This month, the start of Medicaid redeterminations has made national headlines. And financial navigators, advocates, and other healthcare professionals may be wondering what these redeterminations mean for patients and those who serve them.
Here’s what you need to know about the policy, the potential impact, and how to help affected patients:
At the start of the pandemic, the Families First Coronavirus Response Act (FFCRA) was signed into law. Among other provisions, the Families First Act required that Medicaid programs keep people continuously enrolled through the end of the month in which the public health emergency expires. In exchange, these programs would receive enhanced federal funding.
As a result, Medicaid enrollment grew substantially compared to pre-pandemic times, and the number of uninsured Americans dropped. In fact, during the first quarter of last year, the national uninsured rate reached a record low of 8%.
But the passage of the Consolidated Appropriations Act in December 2022 untied Medicaid redetermination from the end of the public health emergency (PHE), which is set to expire on May 11, 2023. Consequently, states resumed determining who is and is not eligible for Medicaid beginning April 1.
According to the Kaiser Family Foundation (KFF), between 5.3 and 14.2 million Americans may lose Medicaid coverage during the year-long “unwinding period.” Estimates from the Department of Health and Human Services (HHS) are even higher—with 15 million people standing to lose coverage, including 6.8 million who may still be eligible.
For hospitals and health systems, this means bracing for the possibility of millions of uninsured patients. And we know that when patients lack the coverage they need, they may skip or delay necessary care—leading to higher costs for more extensive care down the line.
The loss of Medicaid funds and reimbursements places an additional burden on provider organizations that are already struggling financially, particularly in rural areas.
Anticipating these consequences, the American Hospital Association (AHA) released a statement in February, calling for swift action: “After three years of pandemic flexibilities, the return to ‘normal’ will require changes across many parts of hospitals and health systems, and that work should begin now.”
Helping Patients Who Face Loss of Coverage
As the AHA warned, changes will be needed to help both patients and healthcare organizations, as affordability challenges intensify. For example, some health systems have responded by increasing the size of their financial counseling teams.
One thing is clear: “Patients will need financial navigation more than ever in the coming months and years,” said my colleague Erin Bragg, Service Manager, Financial Navigation, TailorMed Complete.
For financial navigators, advocates, counselors, and other professionals who are on the frontlines, below are recommended steps to help impacted patients:
- Stay up to date with news and additional guidelines from HHS and your state’s Medicaid program. Visit Medicaid.gov to sign up for updates and find out how and when your state is handling the redetermination process.
- Identify patients who will be part of the redetermination process and make sure they’re informed of potential changes to their coverage. As of December 2023, 64% of Medicaid enrollees were unaware of redeterminations. Education is key. Check out the Centers for Medicare and Medicaid Services’ (CMS’) communications toolkit for tips on how to effectively discuss the changes.
- Make sure to check eligibility for Medicaid patients prior to each appointment. Many beneficiaries may not communicate a loss of coverage to their providers out of concern that they will be turned away. The sooner you’re aware that a patient’s Medicaid has been discontinued, the more alternative health insurance options you’ll find to assist them.
- Ensure affected patients are aware of opportunities to regain coverage. Many may be eligible to enroll in an Affordable Care Act (ACA) plan through the federal or state marketplace. With the passage of the Inflation Reduction Act, enhanced ACA subsidies will be extended through 2025. These subsidies can help offset the cost of monthly insurance premiums. Some patients may be eligible for plans with no premium—or one that is very low.
Harnessing Technology in Tough Times
By following the steps outlined above, navigators and other professionals can help low-income patients at a time when they may face steeper barriers to care. But with a higher volume of patients in need, navigators may be asked to do more with less. That’s where technology can play a key role. For example, technology solutions can help:
- Identify financially at-risk patients at the point of care, using predictive analytics
- Maximize benefits by analyzing patients’ coverage and providing options to optimize or switch plans
- Find comprehensive funding opportunities drawing from resources such as copay assistance programs, grants, funds for living expenses, and more
- Expedite enrollment by notifying staff when relevant funds open and providing the swiftest methods to enroll
- Streamline workflows by housing all financial assistance activities—from internal communications to patient approvals—within one centralized system
Be Proactive, Boost Affordability
Medicaid redeterminations will have a major impact on patients and providers alike. Now is the time to take necessary action to help patients avoid loss of healthcare coverage. A proactive, technology-supported approach to financial navigation will ensure our nation’s most vulnerable can access the care they need.