What happens when millions of people lose healthcare coverage in one year? That’s the question healthcare providers are apprehensively asking as the COVID-19 public health emergency (PHE) winds down.

An estimated 5-15 million^{i, ii}, people will lose Medicaid coverage during redetermination, starting in April 2023. Many won’t know they’ve lost it until they arrive at their doctor’s office or the Emergency Department (ED). This situation puts providers at risk for lower (or no) reimbursement and creates barriers to care for patients who need it.

There’s no doubt that redetermination will negatively impact the payer mix for healthcare providers. More people will be uninsured, and more people will experience a coverage gap when they should be insured. Providers have a chance now to build their data technology tool kit ahead of the surge of uninsured patients. Doing so can help with staying on top of the churn and maximizing reimbursement levels.

Antiquated state eligibility systems and processes will profoundly impact providers. State data on Medicaid patients is often outdated and inaccurate, which means providers need to find alternate, modern solutions to confirm eligibility and coverage status at the time of the patient encounter.

The best automated healthcare data solutions can access multiple data sources in real time to find, verify, and correct patient information at the time of patient encounter. Automated tools can help providers to assess whether encouraging the patient to go through redetermination is worth her effort. Labor-saving technologies are available for coordination of benefits, propensity to pay, and more.

To learn more about the tools available to help providers cope with the downstream impact of mass Medicaid eligibility redetermination, read the full article in Becker’s Hospital Review.

ⁱ“Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches.” ASPE website, Aug.19, 2022. https://aspe.hhs.gov/sites/default/files/documents/404a7572048090ec1259d216f3fd617e/aspe-end-mcaid-continuous-coverage_IB.pdf Accessed Jan. 6, 2023

ⁱⁱTolbert, Jennifer and Ammula, Meghana. “10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Requirement.” Kaiser Family Foundation website, Dec. 8, 2022, https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/ Accessed Jan. 6, 2023.

Read More About Medicaid Redetermination:

Using Data to Understand Pre-pandemic Enrollment Patterns and Protect At-risk Patients During Medicaid Redetermination