The process of determining Medicaid eligibility is tricky in part because each state’s regulations are different. While the federal government determines much of the standard for regulation of this healthcare service, the individual states have a lot of flexibility in how they implement it. This is why it’s essential for your healthcare organization to be aware of what policies are available, how they are implemented in your state and who is eligible to receive them. Healthcare options that are available in one state won’t necessarily be available in others. The entire process can be complicated and confusing to work through, and this is why we do our best to help healthcare organizations determine their patients’ eligibility for insurance programs. The more you are able to understand and master the eligibility process, the better your revenue cycle management system will be and the better you’ll be compensated for the care you’ve given to your patients.
Different State Guidelines
Medicaid is a voluntary program implemented state-by-state, but all states do participate. However, every state has different needs and ideas about what kind of healthcare support should be offered. Lawmakers appeal to the federal government with changes, waivers and adaptations of Medicaid regulations and must wait for approval.
The current standard of coverage among the states, which has been expanded recently through the Trump administration, is that individuals who make 133 percent of the federal poverty line may qualify for Medicaid. But the kind of coverage they will receive depends on which state they live in. Also dependent on states are eligibility guidelines such as household size, age, work history, marital or caregiver status, and whether or not the individual has a disability. Additionally, this coverage is subject to change depending on which modifications, waivers and requirements are approved or rejected by the federal government.
How Expansion Affects Eligibility
Medicaid expansion is a slow process. While many states have already expanded Medicaid coverage according to the latest regulations from the federal government, some are still waiting on approval for waivers and modifications. Others have not expanded Medicaid and are not likely to at the moment.
DECO can help your healthcare organization with determining Medicaid eligibility for your patients. Eligibility is a confusing topic, but we want to help you understand it better. To that end, we have done extensive research and put together an ebook resource for you to use as an eligibility determination tool. It discusses the Medicaid system, its recent updates, the purpose and function of Medicaid and some of the federal regulations for it. It also provides information on the individual regulations and custom coverage options which each state has so far adopted. As the federal government continues to change the healthcare process and as states respond, this information is subject to change. However, this ebook can be a valuable resource for anyone trying to learn more about the flow of the Medicaid system. Download it today!
As always, if we can help in any other way with your revenue cycle management, eligibility determination and reimbursement process, please contact us!
