‘A huge investment’: Providers race to keep Medicaid patients covered amid unwinding

BY: DANIEL PAYNE | 06/01/2023 05:00 AM EDT

The push to keep Medicaid patients enrolled in the program has hit a frenzied pace — and not just by patient advocates and state workers.

Hospitals and clinics are also trying to minimize the number of people kicked off the rolls amid the so-called Medicaid unwinding, from calling tens of thousands of patients to rethinking check-in and check-out procedures to boost enrollment.

“It’s still a tremendous effort and a tremendous cost … a huge investment,” said Jim Mangia, president and CEO of St. John’s Community Health, a network of clinics in Los Angeles. “We have dozens of staff engaged in capturing people as they come in for a visit, making sure we’re reenrolling them.”

Mangia’s team looks to reach out to from 65,000 to 75,000 patients, whether by email, letter, text or phone call.

And in a small clinic in Alaska, part of the 20-person staff is reallocating some of their time to ensure patients are enrolled.

“A lot of our patients didn’t even realize this was happening,” said Harsha Gowtham, a doctor at Seward Community Health Center. “It has affected my care — some patients are like, ‘I can’t come back because I can’t afford this.’”

The effort to keep patients covered — after a return to rules that were waived during the past three years and the drawdown of government Covid funding — is the latest response to a bumpy off-ramp from the pandemic.

Though the process will be slow for some states, it will almost certainly impact people nationwide. Now that states are reconsidering eligibility and many are removing people from the rolls, an estimated 17 million people could lose coverage, according to KFF.

And it’s already happening: More than half a million people across the11 states that have reported data have lost coverage since unwinding began in April, according to a KFF analysis released this week.

Hit the hardest

Because Medicaid payments are, on average, far lower than commercial insurance payments for a given procedure or service, providers with more Medicaid patients are doing more with less, advocates said.

“The redetermination for Medicaid will have a massive implication for health centers because they care for such a large portion of the Medicaid population,” said Amanda Pears Kelly, CEO of Advocates for Community Health, a group that champions policies to support community health centers. “They have to see these patients regardless of whether they happen to have Medicaid coverage or not.”

Still, many providers said they don’t know which patients need to be immediately reenrolled to keep coverage — and the volume of people they need to reach makes the endeavor daunting, especially for smaller hospitals and clinics.

“I think rural hospitals are really just overwhelmed in many cases,” said Brock Slabach, COO of the National Rural Health Association, which advocates on behalf of rural providers. “It’s a shame that they have to be placed into this mode.”

Big systems scrambling, too

Even large systems that serve a smaller percentage of Medicaid patients are looking to distribute information to patients on how to ensure they remain enrolled.

Hospitals nationwide are working with regulatory affairs professionals to develop best practices in accordance with their state’s policies to maintain patient coverage.

The Tennessee Hospital Association, for instance, has talked with its members for months about how to keep patients enrolled, from checking state databases to offering new information on enrollment to patients.

Despite the efforts, though, a large number of people have lost or are set to lose coverage — already having an effect on patient outcomes.

Some patients in his practice already had their care interrupted, Gowtham said, seeing a year or more of progress being lost.

“A lot of medical care, when you’re talking about Medicaid patients or Medicaid population, we’re talking about chronic issues that require close follow-up and gradual improvement,” he said. “It definitely hurts the underlying care that is given. Without a doubt, I can see it.”