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A Human-Centric Approach to Medicaid Redetermination

For many Americans, the end of the Public Health Emergency (PHE) is a welcome relief to the dreadful pandemic that has forever changed our lives. For others, the end of the PHE will wreak even more havoc due to the potential loss of critical benefits received via the federal government’s Medicaid Program.

Medicaid redetermination — often called “the unwinding” — is the process that states use to ensure that Medicaid enrollees continue to be eligible for Medicaid coverage. For the first time in years, states will be going through the process of redetermination for millions of recipients of Medicaid and the Children’s Health Insurance Program (CHIP). Enrollment expanded dramatically during the PHE. According to the Kaiser Family Foundation, 16.1 million people enrolled in Medicaid from February 2020 to February 2022, creating a total of more than 87 million Medicaid and CHIP enrollees as of February 2022.

To be eligible for Medicaid, a person’s income has to be fairly low, and some populations are also subject to asset tests. So states are required to periodically redetermine enrollees’ eligibility, and disenroll those who no longer meet the eligibility guidelines.

During the COVID public health emergency, Medicaid redeterminations have been paused in every state. This is due to the Families First Coronavirus Response Act, and the additional federal Medicaid funding that states are receiving during the public health emergency. Once the public health emergency period ends, Medicaid redeterminations will resume.

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) has estimated that fifteen million people, including 5.3 million children will be disenrolled from Medicaid after the PHE ends. Some of this is legitimate due reversion of eligibility requirements, others are procedural in nature and should never happen. The disruption of benefits has far reaching impacts for families in poverty and can propel them into a state of crisis.

The end of the PHE also has significant impacts on the state agencies that are responsible for determining eligibility for federal funded benefits programs. As states embark on implementing their return to normal operations an already stressed and over-burdened workforce will be tested. The processing of an unprecedented number of renewals and the increased volume of citizen contacts, could push the strained workforce to the breaking point, causing further impact to families across the nation.

Many of the legacy systems in operations are not equipped to handle the volume and/or to provide the efficiencies needed to adequately enable these necessary business functions. In an effort to support the volume of clients and their experience with the programs, as well as to mitigate workforce impacts, it only makes sense that states will need to leverage technology to support their unwinding activities. Agencies need systems that can augment and improve their ability to respond to the new demand for eligibility redeterminations and disenrollment to ensure coverage continuity for the eligible members without disruption.

All these issues can be quickly and easily mitigated with the right tools. Cardinality.ai provides accelerated integrated eligibility solutions that deliver a lower total cost of ownership to clients, while addressing the unique challenges of the unwinding and related Medicaid redeterminations.

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Our solution approach includes the Cardinality.ai Integrated Eligibility ready-built solution which includes Citizen and Case Worker portals, rules engine, API and Data Integrations and Eligibility recommendations. All of this, “out-of-the-box” means that states are not paying for costly custom coding, and capability is activated quickly. We spend our time focusing on your unique needs to create specific configurations, and only where necessary customizations to the solution. Given the impending end of the PHE, there is no time for anything other than a swiftly executed solution that can meet the complex needs of the Medicaid eligibility process.

The Cardinality.ai Integrated Eligibility solution automates and streamlines self-disenrollment and simple re-enrollments. This takes the burden off your staff to focus on the more complex re-enrollments and disenrollments. Leveraging a variety of omnichannel communications (e.g., SMS, web, email, and paper) increases success rates for locating and corresponding with clients. This decreases inadvertent disenrollments, improves client self-sufficiency and builds trust.

Modern technology solutions are the answer for automation of processing increased volume of transactions, supporting a stretched workforce, and improving citizen experience. Cardinality.ai offers the right solution, quickly, to meet the immediate needs of the unwinding and to provide a foundation for the future. All these things lead to a strong foundation for rebuilding strong communities and creating trust with vulnerable populations who rely on government programs.

Click here for a brief video of our intuitive & AI enabled Citizen Portal and get to know how we can help agencies utilize modern technology to execute the Medicaid Redetermination process smoothly once the PHE ends.