What we learned at Medicaid Innovations

Recently, I attended the Medicaid Innovations Conference in Orlando Florida.  Each year this conference provides updates on the latest changes in legislation and great educational information regarding Medicaid nationwide.  There were presenters from all over the country sharing innovative solutions to address the changing landscape of Medicaid.  Of all of the topics discussed, the three topics I have summarized below, stood out to me:

Increased Medicaid enrollment and utilization challenges

Over the years as more states expand their Medicaid program, these same states are now experiencing a considerable increase in the number of new people that enroll into a Medicaid program.  States and hospitals are in need of innovative support to keep up with the influx of newly eligible people while still maintaining high level of care.  One such innovation is the use of data analytics to determine social detriments of health and how to counteract them with care management for the patient.  The patient data helps managed care organizations, ACO’s and providers assist patients in connecting with resources that will address their social and behavioral risks.  Unaddressed risks, drive poor health decisions and contribute to the over use and bordering abuse of hospital resources.  The influx of new Medicaid enrollees coupled with the care that they may need, has presented a budget issue from a federal and state stand point as they try to determine how to provide reimbursement to healthcare providers for all the services rendered.

Impact of potential regulatory changes

Considering the current political climate, proposed budget cuts and program changes, this likely seems to be an arduous task. The federal government wants to institute a block grant for Medicaid programs which could ultimately affect how states rollout their programs.  This shift in control can cut program benefits, and/or state governments would have to reallocate funds away from other cash strapped programs like education to avoid cutting Medicaid benefits and possible enrollees.   In addition, the Administration is leaning toward approving work requirements in order for future enrollees to become eligible as well as maintain Medicaid coverage.  This, along with other restrictions on Medicaid Eligibility guidelines will inevitably lower the amount of people eligible for Medicaid but will also increase uncompensated care and Charity Care write-offs.

Medicaid expansion

There are 3 states that currently passed the ballot initiative to expand Medicaid, but it has not passed the state as of yet.  There are 14 states that have not passed Medicaid expansion as of March 2019, but some of those states are in heated battle to do so.  The hurdle to overcome is the possibility of adding work requirements as part of the eligibility process or maintaining Medicaid eligibility once approved.  This initiative is starting to gain momentum nationwide.  However, there are states that see the future challenges of adding that additional requirement.  At the moment, there are 7 states that submitted work requirement waivers to CMS with an additional 8 states currently approved for the work requirement waiver.

As I mentioned before, this conference has provided valuable insight into the ever changing landscape of Medicaid with their changes affecting the neediest of the population.  As true patient advocates in the Medicaid Eligibility space, we strive to keep informed in order to serve our clients and their patients in the best possible manner.