21 Dec Medicaid eligibility in a post-COVID world: A Conversation with Dr. Swann
Amid the COVID-19 pandemic, the government afforded additional protection to low-income families or those who qualify for Medicaid or Medicaid-like services. The government froze the reprocessing and eligibility for Medicaid, considered the needs of the citizens, and essentially said, “Everyone who’s eligible for Medicaid now will remain eligible until the pandemic is officially lifted.” Families could continue to qualify for the services regardless of how often they worked or how their income had changed.
Fast forward to today, where we notice that as the government lifts the above protection, families who qualified for Medicaid are no longer eligible. In addition, the criteria for Medicaid qualifications vary from state to state, so what qualifies someone for Medicaid in New Jersey doesn’t necessarily qualify them for Medicaid in Colorado – it’s state-specific on what those benchmarks are.
Now that that protection is getting pulled back, Practice Support is seeing a lot of clients who no longer qualify for Medicaid and are being informed that they are no longer eligible. And, some of the services they’ve received may not be available on alternative insurance.
When the Affordable Care Act was created, it acted as a buffer between private insurance and Medicaid that people could access in an affordable way.
The services that some clients are provided are always authorized under certain ACA plans, so patients don’t always know or understand what services are being covered under the new health plan. Many of these plans are marketed and advertised like Medicaid, which can confuse patients.
The crux of the matter is that clinicians really need to run eligibility and benefits for patients who have Medicaid to see if they will continue to qualify for those services the following month. If Medicaid benefits fall off, the services you’re billing out may not qualify under their new healthcare.
It’s essential to run monthly eligibility and benefits for Medicaid patients
to see if they still qualify for those services.
And if not, to find out if those services are covered under their new plan. The new plan may be reimbursed at a different, lower rate, so we recommend having conversations with your patients ahead of time to plan coordinated care and for the next steps if there are changes in services.
This is also an excellent opportunity to open up a discussion about resources and where patients can challenge decisions about their Medicaid eligibility or go to their local community boards and Department of Human Services and see how to qualify for continued Medicaid coverage under their specific disabilities. Helping them access information can be immensely beneficial for their continued services.
How can Practice Support help?
Practice Support can help by running monthly eligibility and benefits verifications for patients under these plans to verify that the services you’re currently providing are covered under their new plan and what those rates will be.
For providers who see patients on a continuous basis, we typically run their eligibility and benefits verification when they begin services. It’s imperative to continue to run their eligibility and benefits verifications to have that check-in and touch base to isolate which patients to focus on.
We also encourage practice owners to consider the language in their releases of information and disclosure statements about reimbursement for services when insurance falls off.
Practice Support can help you understand what insurance will and won’t allow you to charge patients outside their standard insurance coverage – click here to contact Dr. Swann or one of our team for a free consultation.