At the Margins

Preparing for the Medicaid expansion: Is your registration process ready?

Sarah Gabriel

On March 16, the Department of Health and Human Services released final rules for the Medicaid program expansion mandated by the Patient Protection and Affordable Care Act (ACA). As currently written, Medicaid would be available to individuals aged 19 through 64 with incomes up to 133% of the federal poverty level. That said, the Medicaid provisions of ACA could change substantially when the Supreme Court issues its ruling later this year.

Adding to the complexity, many states are cutting Medicaid reimbursement and issuing more selective eligibility requirements. Regardless of the outcome, health systems must ensure that they receive every dollar earned treating Medicaid-eligible patients. A critical component of this initiative is to improve the process for identifying and enrolling Medicaid-eligible self-pay patients.

Uncover potential Medicaid losses

Barrie Medical Center1, 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 actually eligible for Medicaid but had not enrolled in the program.

Barrie leadership identified two primary drivers of this phenomenon:

  • Front office staff didn't see many individuals with a high probability of being Medicaid-eligible when they presented for care.
  • Despite form distribution by the front office staff, many Medicaid-eligible patients failed to complete the paperwork in a timely manner.

Incorporate Medicaid enrollment into registration

To remedy these problems, Barrie made a concerted effort to incorporate Medicaid enrollment into all aspects of the registration process. Barrie placed enrollment staff at major patient access points in the hospital and clinics, screened scheduled self-pay patients for eligibility during pre-registration, and provided all eligible self-pay patients in the ED with Medicaid enrollment forms.

Furthermore, to ensure that patients completed the paperwork, enrollment staff mailed reminder letters to patients and followed up with them via phone. Due to this focus on enrollment, Medicaid enrollment increased 130% over a four-year period.

Realize high annual revenue impact

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.

Barrie Med Center Medicaid Enrollment

Members can find additional best practices for ensuring coverage in Optimizing Front Office Performance: Best Practices for Securing Coverage and Maximizing Patient Collections.

For more information on the Financial Leadership Council, please contact Josh Gray at