Leveraging Data to Reduce Member Churn, Maintain Access to Care, and Avoid Care Gaps as a Result of the Medicaid Redetermination Process

The following is a guest article by Ashley Perry, MPH, Chief Strategy and Solutions Officer at Socially Determined When Congress passed the Consolidated Appropriations Act of 2023, it decoupled the Public Health Emergency (PHE) from the Medicaid program’s continuous enrollment provision, which was implemented as part of the PHE in March 2020. It also established April 1, 2023 as the date on which the Medicaid redetermination process would resume nationwide.  The continuous enrollment provision resulted in substantial growth in Medicaid enrollment nationwide and helped bring the national uninsured rate to an all-time low. These recent gains in coverage are now in jeopardy with the unwinding of the provision. A recent analysis conducted by the Urban Institute projected that 18 million beneficiaries will lose coverage as a result of this process. While for many, this will be because they no longer meet the program’s eligibility criteria, estimates suggest that up to 40 percent of those who lose coverage will still qualify, they simply will not be able to complete the recertification process successfully, due to administrative and/or social barriers.  This will result in a number of negative consequences. Medicaid Managed Care Organizations (MCOs) will experience material reductions in their membership. Health care providers will experience increases in uncompensated care and bad debt. Most concerningly, some of the most vulnerable Medicaid beneficiaries will experience acc...
Source: EMR and HIPAA - Category: Information Technology Authors: Tags: C-Suite Leadership Communication and Patient Experience Health IT Company Healthcare IT Hospital - Health System Ashley Perry California Department of Health Services CBOs CHWs CMS Community Health Workers Community-Based Organizatio Source Type: blogs