Clinical gaps in care can easily occur when patients lose their healthcare coverage for whatever reason. That’s why healthcare providers need to understand the Medicaid renewal process—also known as Medicaid redetermination or recertification—that’s currently underway.
The Kaiser Family Foundation (KFF) estimates between five million and 14 million people will be affected. HHS says it could be even more—approximately 15 million people with the end of the continuous enrollment provision that ensured enrollees remained eligible during the public health emergency. This provision ended on March 31, 2023. Each state is unwinding the continuous enrollment provision on different timelines which is why it’s difficult to predict the total number of people who might be affected.
The role of healthcare providers
During the Medicaid redetermination process, state Medicaid plans are hard at work updating Medicaid enrollee contact information, conducting outreach, and providing enrollment assistance. However, healthcare providers focused on value-based care also play an important role during this transition. That’s because they, too, can engage patients in re-establishing eligibility. Providers are often uniquely positioned to create awareness because they already have well-established, trusted patient relationships.
The importance of patient identification and Medicaid redetermination
Patient identification is a critical component of providing quality care. Accurate patient identification ensures that healthcare providers have access to the correct patient medical history and health information, enabling them to provide more personalized and effective care. During the redetermination process, efficiently identifying patients allows providers to quickly target outreach and care management programs that can assist patients with Medicaid coverage changes.
Targeted outreach can occur in a variety of ways. For example, providers can leverage email, text, and phone campaigns. They can precisely identify patient cohorts and improve patient engagement using timely targeted messages. The goal is to prevent clinical care gaps, avoid coverage gaps, and reduce the amount of uncompensated care.
Providers can also leverage care management programs such as chronic care management, transitional care management, and educational classes. Care management visits are an opportune time for care managers, and others who interact with patients to emphasize the importance of re-establishing Medicaid eligibility as well as the risks associated with not doing so. (Note that the Annual Wellness Visit is also a great time to remind patients about Medicaid eligibility.) With proper education, CCM and other care management staff can also guide patients through the process of re-establishing eligibility.
Healthcare providers should be especially mindful of individuals at greater risk of losing Medicaid coverage during the unwinding period. According to KFF, this includes people who have moved, immigrants and people with limited English proficiency, and people with disabilities. These patients may experience a gap in coverage due to barriers to completing the renewal process even when they remain eligible for coverage.
Ultimately, the goal is to identify patients whose Medicaid status could change and ensure continuity of coverage. Continuity of coverage, in turn, supports continuity of care and the elimination of clinical care gaps that can ultimately increase costs and cause poorer outcomes. When healthcare providers focus on patient identification and outreach during the Medicaid redetermination process, they’re more likely to promote uninterrupted services that help all patients, especially those with one or more chronic conditions.