The Medicare Breakeven Blog

Is your health system ready for greater Medicaid-eligible volumes?

Sarah Gabriel

Twenty-one states (and the District of Columbia) have already indicated that they will expand Medicaid eligibility to 133% of the federal poverty level, and thirteen states have decided not to participate.

According to a recent report by the Kaiser Family Foundation (KFF), even those states that do not expand Medicaid will experience a bump in Medicaid enrollment because of other mechanisms in the ACA that will encourage currently eligible patients to enroll. KFF’s modeling suggests that increased Medicaid enrollment across the country will be 4.8 million by 2016 and 5.7 million by 2022 if no states expand eligibility.

Regardless of whether their state expands Medicaid eligibility, health systems must ensure they receive every dollar earned treating patients currently eligible for Medicaid. That means they need to get better at identifying and enrolling Medicaid-eligible self-pay patients.

How Barrie increased Medicaid enrollment

Barrie Medical Center, a pseudonym for an academic medical center in the Northeast, is an excellent example of a provider that has already taken steps to improve its identification and enrollment processes.

The hospital historically suffered losses from treating uninsured individuals who were eligible for Medicaid but had not enrolled in the program. Barrie leadership identified two primary drivers of this phenomenon: many individuals with a high probability of being Medicaid-eligible were never seen by front office staff when they presented for care, and Medicaid-eligible patients who were given enrollment forms by front office staff failed to complete the paperwork in a timely manner

To remedy these problems, Barrie made a concerted effort to incorporate Medicaid enrollment into all aspects of the registration process with these four steps:

  • Enrollment staff were placed at major patient access points in the hospital and clinics
  • Scheduled self-pay patients were screened for eligibility during pre-registration
  • All eligible self-pay patients seen in the ED were provided with Medicaid enrollment forms
  • Enrollment staff mailed reminder letters to patients and followed up with them via phone

Thanks to this new strategy, Medicaid enrollment increased 130% over a four-year period.

The financial impact was substantial. Given Barrie’s average utilization rates for enrollees, a single Medicaid patient translates into about $1,700 in Medicaid revenue. With 6,000 people newly enrolled in Medicaid in 2009, Barrie estimated the annual revenue impact to be around $10.2 million.

Learn More

Financial Leadership Council members can learn more about Barrie’s experience and other best practices for patient registration and collections in our study, Optimizing Front Office Performance.

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