Tag: redetermination

In previous posts, I’ve explored the potential ramifications of the end of the Public Health Emergency (PHE) and how it will impact agency plans such as Medicaid eligibility redeterminations. Many states may have already prepared a risk-based approach to address the unwinding process. States need to balance these plans with onboarding new applicants and maintaining the service levels required by the Centers for Medicare & Medicaid Services (CMS). Regardless of the approach, states should look for efficiency in all aspects of the redeterminations process, including aligning pending work with other program recertifications and maximizing the use of available information and tools. What does the end of the PHE mean for state agencies? From the end of the PHE, state agencies will have 12 months to initiate all citizen eligibility renewals and a total of 14 months to complete them. States may begin the unwinding process 60 days prior to the month in which the PHE ends. Many states have already begun Medicaid eligibility redeterminations in an effort to meet this deadline. CMS has provided extensive guidance in their Planning for Resumption document, which state agencies can refer to for full details. Building a proper redeterminations plan Redeterminations plans should verify citizen information with all available information, including residency, age, income, and deceased status. These plans should also support the assessment of identity risk and have the ability to ensure continuous outreach with accurate mailing addresses, phone numbers for calls and texts, email addresses, and assessments of returned mail. CMS guidance encourages states to verify eligibility requirements by mail, email, and other communications channels while minimizing the amount of time and documentation required of beneficiaries. The benefit of standing up this structure? More effective day-forward solutions that can help agencies assess any new and ongoing benefits requests and maintain accurate eligibility lists.   How can Experian help? Experian® has a range of products designed to help organizations verify contact information, such as phone numbers and mailing addresses, as well as income and employment. Our exclusive income and employment data can be leveraged incrementally in non-automated verification methods so that individuals not found by other services can be processed quickly via batch processing — minimizing any impact to beneficiaries while improving overall program performance. Our address verification tools provide improved outreach to beneficiaries with the best and most accurate mailing addresses, leveraging the National Change of Address (NCOA) database, as well as phone number information. The phone number information includes a mobile phone indicator, enabling text message outreach. Additionally, Experian can provide email address provisioning to verify or provide email addresses, which creates another path for contact. All of this helps agencies develop better redeterminations plans to manage the end of the PHE, and better process future benefits requests. To learn more about how we can help, visit us or request a call.  

Earlier this year, I explored the potential impact of the end of the current Public Health Emergency (PHE). The U.S. federal government has been operating under a PHE for COVID-19 for more than 30 consecutive months since it was initially announced in January 2020. On July 15, 2022, this PHE was renewed for a tenth time. Following this latest extension, the Centers for Medicare & Medicaid Services (CMS) has released a roadmap for the end of the COVID-19 PHE. In a related blog, they reiterate the commitment to provide a 60-day notice prior to the end of the PHE, but urge states and healthcare providers to prepare for the end “as soon as possible.” With these upcoming changes in mind, I wanted to review key areas for providers to consider as they prepare for the end of the PHE. Enrollments continue to increase, putting state budgets at risk From the start of the PHE in February 2020 through April 2022, Medicaid/Children’s Health Insurance Plan (CHIP) enrollment has increased by more than 17M people and this is affecting every state. Nearly half of all states have experienced an increase of more than 25% during this time period, with some experiencing increases of more than 40%. Given an average Medicaid cost to states of more than $8.4K per capita, that translates to an increase of billions of dollars. Once the PHE expires, states will have 12 months to redetermine eligibility for continued enrollment in the program, or risk bearing 100% of the associated cost. Preparing for the end of the PHE To avoid unnecessary expenditures and ensure that citizens are receiving access to the correct services, states will have to conduct a holistic review of their Medicaid rolls to confirm eligibility. In CMS’s guidance for states to prepare for the end of the PHE, they recommend creating an automated process to handle this unprecedented review. With the right partner, agencies can perform redeterminations of their existing registration rolls, and prepare for future services requests. The right solution can allow citizens to easily apply for benefits, triggering the automatic, real-time pull of income and employment information so that the agency can verify eligibility. Experian is a trusted government partner that is ready to assist states with preparing and automating the process for redetermination of benefits. To learn more about how Experian can assist with citizen benefit redetermination and registration efforts, visit us or request a call. Learn more

Since January 27, 2020, the federal government has been operating under a Public Health Emergency (PHE) related to the COVID-19 pandemic. On January 14, 2022, this PHE was renewed for an eighth time. While we are currently in the midst of the omicron surge, some suggest that we may be nearing the beginning of the end of the pandemic — and thus the inevitable expiration of the PHE. Impacts of the PHE While the PHE remains in effect, states must maintain current Medicaid enrollees, regardless of changes to their eligibility status. A recent report showed Medicaid enrollment increased 16.8% from February 2020 to June 2021. This is counter to the previous trend, where enrollment declined from 2017 to 2019. Furthermore, the average per capita Medicaid cost to states is estimated at $5K–$10K (states share about one-third of the cost of Medicaid). The combination of the per capita expense and the increased number of enrollees during the pandemic translates to a significant impact on state budgets. Once the federal order expires, states will have 12 months to redetermine eligibility for continued enrollment in the program, or risk bearing 100% of the associated cost. Processing redetermination in a timely manner is critical for states to avoid unnecessary expenditures and to ensure that citizens are receiving access to the correct services. It’s imperative that states start planning for redetermination of benefits for continued Medicaid coverage as soon as possible to be prepared to take action at the inevitable conclusion of the PHE. Preparing for redeterminations At the end of the PHE, states will need a system to easily and confidently review their current Medicaid rolls to confirm eligibility. Implementing this system will likely involve working with a trusted partner who can provide tools and advantages such as: Portfolio analysis Real-time analysis Verification of income and employment Compliance adherence Affordability With the correct systems in place, states can act quickly once the PHE ends, saving unnecessary expenditures and providing better services to citizens in need. If your state agency would like to learn more about how Experian can assist with citizen benefit redetermination efforts, visit us or request a call. Learn more