More evidence of Medicaid 'churn'
Access can help patients keep coverage
Patient access employees often help patients to obtain Medicaid coverage, but in many cases, Medicaid-eligible patients lose their coverage. As a result of the Affordable Care Act insurance expansions, patient access staff can do the following:
• give advice to patients on how to apply on state-specific websites;
• help patients determine their choice of insurance plans;
• explain differences in premiums, deductibles, and copayments.
Patient access employees often help patients determine eligibility for Medicaid coverage, which in many cases means lost revenue is prevented. However, patients don't always keep the coverage they obtain, even if they remain eligible.
In fact, the average Medicaid beneficiary is covered for only part of the year, leading to poorer health and higher-cost episodes of care, according to a new report from the Association for Community Affiliated Plans.1
This "churn" results in millions of otherwise-eligible Medicaid beneficiaries to be removed from the program, due to paperwork issues or small, often temporary, changes in income. Here are key findings of the report, which used new data to calculate the average monthly costs for persons enrolled in the Medicaid program:
• The average monthly cost to the Medicaid program is $345 for adults enrolled in Medicaid for 12 months of the year, compared with $597 for those who are enrolled for just one month.
• There are significantly lower costs for children who are continuously enrolled, with an average monthly cost of $110 for children enrolled in Medicaid for 12 months of the year, versus monthly costs of $151 for those enrolled for just one month.
Excessive Medicaid churning, when patients are dropped from Medicaid even if they are eligible and must re-enroll, has two consequences for hospitals, says Leighton Ku, PhD, MPH, the report's lead authors and director of the Center for Health Policy Research at George Washington University in Washington, DC. "If patients are uninsured when they arrive for care, the hospital must decide whether to provide care and perhaps not be paid by Medicaid, or to deny care, which is also a problem," says Ku.
Even if Medicaid eventually pays, reimbursement might be delayed because of the additional time needed to process an application, notes Ku. "Also, many hospitals have staff who can help patients apply for Medicaid," he adds. "They have more work to do when they must help patients this way."
If state Medicaid agencies either extend eligibility periods or make it simpler for patients to renew their enrollment before they need medical care, says Ku, then both problems can be avoided.
Renewal of Medicaid is largely a responsibility of the state Medicaid agency and the Medicaid enrollee, notes Ku. "Hospital staff might be able to check if patients have renewed their Medicaid coverage," he says. "But it is often impossible for hospital staff to know when a patient's certification period expires, and patients often aren't sure, either."
New ways to help
Ku says that as the Affordable Care Act insurance expansions roll out, patient access staff have new opportunities to help patients obtain coverage. From Oct. 1, 2013, to March 31, 2014, there will be an open enrollment period for the new health insurance marketplaces.
Many patients not eligible for Marketplace coverage or subsidies still might be eligible for Medicaid or the Children's Health Insurance Plan, says Ku. Ku says patient access employees can help in these ways:
• giving advice to patients about how to apply using the new state-specific websites;
• obtaining training to become certified application counselors, who can more directly help enroll patients apply for the health insurance marketplaces;
• helping patients to understand all the different options.
"They may be particularly helpful in explaining some of the more complicated aspects of the marketplaces, such as the differences in premiums, deductibles, and copayments available with each plan," says Ku.
Reference
1. Ku L, Steinmetz E, Bruen BK. Continuous-eligibility policies stabilize Medicaid coverage for children and could be extended to adults with similar results. Health Aff 2013; 32(9):1,576-1,582.
• Leighton Ku, PhD, MPH, Director, Center for Health Policy Research, George Washington University, Washington, DC. Phone: (202) 994-4143. Fax: (202) 994-3996. Email: [email protected].
