How to Navigate Medicaid Redetermination with an Agile Workforce

Since March of 2020, Medicaid coverage has been continuous for recipients in every state, thanks to the Department of Health and Human Services’ COVID-19 Public Health Emergency declaration. However, this protection is winding down, expiring on May 11, 2023. Even sooner, on April 1, states will begin the daunting process of reviewing Medicaid enrollees’ eligibility, better known as Medicaid redetermination. While the onus is on state administrators to determine eligibility, the immense workload of re-enrolling millions of recipients will trickle down to payers and providers in care management.

What does Medicaid redetermination mean for Medicaid recipients?

Current recipients must be re-assessed by state Medicaid programs to determine whether or not they are eligible to continue receiving Medicaid coverage. After they are re-assessed, they will likely fall into one of three groups:

  • Those who maintain eligibility and continue with Medicaid coverage
  • Those who are denied eligibility and switch to commercial coverage
  • Those who are denied eligibility and experience a lapse in coverage

Regardless of where individuals fall, they must take action, which they haven’t been required to do for three plus years now. This has created a sense of angst among recipients and a necessity to pivot and plan on the payer and provider side.

What does Medicaid redetermination mean for payers and providers?

For payers which help administer Medicaid across states and various types of healthcare providers, there is some degree of unknown. On one hand, they know that there will be a significant increase in work to keep track of members or patients who are keeping or dropping Medicaid. On the other hand, they don’t know how proactive they should be in managing the process. Because while state administrators are responsible for the actual redetermination, payers and providers share some responsibility in reaching out to individuals to remind them and help guide them through the process. After all, these individuals need continued care, and payer and provider organizations depend on the associated revenue. There’s also no telling how long the lingering effects of this process will go on, despite federal and state efforts to expedite it.

Non-clinical healthcare workforce flexibility is vital to payers and providers during redetermination.

Considering the mix of knowns and unknowns of redetermination, it’s safe to say that workforce flexibility will be paramount to payers and providers. The need to find new talent to help with the administrative side of the process will be inevitable, and it may be necessary to quickly scale up or down with temporary talent depending on the volume of Medicaid renewals or declinations. On the provider side, expect to see an influx of financial counselors; on the payer side, the demand for positions related to members services is expected to rise. The people in these positions will be critical in helping individuals retain Medicaid—or enroll in a commercial insurance plan—maintaining continuity of care, and ensuring providers minimize lost claims and revenue. Every party has a significant interest.

Assess your readiness.

As you can see, there is so much at stake here. Is your organization ready to handle the wave of Medicaid re-enrollments? Ask yourself and your colleagues the following questions to get a better sense of how prepared you are and which actions you must take.

  • Do you and your staff understand the ins and outs of Medicaid redetermination?
  • Do you know the effects it could have on your organization?
  • Do you know the effects it could have on your members or patients?
  • Do you have a member or patient outreach plan to remind them that they must re-qualify and potentially re-enroll?
  • Do you have the staff to execute that plan?
  • Do you have a plan to efficiently and effectively update member or patient records with updated insurance information?
  • Do you have the staff to execute this plan?
  • Do you need to supplement your team with temporary labor throughout the Medicaid redetermination process?

A healthcare staffing partner can provide you with the flexibility you need.

A proactive healthcare staffing company has been preparing for Medicaid redetermination for months—working to understand the ins and outs of the process, know what it means for clients’ talent needs, and build a deep talent pool to quickly respond to job requisitions. They can provide experienced, pre-vetted talent and help expedite the onboarding process, equipping you with the talent you need throughout the redetermination process, but also supplying you with potential temp-to-perm hires for your broader, long-term strategy.

For more advice on re-enrolling your Medicaid population and maintaining continuity of care, download our guide here. 

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