Client eligibility is one of the three pillars of pain for home care providers who service Medicaid clients. The other two are EVV compliance and payment reconciliation. In general, Medicaid clients can lose eligibility from month to month or change carriers without letting their home care provider know.
In the coming months, changes in Medicaid policies and the end of continuous enrollment present significant challenges, leaving providers at risk of losing clients and facing financial strain.
This article outlines the critical issues presented by Medicaid unwinding, discusses its impact on home care agencies, and explores how Paradigm's innovative eligibility technology empowers providers to continue delivering exceptional care.
What Is Medicaid Unwinding?
Medicaid disenrollment, or 'unwinding', is a process in which Medicaid recipients are losing their coverage due to the Consolidated Appropriations Act passed on December 29, 2022.
According to KFF, during the unwinding, an estimated 8 to 24 million individuals may lose their Medicaid coverage.
Why Are Clients Being Disenrolled?
When the COVID-19 pandemic began, Congress made a law called the Families First Coronavirus Response Act (FFCRA). It said that Medicaid programs had to keep people enrolled until the COVID-19 public health emergency (PHE) ended. In exchange, they would get more advanced federal funding.
However, as the pandemic situation improved and with the passing of the Consolidated Appropriations Act, 2023, the continuous coverage requirement was delinked from the COVID-19 PHE.
As a result, the process of "unwinding" began, meaning that states could start removing people from Medicaid starting from a certain date (in this case, March 31, 2023).
This process may cause some individuals to lose their Medicaid coverage, potentially reversing the gains in coverage achieved during the pandemic period.
States can start removing people from Medicaid in April, May, or June, but they have to follow certain rules to keep receiving federal funding during the unwinding period.
Who's Most At Risk?
According to KFF's brief, some people are at a higher risk of losing Medicaid coverage such as children, people with disabilities, people who have moved, immigrants, older adults, and those with limited English proficiency (LEP). This could put them at risk of losing coverage, even if they are still eligible.
How Does It Affect Home Care Providers?
As mentioned, older adults are most likely to lose their coverage in the unwinding. As Medicaid coverage is potentially reduced or discontinued for millions of individuals, home care providers may experience several challenges and changes in their operations:
1. Lost Coverage Goes Unnoticed
This is an extremely important factor that home care providers need to be aware of. If the client loses eligibility during the middle of their care cycle the provider will not know about it in real-time. Thus, providers run the risk of paying caregivers for care that Medicaid won't reimburse them for.
2. Decreased Client Base
With millions of people expected to lose Medicaid coverage, home care providers may see a decline in the number of clients they serve. This reduction in clientele could impact their revenue and overall sustainability.
3. Administrative Burden
Although millions of people are set to lose their Medicaid benefits, it could very well just be because of administrative issues and not eligibility related. Home care providers may need to allocate additional resources to manage paperwork, eligibility verification, and billing during the unwinding process.
4. Changes in Care Plans
As clients' Medicaid eligibility changes, their care plans may need to be adjusted or re-evaluated. Home care providers may need to modify services or find alternative funding sources for clients who no longer qualify for Medicaid.
How To Prepare for Medicaid Unwinding
The biggest issue for home care providers right now is trying to detect a loss in Medicaid coverage before it happens, so that there isn't a lapse in coverage that providers will be required to pay for.
Paradigm recognizes this issue and has created a solution for all Medicaid providers.
Paradigm's Eligibility Solution
Our Medicaid full back-office support solution has a built-in eligibility product that proactively notifies providers about their clients' eligibility status on a personalized schedule, ensuring they stay informed ahead of time.
This empowers providers to take necessary actions such as discontinuing care, helping the client with payment options, or assisting with the Medicaid redetermination process to avoid any disruptions in care due to coverage gaps.
Paradigm's innovative solution emerges as a crucial lifeline, ensuring continuity of care for vulnerable populations.
By proactively notifying providers, empowering them to take timely actions, and safeguarding against coverage gaps, Paradigm stands as a steadfast ally in these trying times.
Book a call with us today to find out how we can make the Medicaid unwinding process much easier to navigate.
A Path Forward
The Medicaid unwinding crisis is a pressing concern for home care providers as changes in policies and discontinuation of continuous enrollment put them at risk of losing clients and facing financial strain.
The path forward may still hold uncertainties, but with Paradigm's unwavering support and innovative solutions, home care providers can confidently face the challenges ahead and continue their mission to deliver exceptional care to their clients.
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