Medicaid Redetermination

Redetermination is a process that states use to ensure that Medicaid enrollees continue to be eligible for Medicaid coverage. States are required to redetermine enrollees’ eligibility (annually), and disenroll those who no longer meet eligibility guidelines. Redetermination has not occurred in over 3 years as a result of the continuous enrollment provision baked into the Public Health Emergency (PHE).

Consider these concerning facts:

91.5+ million Medicaid patients now need to be redetermined after a 3-year pause during the pandemic.
An estimated 15-18 million patients could potentially lose their coverage.
62% of Medicaid recipients surveyed didn't know they needed to redetermine.

Labs & healthcare organizations will have to manage:

Risk of lost reimbursements due to insurance eligibility
Confused and upset patients
Added administrative burdens

Capabilities

Access to
every state's
Medicaid & sub-plans

Automation to check Medicaid on your
desired cadence

Accurate patient demographic & insurance info

Relevant patient financial data for authorized users

Resources

We're helping labs and healthcare organizations navigate and streamline the complex Medicaid Redetermination process, reducing staff workload & claims denials and helping to ensure eligible patients are taken care of. We're also working with our partners to share valuable insights on Medicaid Redetermination. We recently hosted a webinar with G2 Intelligence on the topic. Click the button below to check it out.

Webinar