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A proactive approach to leveraging Medicaid expansion

Medicaid expansion has many benefits including reducing the uninsured population, increasing the availability of preventative care programs and providing financial relief for hospitals.  These benefits result in fewer inpatient self-pay admissions, a reduction in treatment cost and additional patient revenue.

Expansion provides states and hospitals with the ability to easily complete Presumptive Medicaid Eligibility applications online through a state-run website.  This process does not require any documentation to verify identity, income or family size.  The patient is presumed to be eligible for Medicaid with minimal information and should be approved by Medicaid for 45 days from the date of application. 
A patient can only complete this presumptive process once in a 12-month time frame.  However, with all beneficial programs you need to be proactive in order to maximize the opportunity.  

All presumptive applications should lead to a completed full Medicaid application that must be then submitted to the local government agency in person. This part of the application process can get convoluted, leading to patient frustration.  The presumptive approval process dictates that the patient is to complete all document verifications and submit a full application in order to be approved for the full year of Medicaid coverage.  If this application is not completed, coverage will terminate at day 45 and the self-pay cycle starts over.  This misstep in the follow up of the Presumptive Medicaid process can result in gaps in coverage for the patient and in lost revenue for the facility.

Although challenges remain with patients completing finalized Medicaid applications, hospitals with proactive Medicaid eligibility screening and enrollment processes can minimize the impact of these missed opportunities. Whether your hospital handles the eligibility process in-house or has a vendor partner that is in charge of eligibility, your process must be proactive and efficient.  

Hospitals with proactive eligibility processes reduce eligibility gaps and the number of self-pay cases, as well as improve the patient experience. These proactive organizations guide patients through the process and handle any additional document requests or possible coverage denials.  If you should have any questions about Medicaid Eligibility processes with expansion or non-expansion states, please contact Juan Chico at 609-918-0990.  Also, visit our website at to get to know us.

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