For providers in many states, Medicaid eligibility can feel like a moving target. Not only are states—both lawmakers and voters—endlessly pondering the possibility of expanding and contracting Medicaid, policy at the federal level has ushered in a wave of 1115 waivers, which allows for changes to state-specific Medicaid programs. To date, 47 such waivers in 38 states have been approved, and another 21 are pending across 20 states, according to the Kaiser Family Foundation’s Medicaid Waiver Tracker. The first set of waivers are set to expire in 2019, paving the way for more changes as states decide whether to apply for extensions or change the waivers altogether.
Since Medicaid coverage is directly tied to a hospital’s bottom line, staying on top of this dizzying array of state-specific rules and regulations demands focused attention.
“States are starting to do their own processes related to Medicaid, and understandably hospitals are having a hard time keeping up with all of it and trying to predict what will happen,” says Marie Hinds, who became Parallon’s first director of government relations for Medicaid eligibility two years ago. “My role exists so that we can help our clients be proactive, as opposed to reactive, when changes do happen.”
When Hinds started, she identified a contact in each state and scheduled an in-person meeting with them. “That way, when changes happen, I’ve already established that relationship,” she says.
Hinds lives and breathes Medicaid eligibility. In addition to forming and maintaining one-to-one relationships with state officials, Medicaid offices and state hospital associations, she also pores over 1115 waivers, reading them line for line for important pieces that impact Medicaid eligibility. As questions arise, she can rely on those relationships with state officials.
For example, in New Hampshire, a new 1115 waiver did not include self-employment as a community engagement requirement, a fact that stood out to Hinds.
“We’re finding that each state writes their waivers a little differently,” she explains. “Kentucky, for instance, includes self-employment as a means to prove that you’re working. For whatever reason, New Hampshire didn’t have that.”
She reached out to the state, which informed her it was a political decision. Self-employment was also missing from the initial draft of Virginia’s waiver, Hinds noticed, but it eventually showed up in the final version.
These nuances may seem small, but Hinds knows they can make all the difference for Medicaid eligibility.
After reading through the dense waivers, she then distills all of that complex language into an easy-to-digest executive summary to share with colleagues and clients. She also helps develop financial reports that outline expected financial impacts and is involved in developing and helping implement remediation plans. “Based on the 1115 waiver, we’ll put a plan in place to minimize the risk,” she says.
Hinds is quick to point out that her government relations role isn’t that of a lobbyist—she’s not trying to convince the states to change anything about their Medicaid laws.
Parallon’s goal is for our clients to have an accurate understanding of changes on the horizon to provide them with the flexibility they need to adapt to these changes as seamlessly as possible.