverage for avoidable reasons, usually due to paperwork.
One of the most complicated aspects of coverage management is keeping track of if and when patients have lapsed. In theory, redetermination lists help clinics manage their patients and ensure eligible individuals maintain continuous access to healthcare coverage. However, these lists have proven ineffective at catching Medicaid members who lapse for procedural reasons—mainly because they usually are not on these redetermination lists.
People can fail to show up on Medicaid redetermination lists due to changes in residency, missing or changed contact information, or administrative errors. If redetermination lists only showcase the patients with known and updated data, they unintentionally miss out on the rest of the patient population potentially eligible for redetermination of their Medicaid. This causes headaches for the providers who are caught in a cycle of perpetual re-enrollment at point-of-care and patients who may have to forgo medical treatment if they find themselves without coverage. It is unsustainable.
To be fair, these unexpected gaps in Medicaid coverage existed long before the COVID-19 pandemic. In a recent interview with us, Salliann Alborn, the CEO of MCHS, an IPA in Maryland with close to 80,000 Medicaid members, noted that her team had witnessed Medicaid members being dropped from coverage unexpectedly prior to the PHE and that the redetermination lists they were working from were historically inaccurate. Fortunately, PointCare’s coverage management solutions are readily available to help healthcare providers engage and re-cover patients who have fallen out of coverage and didn’t land on a redetermination list. Our solution provides proactive identification and resolution of coverage issues to ensure continuity of care, improving the Medicaid member’s coverage experience.
See What Coverage Management Can Do For Your Clinic
Using PointCare’s Coverage Management tools, Alborn’s team was able to identify five times more Medicaid terminations than their redetermination list. Coverage Management tools simplify the engagement and recovery process for both providers and patients, ensuring continuity of care. PointCare’s solution was built for scale and automation to help ensure clinics of all sizes could benefit. Our goal is to keep patients covered on the same health plan and anchored to their clinic, ensuring timely revenue for clinics when they visit, reduced self-pay visits, and a perpetual coverage experience for the patient.
Contact PointCare if you’re ready to keep your Medicaid patients covered into perpetuity with our Coverage Management solutions.
