The 2021 Medicaid Enterprises Systems Conference (MESC) kicked off with a series of sessions urging attendees to think about how to improve Medicaid processes, innovate their technological solutions, and identify the unique challenges that COVID-19 poses to these topics. Set in Boston, Massachusetts, the conference brings together state, federal, and private sector individuals to facilitate the exchange of ideas related to Medicaid systems and the future of the industry.
If you were not able to attend, here is a recap of the key topics discussed at one of the conference sessions:
The State of Medicaid Reassessments Post PHE
Nonis Spinner, Indiana’s Medicaid Eligibility Director, highlighted challenges experienced during the Public Health Emergency (PHE) regarding Medicaid enrollment and reassessments. Spinner explains that even though enrollment rates are up 28% compared to 2019, new applications are down 66%. Outside of the PHE, the majority of applicants had their Medicaid cases previously closed. This increase in churn – where individuals cyclically enroll and are removed from Medicaid – precedes the expected clog of Medicaid reassessments after the end of the PHE.
Indian’s approach is to get ahead of this upcoming clog by continually updating member data and categorizing renewals into three categories:
1. Ex Parte Renewals
All eligibility information is present, and automatic renewal ensues.
2. Opportunity to Report Changes
Provided information needs to be re-verified. “Need Not Return” mailers are sent to provide enrollees the opportunity to update their information.
3. Required to Submit Verification
Eligibility is called into question; unless additional information is provided, Medicaid will be closed. Members in this bucket are not currently being contacted during the PHE.
The number of individuals in the third bucket continues to grow. Between April and May 2021, 18% of enrollees fell into the third bucket. This is a stark increase from the 7% of members due for redetermination just two months before the PHE.
Efforts to Reduce the Clog
Indiana increased efforts to remove individuals from the third bucket to prevent an excessive number of reassessments required within six months following the end of the PHE. The end of 2020 saw the implementation of Indiana’s integrated Asset Verification System (AVS), which provides aspects of the information needed to determine which bucket members fall into each month. Despite this, the number of enrollees in the third bucket saw continued growth.
To mitigate this issue, Indiana allowed mailers to go out to all members except those eligible for Ex Parte renewals starting in July 2021. No members will be removed due to failure to respond to these mailers; rather, Indiana only hopes to move more members into the first two buckets before the end of the PHE to prevent a backlog of reassessments.
Ongoing and comprehensive communications with members will help those at risk of being removed and prevent them having to reapply for Medicaid. This situation will further overwhelm the system as the number of reassessments will grow in conjunction with new applications. Indiana plans to send out multiple final notices to members at the close of the PHE in an effort to prevent this situation.
Use of Technology to Prevent the Clog
Michael Sasko, VP of Government Solutions at Softheon, spoke about how innovative technology solutions can effectively reduce administrative overhead and prepare a state to effectively tackle Medicaid reassessments.
In Indiana, via monthly batch files, 25,000 to 40,000 members have their assets searched, and states are provided color-coded risk scores. These indicators make it easy for enrollment specialists to prioritize high-risk enrollees and accelerate workflows. Optimizing systems now can help mitigate the massive clog of reassessments sure to follow the end of the PHE.
COVID’s Impact on Healthcare Data
Essential data that impacts decisions made in healthcare has been heavily impacted by COVID-19 in ways that are not blatantly apparent at a high level. Josh Baker and Julia Baller from Mathmatica spoke about how they account for these inconsistencies when developing the Medicaid and CHIP COVID-19 Snapshot with CMS. Changes to data reporting such as overwhelmed systems leading to incomplete data, longer return times, and ever-changing policies are just a handful of the many disruptions. COVID-19 impacts the data at every single step along the way and influences how trends are acted upon.
Adjusting to Changing Measures and New Baselines
Baller speaks to the question of telehealth and how the boom in this industry during the pandemic has redefined how the standard access to care is determined. Time and distance from primary providers and specialists may no longer be an accurate judge of access to care due to the option of communicating with providers at home; however, additional considerations must be addressed, such as availability of technology and when telehealth is an appropriate substitute for traditional avenues of care.
Baker goes on to map both the short and intermediate responses to mitigating COVID-19 data anomalies. Initial responses largely supported a “pause” in incomplete or unnecessary measurements that can be replaced with estimated trend data. Intermediate-term responses shifted to “new normal” approaches to accommodate trend shifts.
Check back tomorrow for our recap of Day 2 at MESC 2021!