The unique needs of dually eligible populations present distinct challenges in the unwinding of the PHE
In the coming months, millions of older adults who are eligible for both Medicare and Medicaid services will have their Medicaid eligibility reprocessed.The unwinding of the Public Health Emergency (PHE) and subsequent end to emergency-related flexibilities, including the Medicaid continuous enrollment requirement, pose unique challenges specific to this population.
Dually eligible individuals are more likely to report at least one daily living (ADL) limitation, meaning they require assistance with particular tasks. Additionally, a low-income or disability status that makes them eligible for Medicaid, coupled with potentially higher rates of hospitalization or chronic health issues, could mean they are more susceptible to housing and financial insecurity. These aspects of their care present significant barriers to navigating the already confusing redetermination process, including the management of paperwork or appointments that may become necessary in their Medicaid eligibility redetermination. If unable to navigate the reenrollment process, they risk being disenrolled from their services.
In many cases, the dually eligible determination affects both the services participants are eligible for, and the way they are charged and must pay for those services as well. For example, while they remain dually enrolled, their Medicare premiums are waived. But if they are no longer eligible for Medicaid, those premiums may be automatically deducted from social security income. In some cases, this unexpected expense has reduced participants’ monthly income significantly, putting them at severe risk of losing housing or having to delay vital treatment.
Advocacy organizations are joining the conversation and suggesting measures to mitigate these potential consequences. Most notably, groups like Justice in Aging suggest measures that will prevent churn in the first place, like mandating increased transparency about the unwinding process and maximizing the use of the ex parte renewal process. Additionally, there are calls for more targeted outreach efforts, which could reduce confusion and give dually eligible populations and their families ample time to prepare documentation.
Whether suggestions are adopted or not, FEI’s solutions can support agencies in their efforts to reduce churn. Our Blue Compass case management solution for LTSS uses process automation to make it easier for agencies to keep currently eligible beneficiaries enrolled in Medicaid. It streamlines initial client screening, eligibility determination and enrollment functions, and can house the data for ex parte renewals in subsequent years. The solution is configurable to meet the needs of individual states and agencies. Once eligibility is determined and plans of care are created, it automates enrollment and re-enrollment processes, based on agency rules. Configurable timelines trigger automated processes appropriately, saving significant time.
As eligibility redeterminations continue in the wake of the unwinding of the PHE, FEI stands ready to support our state partners with our comprehensive solutions to reduce churn among dually enrolled individuals in the greatest need.
