Medicaid system braces for a body blow

https://ift.tt/30uqSB4

“We’re awaiting guidance at the federal level around what’s going to happen with the public health emergency and also at the state level to see how exactly that process is going to be rolled out,” says CountyCare CEO Aaron Galeener.  

After nearly two years without redeterminations, “there could be a lot of clean up,” says Jane Longo, deputy director of the Illinois Department of Healthcare & Family Services, or HFS, which oversees Medicaid in the state. “We always have problems with addresses—people move around a lot. But we will work hard to keep people on. We want everybody who’s eligible to stay on.” 

Many people lose coverage not because they’re no longer eligible, but because they fill out redetermination forms incorrectly or fail to respond to notices, which are sometimes mailed to the wrong address. 

“With most contact information on file with the state being incorrect and the COVID-19 realities, such as evictions and homelessness (or) temporary housing, we anticipate that a lot of members will lose coverage even if they are still eligible,” says Glenn Harston, spokesman for the Illinois Association of Medicaid Health Plans, or IAMHP, which represents all the insurers in Illinois’ program. 

Coverage gaps are hard on patients, particularly those managing chronic conditions, as well as doctors and hospitals that depend on Medicaid to pay them for providing care. Even beneficiaries that take too long to complete the necessary paperwork risk getting reassigned to another plan that contracts with different health care providers.   

HFS doesn’t predict how many Illinoisans could lose coverage—either due to redetermination process issues or because they’re no longer eligible. In addition to income considerations, people will come off the rolls if they left the state or died. 

CountyCare was the only Illinois Medicaid managed care plan that provided an estimate of likely membership losses. Blue Cross & Blue Shield of Illinois declines to “speculate on future enrollment numbers,” while Meridian and Molina Healthcare didn’t return calls and Aetna deferred to the IAMHP. 

Nationally, the number of Medicaid enrollees could decline by about 15 million in 2022 if the public health emergency ends later this year, a recent analysis by the Washington, D.C.-based Urban Institute predicts. 

Some advocates are urging the federal government to provide enhanced financial and administrative support to help states ease disruption as they resume their normal Medicaid operations, including eligibility reviews. The Centers for Medicare & Medicaid Services recently told states they can take up to 12 months to determine eligibility. HFS is considering that option, Longo says, noting that a phased approach could prevent large numbers of people from falling off the rolls at once.   

“Time pressures increase the risk of errors, especially when states are allowed to use old information and data to determine that a beneficiary is no longer eligible—for example, income from summer employment earned by working adults who later were laid off in the fall,” George Washington University researchers wrote in a January analysis. 

Issues with the state’s redetermination process existed long before COVID-19 started spreading. In 2019, Illinois announced plans to hire hundreds of workers to resolve delays of at least 45 days for initial Medicaid applications and at least 60 days for renewals. 

With the redetermination process paused during the public health emergency, HFS chipped away at its backlog of new Medicaid applications. Longo says the number of unprocessed applications has dropped to 5,000 from 147,000 in January 2019. 

Now HFS is looking at ways to simplify redetermination, with the goal of making it easier for residents to apply and stay on the rolls. For example, adults are removed if their income rises above the threshold, but allowing them to keep coverage for a full year—despite the increased cost to the system—could improve health outcomes by encouraging continuity of care, Longo says. 

via Crain’s Chicago Business

October 18, 2021 at 04:06PM

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s