Timely data, enhanced automation and an integrated system can help state health and human services agencies prepare for a potential influx of Medicaid redeterminations.
The nationwide COVID-19 public health emergency was renewed yet again by the Biden administration through October 2022. While it remains unclear when the official end of the PHE will occur, one thing is certain: The Medicaid and Children’s Health Insurance Program (CHIP) redetermination backlogs will continue to grow. State health and human services agencies risk being overwhelmed by renewals if they don’t take steps to prepare now. Rather than waiting, agencies can ensure they’re equipped to continue providing quick relief – today and in the future – even with changing policies and amid heightened need. Here are a few strategies.
1. Know what to expect
As part of the 2020 Families First Coronavirus Response Act, the “continuous coverage” requirement deems individuals eligible for Medicaid until the end of the month in which the PHE ends. At that point, agencies must review the eligibility of all claimants enrolled in Medicaid. With the end of the PHE looming, Medicaid and CHIP enrollment is at a record high – with more than 17 million new enrollees since February 2020, according to the most recent data from April 2022.
While state HHS agencies might be tempted to leave the problem for a later date, they can set themselves up for future success now by reviewing their existing caseloads to get a better handle on the volume of redeterminations they’ll be facing when the PHE ends. To help reduce churn and maintain continuity of coverage for beneficiaries, agencies can and should leverage current, real-time data paired with an automated workflow and integrated solution.
2. Leverage timely, data-driven insights
Access to current data sources, including income, employment, address and incarceration information, plays a vital role in helping state human services agencies improve their renewal and eligibility determination processes. As the end of the PHE approaches, eligible beneficiaries could lose coverage if they don’t receive a notice to renew or are unable to return the required documents in the requested time frame. Here’s how different types of unique datasets can help:
- Income and employment – Verifying applicants’ income and employment information is a vital step in benefits determinations and renewals. Agencies can work with a commercial data provider to quickly and securely verify an individual’s income and employment information – with data contributed directly by employers and updated with each pay period.
- Address – Current address information is an easily overlooked yet essential component of ensuring eligible enrollees stay insured. Access to current address information not only helps agencies verify eligibility and communicate with clients to ensure renewals are made, but it also helps align households to the appropriate administering offices and regional providers.
- Incarceration – Access to jail and prison data that provides an up-to-date, extensive view of the nation’s incarcerated population can help ensure continued access to health care upon release and assist states’ compliance with the Medicaid inmate-exclusion policy by pointing states to primary sources. Leveraging data that’s focused on current custody status with booking and release data updated in near real-time can also alert an agency to further verify a beneficiary’s or applicant’s incarceration status, when needed.
3. Adopt automated workflow processes
States must take steps now to ensure that eligible individuals remain on Medicaid and to help those no longer eligible for Medicaid transition to other coverage. Paired with timely data, enhanced automation and an integrated system can help agencies do just that.
As the end of the PHE approaches, adopting an automated solution that leverages current data-driven insights that is integrated with an agency’s existing system can help minimize the time caseworkers spend determining and confirming initial and renewal applicant eligibility for Medicaid. Enhanced automation can also help expedite ex parte (automatic) renewals of Medicaid coverage and adjustments to premiums or cost-sharing payments.
Current data-driven insights, enhanced automation and system integration together can deliver the real-time verifications of income, employment and address as well as valuable incarceration data that state health and human services agencies need to continue providing timely access to services, so that individuals remain covered even once the PHE ends.
Lynn Blackmore is Solutions Consultant for Equifax Workforce Solutions.