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Addressing Medicaid Determination.

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 Today Medicaid, redetermination and what it means and how it's being handled.

 My name is Bill Russell. I'm a former CIO for our 16 hospital system and creator of this week Health. A set of channels dedicated to keeping health IT staff current and engaged. We want to thank our show sponsors who are investing in developing the next generation of health.

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 Okay. Medicaid redetermination is upon us. I'm gonna start with a story about what they're doing in Maryland, and then I'm going to really explore the Medicaid redetermination a little bit more on what it means for healthcare and health it. Okay. So, , this article, healthcare Innovation Crisp Supports Maryland and Medicaid, redetermination, notifi.

All right, so Crisp is their h i e. They're statewide. Hi e. With the end of the public health emergency, on April 1st, states will have 12 months to Redetermined Enrollee eligibility, a huge task in Maryland. The State Health Information Exchange is providing data to help Maryland Medicaid and healthcare providers with outreach to members.

Chris. The state designated h i e is expanding its medicated redetermination notification project to all interested providers and managed care organizations. MCOs the program aims to rally support for nearly 1.6 million Medicaid members across Maryland who will face redetermination and possible loss of coverage and what will be a, the single largest healthcare coverage transition since the affordable care.

In partnership with Maryland Medicaid, the project provides healthcare delivery organizations with a, , secure report of all their patients who will face redetermination within the next 90 days. Chris said the program breaks down data silos ensuring healthcare centers have access to timely and accurate patient information, so care teams can.

Outreach and navigation and navigate patients through the redetermination process. The notification project is currently available to Federally Qualified Healthcare Centers, FQHCs and will expand to all CRISP participating organizations by May, 2023. Chris will conduct outreach with more information to all eligible organizations as the project expands.

Medicaid is a lifeline, so forth. , Maryland Medicaid will conduct redetermination of members in stages. The project initially launched as a pilot in February 23. To help the federally qualified healthcare clinics navigate redetermination for their patients who account for an estimated 10 to 15% of Maryland's Medicaid population.

The PhD has lasted for more than three years, leaving experts concerned about the serious impact the expiration will have on patients, providers, and care centers across the state. Many clinics report not having recent contact information for their PA patients to conduct outreach. The Medicaid check-in campaign, a statewide joint.

By Crisp mdh, MCOs, Maryland Health Commission. Just a whole bunch of acronyms. I was looking to generate awareness of upcoming redetermination and encourage Medicaid patient. To update their contact information and they talk about their worries a little bit, and then they say All states will enter redetermination for 91.3 million people across the country. , the critical role of HIEs can provide during redetermination by leveraging the infrastructure and technology already in place.

All right, so that's the story, and I think it's an interesting story. , you know, the h i e is potentially a, the statewide h i e is potentially a more accurate. Representation of the patient population in that community than the local health system. Right now, obviously the local health systems are connected to the h I e, however, I'm, I'm just making this point that, , the h i e is connected to more systems.

If you don't have an integrated system that h i e could be, you know, if the patient is bouncing from different health system to different health system, could be, , a better source of information. I like this use of the h ie. , this was the promise of the h i e, right from the, from the get-go. , Maryland is a pretty well run, h i e.

It's a pretty, , top-down kind of, , , state with regard to the, , health information exchange and driving that. So as, as those of you who know, Maryland's a little different, , animal than most of the other states that are out there, I do want to talk about Medicaid re determin. This is a big deal.

It's a huge deal. I mean, what was it? 91, 91 0.5 million people out of what? 350 million in the United States. Okay, so that's a significant number of people. These people are gonna go in a couple of different directions. They are gonna go into the uninsured category cuz they can't afford insurance. That's the thing that everyone's most concerned about.

, they could go into the category of, , another payer, right? So the public health emergency locked people in. They could not be released from the medicated roles. Now there are some people who are on Medicaid right now that shouldn't be on Medicaid and they will be moved off. , and. Those people will be moved off and be moved in a, into a, , the direction that they should in the, into the category of the insurance that they can afford to have.

Then there will be people who will in, in some cases, move off or be lost in transition and essentially, , not be insured anymore. They will go on to the roles of the people who show up in hospital. That do not have insurance that we care for. , the misnomer is that they do not receive care. If they don't have insurance, they do receive care.

, I can't think of a hospital that's turning people away who, , who are in need of care. So, , but it will also create, could potentially create a situation for our. , emergency departments or emergency rooms, , could be filled again with this population if it's not already. I mean, this population, unless we really worked at it, , generally does go to the ed.

and that has been a problem for years. , some creative health systems have done some really cool things, in which case you walk in that front door of the ED and you go to the right, you can actually go to a telehealth visit, go to the left, you go into the waiting room for the ed. Now the telehealth visit might lead to an ED visit, , but you'll see the doctor a lot quicker.

Could be a, a lot lower cost, , in. , a lot of lower cost, , , point of care for you. And if they cannot solve the problem or if it requires a deeper level of care, they might just refer you across the hall to the emergency department. I think that's a very creative way to do it. I've heard of at least two or three health systems that have done it.

, the first one to talk about on our show was Daniel Barchi with New York Presbyterian. Now with, , common Spirit Health. So, . Anyway, there's a lot of different ways to handle that influx of people into the ed. , you know, , this, this will impact our financials. I'm not sure how it will impact our financials, but this is the kind of stuff that leadership in healthcare, , should be in front of.

I mean, if this is not a very front and center conversation in your health system right now, you're behind the curve. Don't let yourself get even further behind the curve. , you should know your population, percentage of Medicaid, Medicare, , commercial, , you know, your payer mix pretty well. , understand which patients.

, potentially in this process of redetermination, , be a part of the solution of communication, of helping to navigate that and, , move them into the, , into the appropriate, , model. So I, I, I have this conversation just to say this is gonna be a very common. Problem For most health systems, this terminology, Medicaid redetermination will become more and more front and center.

, health systems that are not led well will start to raise their hands and say, we need more money. We need more money, we need more money. , and they may, I'm, I'm not saying that they don't, I'm saying that, , that this is a problem we knew was coming for three. We knew that it had locked people into Medicaid.

We knew they were gonna be moving off. This is not, , in information that we didn't have. It is not analysis that we couldn't do based on our population and our information. And, , this is the kind of thing that we could do financial projections on pretty easily. , now if those fi financial projections have been done, Then by all means, make the case for, , there's not gonna be enough money and it needs to go in one direction or another.

If on the other hand, it's more of a, Hey, we need more time, I, this really surprised us kind of thing. That's, that's the poor leadership aspect. So anyway, Medicaid, redetermination. Is something that, , is upon us and something we need to be ahead of. I like what the state of Maryland is doing with their h i e, potentially your h i e in your state is a source for, , quality information and , some sort of program for outreach and helping people to navigate.

This is definitely something I think the better health systems are going to be doing. So,

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