Without systems that can share data, states will face a daunting task redetermining eligibility for Medicaid and CHIP recipients.
The COVID-19 Public Health Emergency has been extended to mid-July, and states will be depending on their technology to ensure that people who were covered under PHE’s Medicaid and Children’s Health Insurance Program (CHIP) waiver can still get the benefits they need, an expert says.
PHE went into effect on Jan. 31, 2020, and has been renewed nine times since in response to the continuing pandemic. Its expiration means that states must redetermine whether the record 80-plus million recipients are still eligible for Medicaid and CHIP – a task that will be daunting without systems that can share data, said Heather Korbulic, senior policy and strategy lead at GetInsured and former executive director of Nevada’s Silver State Health Insurance Exchange.
“The Public Health Emergency has taught us about how siloed our systems are,” Korbulic said. There is an opportunity for states “to find synchronicity and to find common areas of data and to pool and thread each other’s systems,” she said. “In an ideal world, a Medicaid agency could [use application programming interfaces to connect] to an unemployment system and automatically compare contact data.”
Some states will be in better shape than others because of their technology, she added, but all need to ensure that recipients’ most recent contact information is on file, whether by comparing the data in multiple systems or through outreach.
That administrative work now will pay off later by reducing turnover, said Korbulic, adding that 80% of people who lose benefits will do so because they didn’t participate in the administrative processes, while 20% will lose them because they’re no longer eligible for Medicaid or CHIP. In those latter cases, states should have a way to automatically point them toward a state-based health insurance exchange or to HealthCare.gov, the federal health insurance exchange website.
For example, when Nevada’s Medicaid agency sends an account transfer for someone who is no longer eligible because of their assets, their information is automatically populated into a health exchange application, and they’re notified about their new options.
“Not only do we actually have connecting systems, but we also have in state better partnerships than we ever had before. We are able to divide and conquer and problem solve holistically rather than trying to do it with HealthCare.gov, which was rigid in a way that wouldn’t allow for state flexibility,” Korbulic said of her work with the state exchange.
Last month, the Centers for Medicare and Medicaid (CMS) released guidance to help states as they “develop a comprehensive ‘unwinding operational plan’ to restore routine operations to their Medicaid, CHIP and [Basic Health Program] programs” within 12 months. CMS requires states to transfer to either a state-based or the federal health insurance marketplace the electronic accounts of beneficiaries whom the state assesses as potentially eligible for coverage. “Such transfer must include all eligibility-related information available to the state,” according to the guidance.
That means “states must be engaged right now in efforts to get their roles and their data and their contact fields updated because everyone recognizes that when somebody doesn’t participate in the administrative part of Medicaid … that means they have to cycle back through,” Korbulic said. It’s more work “to not retain somebody that’s eligible than to retain them, so the goal right now is to get that contact information updated.”
Although it’s too late to rip and replace eligibility systems, she added, there are integration opportunities that would allow for more automation. Additionally, funding exists to help states with future technology modernization efforts. For instance, CMS will cover up to 90% of costs for Medicaid eligibility systems, and states may use American Rescue Plan Act funding for Medicaid information technology. Virginia and Washington, D.C., have formulated plans for using ARPA funding for IT.
What’s more, last June CMS announced $20 million in ARPA funding to support state-based marketplaces.
“I’m cautiously optimistic” about the transition from PHE, Korbulic said. “There’s a spectrum of who will perform better and who will likely perform worse. A lot of that has to do with the technology involved.”
Stephanie Kanowitz is a freelance writer based in northern Virginia.
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