2019 was an important year for Medicaid changes and expansion, with many states taking advantage of the expanding policies the federal government created. However, 2020 will see even more significant change that will be worth keeping an eye on, especially as policies from the American Health Care Act (AHCA) begin to take effect. Here are the Medicaid changes that every healthcare organization should keep track of as the New Year begins.
Current State of Medicaid
In 2019, many states expanded their Medicaid services, with several remaining that have not done so. Debates over expansion are ongoing in Kansas, Missouri and North Carolina. Some Medicaid trends that have been put to use and will be worth tracking are prescription drug cost control, coverage for mental health services and assistance for people recovering from addiction in the midst of the opioid epidemic (i.e. the SUPPORT Act).
What to Expect in 2020
Several Medicaid changes are taking effect on January 1. The federal government will no longer fund Medicaid for newly-enrolled members of the “expansion population” (childless adults), which means states will have to pay for that part themselves. Medicaid beneficiaries of that category who are already enrolled will be able to keep their plans, but their coverage will start being re-determined every six months. Many people covered by Medicaid are in need of treatment for increasingly expensive chronic conditions. They may not be able to afford a quality standard of living due to disability and lack of resources, so this change will be something to keep an eye on. Also ending January 1 is hospital presumptive eligibility, in which certain healthcare professionals can determine patient insurance eligibility themselves, though the effects of this change are expected to be minimal.
The onset of new AHCA policies will also mean a significant change in how Medicaid works. Lawmakers are looking to change funding methods to per capita caps and block grants. Per capita caps will allow flexibility in the funding system for each individual, while certain populations that work better with block grants will receive set amounts of funding that are government-controlled. These potential changes could result in a loss of coverage for some individuals, the accrual of bad debt for both patients and healthcare organizations and an increase in charity care. This is why DECO offers revenue cycle management solutions so that these reimbursement issues can be properly handled or avoided.
Retroactive Medicaid may also disappear as a result of AHCA policies. Retroactive Medicaid has been a boon to those who were not covered by Medicaid before medical treatment, as it allows back-pay to healthcare organizations for services rendered when the patient was not covered. If retroactive Medicaid goes away, the risk of bad debt accrual once again increases.
Among other changes in Medicaid that the AHCA could bring about is more work and healthcare payment requirements. Changes like these may result in more people going to the Social Security Administration for Supplemental Security Income. However, it will also allow enrollees to find private insurance policies to help them if Medicaid will not work as they hope. Finally, the AHCA seeks to set aside funds for updating healthcare computer and tracking systems so the entire process can be more streamlined.
A lot of variation already exists amongst the states in how Medicaid is implemented. With the AHCA’s policies in effect and each state using them differently, there will be 51 (including D.C.) different ways in which it will be implemented through Medicaid. So it will be worthwhile to pay close attention to your particular state’s Medicaid changes, as Medicaid will certainly not be one-size-fits-all. Fortunately, DECO has developed an ebook guide to state-by-state Medicaid regulations to help healthcare organizations stay informed.
How DECO Can Help
At DECO Recovery Management, we make a priority of knowing the latest about insurance and eligibility so the healthcare organizations we help can work effectively and be reimbursed for their services. Healthcare regulations change all the time, but we can help you understand and work through them. Contact us today!
