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Boosting Medicaid Redetermination Rates: Effective Strategies

In response to increases in unemployment rates and other socioeconomic factors caused by the COVID-19 pandemic, The Centers for Medicare and Medicaid Services (CMS) halted annual eligibility checks for patients covered by Medicaid to ensure continuous enrollment throughout the public health emergency. However, as of December 2022, CMS announced that these eligibility checks would resume starting on March 31, 2023—the process known as Medicaid Redetermination.

Due to this previous pause in process, there has been a massive increase in the number of Medicaid members, since members have not been dropped in several years. With Medicaid Redetermination now in place, it has been estimated that up to 15 million Medicaid members (1 in 6 of the ~84 million current members) could lose coverage – in fact in the past few months alone, almost 1.5 million people have already been dropped from Medicaid. The federal government estimates that of the members who lose their Medicaid coverage, up to half will lose it simply because they did not complete the paperwork to update their personal information.

The Financial Impact of Lapsed Coverage

If the reported estimates of the number of members who will be dropped from Medicaid are correct, it can be assumed that the number of uninsured patients will also increase – and fast. With a rise in uninsured patients comes an associated drop in federal assistance that practices receive for treating Medicaid patients. If a patient does not submit for Medicaid re-enrollment or find another plan, this could result in significant financial implications for practices across the country.

DRVS Tools for Medicaid Redetermination*

To support Medicaid Redetermination efforts, Azara has rolled out enhancements and features across the Azara DRVS platform that will help mitigate patients’ risk of losing coverage. Additions include alerts on the Patient Visit Planning Report and Care Management Passport, three new Azara Patient Outreach text message campaigns, and enhancements in Azara Care Connect.
  
With these new features, Azara provides three ways to respond and act:

  1. Identify: Streamline the process of identifying patients impacted by Medicaid Redetermination through Azara Care Connect and DRVS alerts, including the Patient Visit Planning report (PVP), making it easy for care teams to uncover need.
  2. Outreach: Provide automated reminders to Medicaid patients of upcoming or passed Medicaid Redetermination dates through three new Azara Patient Outreach text messaging campaigns.
  3. Track: Review outreach metrics in Azara Care Connect (ACC) reporting dashboards to see what is working and what needs improvement, enabling care teams to refine outreach processes. 

The Redetermination process can have a significant financial impact on both patients and providers. By effectively leveraging DRVS tools, practices can improve successful Redetermination rates and help ensure that eligible individuals continue their Medicaid coverage. Avoiding lapsed coverage also has a direct impact on a practice’s financial stability and performance. DRVS tools enable care teams, and others responsible for Medicaid Redetermination, be more efficient while helping patients maintain the necessary coverage for optimal health.

*To utilize new Medicaid Redetermination features and functionality in Azara DRVS, practices must have payer integration and be able to provide Azara Medicaid Redetermination Dates. This data is not automatically sent to Azara and is necessary for new features to be enabled.

To learn more about Medicaid Redetermination tools in Azara DRVS, contact your Client Success Manager or enter a support ticket at support@azarahealthcare.com.

For more information about Azara DRVS or to schedule a demo, email solutions@azarahealthcare.com.


Sources:
https://www.cbsnews.com/news/medicaid-cliff-millions-of-americans-lose-coverage-cbs-news-explains/
https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous- enrollment-provision/#nine
https://apnews.com/article/medicaid-eligibility-states-coronavirus-pandemic-46484af651466539d6874c1a97397b50