Medicaid and the end of SOP March 31, 2023 is the date to end all dates. What does that mean for your state’s status on restarting Medicaid redeterminations? On December 29th, the dreaded news was received. The temporary pause on Standard Operating Procedure (SOP) would be over as of 3/31/23. So many people will be […]
March 24, 2023
March 31, 2023 is the date to end all dates. What does that mean for your state’s status on restarting Medicaid redeterminations?
On December 29th, the dreaded news was received. The temporary pause on Standard Operating Procedure (SOP) would be over as of 3/31/23. So many people will be affected by the sudden overwhelm of required eligibility redeterminations, especially healthcare facilities.
During the pause of SOP, states were required to allow those who were eligible to enroll easily, and no one was allowed to be terminated during the past 2.5 years. This obviously led to a whopping 30% increase in Medicaid enrollment. 19.5 million people according to federal data. Quite a jump.
Putting redeterminations and terminations back into effect is going to be quite a process. It will look different from state to state.
Each state has the authority to decide how to meet the federal phase-out requirements over the course of 2023. With a deadline of 12-14 months.
What are the requirements in your state? Have you been educated on how this will affect your facility?
Keeping the old and adding new.
States have the responsibility to maintain their previous Medicaid eligibility requirements and now have to work with the phase-out restrictions as well. These are all detailed in the Consolidated Appropriations Act.
Some of the new additions:
☑️ Conduct renewals in accordance with all federal requirements in addition to temporary flexibilities to keep the process smooth
☑️ Ensure they have up-to-date contact information using all reliable sources available to them
☑️ May not disenroll anyone on the basis of returned mail unless they have made a good faith effort to contact them using more than one means
☑️ Publish monthly data reports until June 2024
Oldies but goodies:
☑️ Must not make Medicaid eligibility standards, methodologies, and procedures more restrictive
☑️ Must not raise premiums
Millions will be without coverage. The redet will be huge.
Starting as early as April 1, 2023, states must resume their redetermination process. This means that all applicants will be required to prove eligibility and will be disenrolled if they do not meet the requirements. The onslaught of redeterminations will be a lengthy complicated process that will overwhelm DHS.
Tracking all this progress for all your residents will be nightmarish.
A strongly reinforced infrastructure is necessary to be able to handle the tracking of communication with an overwhelmed Medicaid office.
Many healthcare facilities have focused on bolstering their communications systems to curtail a loss of coverage due to technical reasons, such as failing to complete or receive eligibility forms. Increased organization and optimization are the name of the game. Many back offices have also prepared each resident’s application from scratch. Preparing all the documentation needed to answer and support any question they’ll be asked.
The larger or more populated the state, the greater their Medicaid agencies assumedly. The greater their Medicaid agencies, the more extensive their list of currently enrolled Medicaid beneficiaries. A strongly reinforced infrastructure is necessary to be able to handle this onslaught.
Some agencies have focused on bolstering their communications systems to curtail a loss of coverage due to technical reasons, such as failing to complete or receive eligibility forms. Increased organization and optimization are the name of the game.
How can state Medicaid agencies track all of their beneficiaries through the redet? Will they have enough staff? Proper software? 💭
We’ve broken down the resources available to help you plan for the worst and hope for the best:
What is your state’s status on restarting Medicaid redeterminations?
Here are some articles to help you find the information you need for your state:
As a first basic step, you need to make sure that you actually receive the redetermination letters.
We suggest that you do the following:
We’re ‘acing the Medicaid maze’ together!
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