Policy changes and new initiatives may have your Medicaid agency struggling to meet compliance on a budget. Luckily, the best way to plan is to learn from other agencies.
Health Care IT Connect (HITC) is an annual conference that brings together Medicaid directors, health IT experts, and other healthcare professionals to discuss the latest developments in healthcare technology and policy. Medicaid leaders discussed strategies to overcome prevalent challenges at the 2023 HITC conference.
Here are the highlights from three particularly impactful sessions.
Gaining Real-Time Access to Medicaid Enrollee Data
State agencies, who are already struggling with understaffing, need to review eligibility for over 90 million recipients. A daunting task when coupled with a 12-to-14-month time limit.
Ed Dolly, Director of the Division of State Systems at CMS, shared strategies for properly executing renewals. Dolly emphasized the need for Medicaid agencies to gain real-time access to enrollee data. Having a deep understanding of enrollees’ data allows for both automated and personalized reassessments.
For example, ex-parte renewals use pre-existing data sources to conduct redeterminations. Capitalizing on existing data reduces the administration burden for both enrollees and staff.
State agencies are also concerned with member communication. Many Medicaid members relocated during the Public Health Emergency, meaning historic data is largely inaccurate.
States like Ohio are partnering with managed care organizations (MCOs) who communicate more frequently with enrollees. While MCOs and other third parties can provide current contact information, Medicaid agencies need a process in place to receive that information.
Medicaid unwinding is not the first nor last event that will require Medicaid agencies to quickly pivot. Dolly discussed the role of data analytics in identifying trends so health agencies can respond rapidly to future health emergencies.
Having a comprehensive understanding of the needs of your enrollees allows agencies to construct custom responses. For example, state-specific unwinding plans were crafted by considering both the limitations of the agencies and the needs of the state residents.
Educating Members to Improve Third-Party Liability Rates
As dual-enrollments and multiple-payers become more common, Medicaid agencies may struggle with Third-Party Liability (TPL).
Patrick Tighe, Bureau Chief at the Ohio Department of Medicaid, and Valerie Berger, Director of TPL and Premium Assistance at MassHealth, discussed strategies for improving coordinated payments between Medicaid and other payers.
They identified enrollees’ education and experience as a main hurdle in fulfilling TLP. Berger noted that many enrollees are not aware of their TPL responsibilities and find the process confusing. Simplifying the enrollee experience and providing support can vastly improve TPL rates.
Medicaid Directors’ Call for Increased State and Federal Collaboration
Medicaid directors from several states discussed their experiences and challenges improving healthcare technology, payment reform, and patient engagement.
They emphasized the importance of collaboration between states and the federal government as well as the need for flexibility and innovation in Medicaid programs.
From data sharing to coordination of benefits with third-party payers, the conference highlighted the challenges and opportunities of delivering high-quality, affordable healthcare to vulnerable populations.
To learn about how healthcare technology can help your state agency achieve compliance without increasing overhead, contact Josh Schultz at jschultz@softheon.com.
About HITC
Health Care IT Connect (HITC) is an annual conference that brings together Medicaid directors, health IT experts, and other healthcare professionals to discuss the latest developments in healthcare technology and policy.
About the Author
Josh Schultz
Josh Schultz is a Senior Policy Analyst at Softheon, where he advises the company on health policy issues affecting businesses and government health agencies. Prior to Softheon, Josh worked for a non-profit agency assisting Medicare beneficiaries, a technology company, and consulting firms.