The Rising Volume and Cost of Medicaid Program Management
Economic and employment uncertainty were top of mind during the latest webinar in the State HIT CONNECT series, co-hosted by Equifax and Sellers Dorsey. Unprecedented job losses from the pandemic have led to increased applications for Medicaid and other social safety net programs. In fact, the Medicaid program added an additional 1.7 million Americans during that roughly three-month period. That's according to a Health Affairs study that analyzed early reports covering the period of March 1 through June 1 of this year.
At the same time, states are facing budget shortfalls that can jeopardize program delivery for services like Medicaid. Congress did increase federal matching funds for Medicaid by 6.2 percent. That was an effort to help stabilize the critical safety net health program during the pandemic. Legislators also provided other waivers and flexibilities to increase eligibility. Yet, states still face budget uncertainty, resource constraints and increasing pressure on public programs.
States Need New Tools to Address Applicant Volume
During the webinar, Leesa Allen, Deputy Managing Director at Sellers Dorsey, summarized the challenge. “States really need tools to address the backlog and workload issues in an efficient manner, while not adding costs to their budgets,” she said. “And CMS [Centers for Medicare & Medicaid Services] can’t expect states to change course on a moment’s notice. These are large organizations and states often plan years in advance of any systems or design changes that they’re going to make. So it does require lead time to prioritize, plan and implement those changes.”
Fortunately, there are solutions to help states handle the increase in demand for Medicaid -- without increasing costs. Discussion turned to the CMS Federal Data Services Hub. It permits state agencies to instantly access applicant income and employment data, including:
- employment status
- annualized income
- changes in employment
- changes in income
- pay frequency
- pay period details
Powered by The Work Number® database, the CMS Hub offers a zero-development solution. It helps states access the necessary data in the way that works best for them, either through the website, system integrations or batch data pulls.
States to Face Additional Issues in Coming Months
The CMS Hub can help address applicant backlogs and the increasing need for re-determinations, while also containing data costs. With guidance changing as the public health emergency continues, Allen said states are likely to face other issues in coming months:
- The intersection of states’ regular redetermination cycles and the COVID-era legislation mandating them to maintain program eligibility until the end of the public health emergency
- Need for timeliness in verification processes given the sharp increase in demand
- Growing backlogs for state eligibility offices resulting from coronavirus waivers and flexibilities
- The uncertainty around when the waivers and flexibilities will expire, and concern about how quickly states will be expected to revert back to traditional eligibility requirements
Strategies for Streamlining Medicaid Programs
The ability to transition and deliver service under a variety of temporary guidelines adds a layer of complexity. Data can help states with both efficiency and program integrity. Adding instant and automated verifications of income and employment is a start, as is using data to confirm the identity of an applicant and verify residency requirements.
The panelists discussed these challenges and potential solutions. Leesa reminded the audience that Medicaid is often the second-largest state budget driver. As a result, it's likely to be a focus as state policymakers grapple with revenue shortfalls and cuts to balance budgets without additional federal aid. Therefore, it's important to solve for audits, renewals and reconciliation without complicated set up or IT resources. And to maintain timely delivery of service, it's critical to identify and implement new ways to more efficiently process Medicaid applications.
Learn more about the Equifax solutions for social service agencies.