Changes to Medicaid are not slowing down any time soon.
The program is ever-evolving with multiple Section 1115 Waivers submitted, lawsuits pending or state policy, process or technology modifications.
As a revenue cycle industry leader in Medicaid eligibility services, Parallon continues to research the details, push for change and act as advocates on behalf of the patients we serve.
With working knowledge at more than 200 hospitals across 39 states, we are committed to collaborating with government agencies to navigate obstacles and research policy updates in the legislative landscape that will impact patients’ ability to alleviate financial burden and receive coverage.
What to watch in Q4:
Health First Colorado
Medicaid Assistant Site changes and eligibility system delays
Colorado’s Medicaid Assistant (MA) Site requirements will be changing and are tentatively scheduled to take place during winter 2019. However, there has been no discussion or feedback communicated regarding actual timeframes. Included in this change is limiting MA Sites to only accepting and processing intake applications within the Colorado Benefits Management System (CBMS).
In addition, the new CBMS system has experienced statewide issues since the implementation in August 2019. Inventory pending has increased due to issues with retro coverage needs, windows unable to be completed, information not populating from the previous CBMS system and a required help desk ticket for each issue found for potential resolution.
The Colorado Hospital Association is diligently working with the state towards resolving all issues.
Changes in state policy
There is controversy over technicalities for what Florida’s department of Medicaid deems the patient to be effective. They are currently utilizing the date an application was reviewed by a DCT employee. We are requesting that the state modifies the policy to reflect the date that a patient’s application was submitted. Parallon continues to advocate for this change since the impact on hospital patients can be significant for those applying on the weekends or during the end of the month.
In addition, throughout the state, reports indicate a drop in children with health insurance. There could be multiple reasons beneath the decrease, including fear of changes to the immigration laws. Parallon will continue to research and delve into details as to why this is happening.
New Section 1115 Waiver unveiled and significant processing delays
Georgia recently revealed plans for a Section 1115 Waiver titled Georgia Pathways which would expand Medicaid up to 100 percent of the Federal Poverty Line (FPL) for childless adults, including work requirements and premium payments. The state revealed plans that are estimated to give 408,000 residents the ability to have access to health insurance.
In short, the waiver is expanding coverage, but not providing retroactive coverage for the newly expanded population. Although there may be an increase in insured patients, if a patient enters the facility uninsured, their coverage will not begin until the following month after the premiums are paid.
Significant delays are impacting turnaround times of disability applications due to the state not backfilling a disability examiner position. Many of Parallon’s applications are processed through the state—not through Social Security. In the past, Georgia had one position overseeing this process, but recently, we were advised that the position has been vacant since June and that the state is in the process of hiring two people to handle the backlog.
Medicaid Expansion Enrollment
Effective November 1, 2019, residents are not only able to sign up for Health Exchange plans under the Affordable Care Act—they will also be able to sign up for Medicaid expansion. Voters passed a proposition in 2018 to expand Medicaid. Healthcare coverage begins on January 1, 2020.
It has been estimated that the expansion will add an additional 18,000 Medicaid recipients across the state. Parallon has created processes and plans to prepare for the new influx of patient applications.
Effective January 1, 2020, the Kansas Department of Health and Environment (KDHE) will transition all aged blind and disabled applications previously processed by Maximus to a dedicated KDHE worker.
Kansas’ Governor signed an order creating the Governors’ Council on Medicaid Expansion. The group will serve as an avenue to educate Kansans on the importance of expanding Medicaid.