With the end of the public health emergency on April 1, states will have 12 months to redetermine enrollee eligibility, a huge task. In Maryland, the state health information exchange is providing data to help Maryland Medicaid and healthcare providers with outreach to members.
CRISP, the state-designated HIE, is expanding its Medicaid Redetermination Notification project to all interested providers and managed care organizations (MCOs). The program aims to rally support for nearly 1.6 million Medicaid members across Maryland who will face redetermination and possible loss of coverage in what will be the single largest health coverage transition since the Affordable Care Act.
In partnership with Maryland Medicaid (MDH), the project provides healthcare delivery organizations with a secure report of all their patients who will face redetermination within the next 90 days. CRISP said the program breaks down data siloes, ensuring healthcare centers have access to timely and accurate patient information, so care teams can perform outreach and navigate patients through the redetermination process. The notification project is currently available to Federally Qualified Healthcare Centers (FQHCs) and will expand to all CRISP-participating organizations by May 2023. CRISP will conduct outreach with more information to all eligible organizations as the project expands.
“Medicaid is a lifeline for 1 in every 5 people and 1 in every 3 children in Maryland,” said Craig Behm, president and CEO of CRISP, in a statement. “It’s imperative that all care team members know when their patients are up for redetermination and who’s at risk of losing coverage. This project streamlines the process and is a safety mechanism for patients who depend on Medicaid.”
Maryland Medicaid will conduct redetermination of members in stages. The project initially launched as a pilot in February 2023 to help FQHCs navigate redetermination for their patients who account for an estimated 10 to 15 percent of Maryland’s Medicaid population.
The PHE has lasted for more than three years, leaving experts concerned about the serious impact the expiration will have on patients, providers and care centers across the state. Many clinics reported not having recent contact information for their patients to conduct outreach. The Medicaid Check-In Campaign, a statewide joint effort by CRISP, MDH, MCOs, Maryland Health Connection (MHC) and the Maryland Department of Human Services (DHS), launmed last to generate awareness of upcoming redeterminations and encourage Medicaid members to update their contact information to avoid disruptions in health insurance coverage.
“I worry about the parents of a child with an asthma exacerbation who may have to make a difficult choice between the best clinical care for their child and avoiding a bill they cannot afford,” said Marc Rabner, M.D., M.P.H., chief medical officer at CRISP in a statement. “Many of my patients and their families have never needed to go through redetermination and are likely unaware they’ll need to. There’s a real chance this could push families deeper into poverty simply because they missed a deadline.”
All states will enter redetermination for 91.3 million people across the country. Behm emphasized the critical role HIEs can provide during redetermination: “By leveraging the infrastructure and technology already in place, HIEs can modernize the process and significantly reduce the burden on providers, clinics and state Medicaid agencies so they can instead focus on supporting patients. The healthcare system as a whole must do everything we can to ensure these patients don’t fall through the cracks," he added.