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There’s no sense in getting comfortable, not if you’re in the healthcare, health insurance, or Medicaid industries. The dynamics continue to change as states and regions still grapple with recovery efforts from the pandemic. The latest bill passed in Washington should surge additional funds to many states directly for vaccination deployment and virus mitigation support.

The next two years should start to veer back to some degree of normalcy, though, despite the various changes, including government program policies. The CMS just sent a letter to State Health Officials (SHO) with a few immediate and trajectory requirements. Medicaid reassessment efforts are part of those guidelines, as states need to determine ongoing who still qualifies for Medicaid and CHIP programs and who does not. This may mean state officials and organizations will soon be looking for software and service solutions, like those Softheon offers, to help with compliance.

The Medicaid and CHIP Response to COVID-19

Medicaid and CHIP (the Children’s Health Insurance Program) has long played a critical role in helping Americans will support at the state level. From public health emergencies to natural disasters, these federally regulated programs serve as much-needed benefits in times of crisis. The Coronavirus proved to be such a catastrophe, and the Centers for Medicare and Medicaid Services (CMS) responded.

Flexibility was the order of the day, and CMS response efforts explored a variety of customized solutions. Local outbreaks drove changes to the eligibility requirements for benefits. The Coronavirus Aid, Relief, and Economic Security Act (CARES) and the Families First Coronavirus Response Act (FFCRA) authorized temporary percentage point increases for the federal medical assistance percentage (FMAP) based on certain enrollment requirements. And states were prohibited from terminating Medicaid or CHIP benefits, in these scenarios. In other words, assistance, support, and funding were allocated based on enrollment and regional necessity.

The Important Letter from CMS to State Health Officials

CMS issued a letter to State Health Officials (SHO) outlining the latest round of requirements as states continue to navigate the pandemic realities. Part of this letter recognizes that some states are at different phases of COVID-19 control, warranting an ongoing effort to address changing needs. However, some of the flexibilities, which were initially part of the original response to the pandemic, are no longer efficient tools for some. From emergency administrative relief to relaxed rules for individuals, not all states still need all of these afforded flexibilities.

To determine which states still need more comprehensive access and support for Medicaid and CHIP programs, CMS is requiring a reassessment of eligibility at the state level. Originally, there were four checklists created to help states authenticate other authorities to help implement the Medicaid and CHIP programs more effectively. Those checklists come into play now, as well, as states are looking to reassess their needs for flexibility.

Originally, CMS authorized a 30-day delay regarding the Pre-Admission Screening and Annual Resident Review (PASRR) Level one and two assessments. Those applied to diverting unnecessary nursing home states or transitions for affected individuals out of nursing home stays because of developmental disabilities or mental illness concerns. But now, CMS is strongly encouraging states to abandon those delays and return to standard timelines.

The Reassessment of Medicaid Eligibility

As part of the reassessment requirement, states will have to look at taking appropriate steps to review current individuals’ statuses and eligibility. Some people will still qualify for Medicaid and CHIP benefits. However, as many states venture back to reopening economies and businesses attempt to bring employees back to work, there will be many who no longer qualify for the added benefits. Maintaining eligibility or terminating coverage where applicable is the next step facing many states. And the administrative side of this task could be daunting if there weren’t already tools available, like those specifically offered by Softheon.

Make Quick Work of a Tall Order with the Right Tools

With this latest CMS letter and request for state reassessment, what you may need is a tool to help facilitate the process. Softheon offers Medicaid and HHS Asset Verification Service (AVS) that may be a game-changer. Medicaid eligibility reassessments just got a whole lot easier.

So how does AVS work, you ask? It’s two easy steps, and Softheon only needs the first and last names, a social security number, and current address to check databases for likely Medicaid eligibility.

1.) Provide a list of Medicaid enrollees

2.) Receive a thorough risk score analysis

Data flows seamlessly and securely using an encrypted database in conjunction with Softheon’s PCI-compliant ecosystem. The return data not only outlines general eligibility but also prioritizes a list of members who may need additional eligibility confirmation.

States see huge benefits of outsourcing this eligibility review in having one compliant provider. The external analysis can snapshot Medicaid populations efficiently and with the verification data to back it up, including state residency, financial assets, identity confirmation, motor vehicle information, and social security checks.

This service not only identifies immediate individuals who may no longer be eligible for Medicaid or CHIP. It also provides the risk score analysis that outlines upcoming reassessment of individuals who may require additional case manager scrutiny. Scoring goes from one to 100, and high-risk individuals are color-coded red accordingly. Yellow indicates a medium risk, while green signifies a low risk. And the supporting analytics are indeed robust, allowing states to make quick work of tedious reassessments.

Pricing for these reassessment services is incredibly competitive and well-worth it in comparison to alternative tools. The return times are fast, and Softheon can work with batches at a time. To learn more about how Softheon can help with the recent reassessment requirement, contact us!

Once the Public Health Emergency (PHE) is over, the redetermination of Medicaid and CHIP eligibility will return to normal operation guidelines. If you happen to work within one of the four states currently supporting the Softheon AVS platform, you’ll have access to an invaluable tool and service to help ensure compliance. To find out more about how we work or to explore other Softheon solutions your state may need in the coming months, contact us.