As the COVID-19 pandemic policies wind down, state Medicaid programs seek to maintain high-quality care for their beneficiaries while improving their operations. However, this is not without challenges, especially considering the recent report that up to 18 million people could lose Medicaid coverage after the Public Health Emergency (PHE). 

It's a tricky situation, but only one with hope. State Medicaid programs can turn to RPA automation as a solution, particularly in Medicaid eligibility, revenue cycle management, and renewal processes. With this in mind, let's explore three impactful ways that state Medicaid programs can leverage automation to strengthen their renewal process, ensuring their beneficiaries continue to receive state-of-the-art care.

Use Automated Eligibility Verification

Many states require their Medicaid beneficiaries to renew their eligibility annually. This process can be complicated for both beneficiaries and caseworkers, as it involves navigating complex eligibility criteria. However, automated eligibility verification can simplify this process and reduce errors, making it more efficient and effective.

Using RPA automation, states can quickly and accurately verify a beneficiary's eligibility for Medicaid by extracting data from various sources, matching it with eligibility criteria, verifying submitted documents, and notifying beneficiaries of their eligibility status. This approach can save caseworkers time and lead to a smoother renewal process, ultimately benefiting Medicaid beneficiaries and the entire system.‍

Implement Automated Reminders

Another way to strengthen state Medicaid renewals with automation is by implementing automated reminders. So often, beneficiaries need to remember to renew their eligibility, leading to a gap in coverage and additional administrative burdens for caseworkers.

Automated reminders ensure that beneficiaries renew their eligibility on time. These reminders can be sent via text, email, or automated phone calls. By automating this process, states can save time and reduce administrative costs while ensuring beneficiaries receive the care they need.

To understand the impact automated reminders can have, consider this case study. The Colorado Department of Health Care Policy and Financing has streamlined Medicaid eligibility renewals with a computerized renewal system that includes reminders. The system sends notifications via mail, phone, email, or text to remind beneficiaries of their renewal date. Then, using an online portal, beneficiaries complete their renewal application, which is automatically processed and reviewed.

The result? Colorado has seen a significant reduction in renewal processing time and a reduction in staff time, according to a case study published by the Centers for Medicare and Medicaid Services. The automated renewal system has also significantly decreased the number of missed renewals, making the renewal process more efficient and effective for beneficiaries and caseworkers.

Use Automated Document Processing

Beneficiaries demonstrate their Medicaid eligibility by submitting various documents, such as proof of income, residency, and other factors. However, this process can be time-consuming and prone to human error, leading to delays in coverage or even denials of eligibility.

Automated document processing can help streamline the Medicaid renewal process by automating the verification and processing of these documents. For example, optical character recognition (OCR) technology can scan crucial documents, extracting all the necessary information. This reduces the need for manual data entry and improves the accuracy of the renewal process.

For example, let's consider proof of income. Automated document processing can extract income information from pay stubs and tax returns. This can speed up the verification process and reduce the likelihood of errors that may delay or deny coverage to eligible individuals. Similarly, residency is another crucial factor in Medicaid eligibility. Medicaid coverage is typically limited to residents of a particular state or region. RPA automation scans documents like driver's licenses, utility bills, and leases to ensure that only eligible residents receive Medicaid coverage, preventing fraud and abuse of the system.

Here's the bottom line. Automated document processing can help streamline the Medicaid renewal process and improve the accuracy and efficiency of eligibility verification.

Final Thoughts

State Medicaid programs should consider using automated eligibility verification, reminders, and document processing to simplify their operations and ensure that eligible individuals continue to receive the care they need. Now, explore RPA automation solutions to strengthen your state Medicaid renewal process.