Continuous Medicaid enrollment established under the Families First Coronavirus Response Act (FFCRA) ended on March 31, 2023. I am sure I am not the first to tell you about the millions of Medicaid beneficiaries that will lose coverage in the coming months. Nonetheless, I hope I can offer a few insights to better prepare you for the ramifications of so many patients potentially changing coverage in a short period of time.
In exchange for a 6.2 percent Federal Medical Assistance Percentage (FMAP) payment increase, state Medicaid agencies agreed to implement continuous enrollment. Specifically, they agreed not to terminate Medicaid coverage for any recipient during the COVID-19 public health emergency (PHE). Under these protocols, Medicaid enrollment ballooned from 72 million to over 95 million beneficiaries. With the termination of the continuous enrollment mandate, some experts expect states nationwide will cumulatively unenroll between five and 14 million individuals.
When States Terminate (and territories, too)
Every state will alert affected individuals of pending coverage termination at least 60 days in advance. Most states are providing between 60- and 90-days’ notice. The notification windows give affected individuals time to dispute terminations or find new coverage before losing Medicaid benefits.
The following list groups states and US territories by the month in which they plan to terminate Medicaid beneficiaries no longer eligible under pandemic-era rules:
- April 2023
- New Hampshire
- South Dakota
- May 2023
- Mariana Islands
- New Mexico
- West Virginia
- June 2023
- Washington D.C.
- New Jersey
- North Dakota
- Puerto Rico
- Rhode Island
- South Carolina
- July 2023
- New York
- North Carolina
Oregon announced plans to terminate ineligible Medicaid beneficiaries in October 2023.
For suppliers with customers in any territory not listed above, we recommend monitoring the applicable Medicaid websites for updated information.
Proactive Eligibility Verification is Key
Medicaid agencies will not communicate with suppliers directly. Instead, proactive eligibility verification and early intervention is key to minimizing the costs of posting, investigating, and resolving an influx of Medicaid denials.
We recommend suppliers talk with software vendors about automated eligibility checking for Medicaid payers. Billing software vendors usually charge a fee for each transaction, especially if they use a third-party integration, but we suspect it may be a worthwhile investment over the next several months. The alternative is much higher administrative costs, delayed revenue, and possibly lost equipment. Timely eligibility checks will be especially important for patients in each serviced state during the month of that state’s planned unwinding.
Suppliers should contact customers as soon as they discover an upcoming insurance termination. For those with new coverage, the new policy may require prior authorization, a physician’s visit, or other documentation. For those that will not have other insurance, suppliers should make other arrangements for patient payment or consider picking up equipment and discontinuing service.
Suppliers may also want to consider proactive customer messaging through paper mailings, telephone calls, text messages, and even social media. Regardless of the medium, suppliers should alert patients of their state’s transition date and encourage any that receive a Medicaid termination letter to communicate with the supplier immediately. It is a good idea to let customers know there is a process to maintain active DME services without interruption.
Staying ahead of the Medicaid unwinding can minimize negative impacts on the company’s cash flow and operations.