PREPARING FOR THE UNWINDING PROCESS

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 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:

CMS Resources

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:

1. The rules divided by state 50 State Unwinding Tracker
2. The resources that have been shared with each state’s DHS.
3. Ending Coverage in the Optional COVID-19 Group: Preparing States for the End of the Public Health Emergency (Posted 10/17/2022 at medicaid.gov/resources)

As a first basic step, you need to make sure that you actually receive the redetermination letters.

We suggest that you do the following:

1. Update residents’ contact information - DHS will be overwhelmed and there will be errors and wrongful terminations.
2. Check all residents’ mail - Open every piece of mail addressed to the facility, even the routine looking ones. Ensure that all resident mail is delivered to the resident. Change address for new residents who are admitted with Medicaid. The mail is likely going to an old facility.
3. Complete renewal forms in a timely manner - Keep all records and certified receipts so that documentation is submitted on time. Send every piece of mail with proper tracking. 
4. Use Aidace to keep track of deadlines. After termination a beneficiary has 90 days to reinstate terminated coverage without needing a completely new application but you have only 55 days to submit the application to reinstate it.
5. Notify residents and their families of what to expect in case they are handling their own applications or receive mail. Communication materials and toolkits in a variety of languages are available here through Medicaid.gov. We have created a template of a letter to share with residents and families, contact us at [email protected] to request it!

We’re ‘acing the Medicaid maze’ together!

Stay in the know by

1. Signing up for our email newsletter.
2. Downloading our Unwinding Handbook.
3. Downloading our template of a letter to share with residents and families.
4. Following us on LinkedIn
5. Checking out our blog

Email us at [email protected] with tips, resources, and processes you’d like to share with others.