Beginning April 1, 2023, providers will have to pay special attention when verifying benefits, as the expiration of a pandemic-era rule that temporarily expanded coverage will see Medicaid benefits ending for a number of previously-covered patients.
Why are Medicaid benefits ending for some enrollees?
As part of the Families First Coronavirus Response Act (FFCRA) passed in 2020, states were required to adhere to a Medicaid continuous enrollment provision that prevented them from dropping otherwise ineligible patients; in exchange, states’ Medicaid programs received a temporary 6.2 percentage point Federal Medical Assistance Percentage (FMAP) increase. However, with the passage of the 2023 Consolidated Appropriations Act, Congress set a March 31, 2023, end date for the Medicaid continuous enrollment provision—and gave states 12 months to return to normal eligibility and enrollment standards. This means that as of April 1, 2023, states will be able to terminate enrollment for ineligible individuals, following a redetermination.
However, different states are moving at different speeds, and according to one report from the AP, Arizona, Arkansas, Florida, Idaho, Iowa, New Hampshire, Ohio, Oklahoma, and West Virginia will begin removing ineligible Medicaid patients as soon as April, with other states following suit in May, June, and July. (If you’re wondering where your state is in unwinding continuous Medicaid coverage, you can check this tracker built by the Georgetown University Health Policy Institute.)
What do affected patients need to know—and what should they do?
With eligibility requirements being put back in place, millions of current recipients could see their Medicaid benefits ending in the coming months. According to one estimate from the Kaiser Family Foundation, as many as 14 million Medicaid enrollees could be dropped as states reconfigure their Medicaid rolls. Fortunately, current Medicaid enrollees won’t be caught unaware by a coverage gap when they show up for their next appointment. States will be sending Medicaid renewal forms to enrollees’ homes, and are also required to contact patients via phone, text, or email with additional reminders. Patients will then have 30 days to complete the renewal form. So while Medicaid patients can rely on texts, emails, and phone calls as a backstop, it’s a good idea to recommend that they ensure their contact information is up to date with their state’s relevant agency.
In the event the patient loses Medicaid coverage, they can go to the Affordable Care Act’s Marketplace to seek coverage through a “special enrollment period” that will run from March 31, 2023, until July 31, 2024. Be mindful that beneficiaries have 60 days to enroll in new health insurance after they lose their coverage.
If parents lose Medicaid coverage, do children lose it as well?
The Children’s Health Insurance Program (CHIP) covers children whose families do not qualify for Medicaid coverage, but are still unable to afford private insurance. With Medicaid benefits ending, families that lose Medicaid coverage may have children that are still eligible for CHIP; per one Department of Health and Human Services (HHS) study, 73% of children who are expected to lose Medicaid coverage through administrative churning would still be eligible for CHIP. Parents and healthcare providers should be active in delving further into their state’s eligibility requirements to avoid any children slipping through the cracks.
What does this mean for rehab therapists?
With Medicaid benefits ending, these changes could have an impact on clinicians treating Medicaid patients—which means that you might need to take some additional measures to ensure your clinic is prepared. We strongly recommend scrubbing your clinics’ caseloads and re-verifying patient benefits—starting with current Medicaid patients—to ensure your organization has the most up-to-date patient information possible. For the near term, you can use the aforementioned tracker to align your reverification process with your state’s Medicaid unrolling timeline. Or better yet, verify insurance monthly—something you can actually automate with WebPT Electronic Benefit Verification (eBV)—to ensure your clinic won’t be caught unaware one way or another.
Should clinics give their patients a heads up?
Some Medicaid patients don’t keep track of their correspondence or follow up on changes to their insurance, which means that some of your patients might be unaware that their coverage could be discontinued. To help them continue with their care and stay among the “Active” list on your caseload, you can direct them to check with your state’s Medicaid representative to determine their eligibility status. Make sure your front office is equipped with this information ahead of time so they are prepared for these conversations—and can even find ways to naturally weave it into their normal dialogue with affected patients.
What can WebPT Members do?
If you’re a WebPT Member, you can take advantage of the ability to sort patients by insurance and separate Medicaid patients to check their benefits. Using the advanced search tool in the WebPT EMR will allow you to sort patients with Medicaid as their primary insurance so these patients can be prioritized for benefits verification checks and in-person follow ups. It’s important to note that many patients with Medicare as their primary insurance have Medicaid as a secondary insurance. If you want to run a search for patients with Medicaid as a secondary payer, you’ll want to follow the instructions offered in this article from our Knowledge Base, where you can leverage the Documented Visits report in WebPT Analytics to filter secondary insurance for Medicaid.
And if you’re using WebPT eBV, you can quickly verify benefits with all state Medicaid payers, save Rhode Island. All you’ll need is a working NPI to run checks on each of those patients, and in the case of California-based providers, a provider PIN.
While this Medicaid change is more of a return to pre-pandemic rules rather than a major shift in the program’s policy, it will have an effect on millions of patients—many of whom are undoubtedly being treated by rehab therapists. Clinicians and staff need to be aware of when these changes are being implemented in their state—and how they can prepare themselves and their patients to avoid any coverage issues.