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The Expiration of Medicaid Eligibility Could Impact 18 Million People. RPA Can Help.

Millions of people who enrolled in Medicaid during the COVID-19 pandemic risk losing coverage in the spring of 2023, leaving many worried about their healthcare coverage and many healthcare providers struggling to redetermine coverage. It's an anxiety-inducing situation, but robotic process automation (RPA) is on hand to help. 

What's the Situation?

States were required to keep people enrolled in Medicaid throughout the pandemic due to a decision made by the HHS declaring COVID-19 as a Public Health Emergency (PHE). However, PHE is set to end on April 11, 2023. And while the HHS has extended the PHE in the past, it's unlikely to do so again. 

What's the Impact?

It's currently unclear exactly how many people will lose their Medicaid eligibility in spring. Some publications have this figure at 15 million, while others have it as high as 18 million. But whatever the precise figure, millions of people will be left without health coverage and forced to find another source of coverage. 

It's also thought that this change will disproportionately affect children and young adults, with 5.3 million children and 4.7 million young adults expected to lose Medicaid eligibility. 

The withdrawal of the PHE will undoubtedly impact healthcare providers too. Medicaid eligibility and verification checks are already one of healthcare organizations' most time-consuming administrative activities. And faced with millions of people suddenly ineligible, this task will quickly become unmanageable. As a result, it's fair to assume healthcare admin teams will become overwhelmed, overworked, and face a massive backlog of Medicaid eligibility checks that take them away from other equally important activities. 

How Can Automation Help Redetermine Coverage? RPA to the Rescue

RPA excels at executing repetitive, mundane, and rules-based tasks typically performed by humans. And Medicaid eligibility and verification fit the bill perfectly. 

Whatsmore, the healthcare sector is facing a massive labor shortage, putting a strain on medical personnel who manually process claims, enter data into electronic health records, and interact with patients through digital channels. RPA bots reduce manual labor, free up workers' time, and help companies save money in critical areas. 

Come April; this situation will only be exacerbated further, with people who lose coverage being forced to reapply or re-enroll state by state. As a result, healthcare organizations will be in greater need of automation than ever before. But how exactly can automation help with Medicaid eligibility and verification checks?

RPA Bot For Mass Medicaid Eligibility Checks

Thoughtful is building a powerful bot that can check patients' Medicaid eligibility and verify coverage across various healthcare organizations, hospitals, clinics, doctor's offices, etc. This bot can execute a one-time check of all enrollees to ensure they meet the requirements for Medicaid coverage. With this information, healthcare providers can get ahead of the situation and ensure they can meet their patient's needs without delay. 

This bot will also dramatically reduce the burden on healthcare admin staff to conduct time-consuming and error-prone Medicaid eligibility checks at a time when the backlog will be more significant than ever before. And when workers have to process increasingly high numbers of eligibility and verification reviews every day, the probability of costly errors and delays skyrockets. These delays worsen the problem and heighten already rising patient anxieties. 

Additional Coverage

Uncompensated care has cost hospitals an eye-watering $660 billion since 2000. As a result, healthcare providers are missing billions in compensation by not searching for additional coverage to meet patients' needs. 

RPA bots can perform regular checks to uncover additional coverage for patients. This may mean that patients can access more substantial levels of care they didn't know they were eligible for, allowing healthcare organizations to meet and exceed patient expectations. 

Reducing Claims Denials

Denied claims impact healthcare organization's bottom line and cause much stress and frustration for patients. And with millions of people losing Medicaid coverage this spring, shares denials could surge. RPA bots can help determine eligibility before the patient arrives at the clinic, ensuring there are no unwelcome surprises later down the line. In addition, RPA bots can help with claims denials in other ways. For example, they can ensure that all information relating to patient details and treatment received is correct and free from errors. 

Wrapping Up

With the proper support, healthcare organizations will avoid an administrative nightmare when the PHE ends this April. Unprepared organizations will be thrown into chaos, manually conducting Medicaid eligibility and verification checks on a scale not seen before. Luckily, RPA bots can reduce this strain and allow healthcare organizations to focus on what matters most - excellent patient experiences and outcomes. 

Published On:

January 18, 2023

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