It’s a new year filled with new updates to state Medicaid programs. It is the single largest source of healthcare coverage in the U.S. and ever-evolving on both the federal and state level, with Medicaid policy, process and technology modifications.
As a revenue cycle industry leader in Medicaid eligibility services, Parallon continues to research the details, push for change and act as advocates on behalf of the patients and healthcare organizations we serve.
With working knowledge at more than 200 hospitals across 39 states, we are committed to collaborating with government agencies to navigate obstacles and research policy updates in the legislative landscape that will impact patients’ ability to alleviate financial burden and receive coverage.
Here are Medicaid updates to watch in Q1:
Changes in state policy
There is controversy over technicalities for what Florida’s department of Medicaid deems the patient to be effective. They are currently utilizing the date an application was reviewed by a Medicaid employee. We are requesting that the state modifies the policy to reflect the date that a patient’s application was submitted. The largest impact to the policy is patients who visit the hospital when the end of the month falls on a weekend or holiday. The state is engaged, analyzing our request and working internally to see what can be done.
Processing Changes and Medicaid Expansion
Effective January 1, 2020, the Kansas Department of Health and Environment (KDHE) transitioned all aged blind and disabled applications to a dedicated KDHE worker instead of previously being processed by Maximus.
Kansas’ Governor, Laura Kelly (D), and the Republican Senate leader publicly announced a deal to expand Medicaid. The final approval must come through the state legislature, but at this time, approval appears likely. This will make Kansas the 37th state to expand their Medicaid program to allow childless adults to obtain coverage up to 138% Federal Poverty Line (FPL).
South Carolina Healthy Connections Medicaid
New Section 1115 Waiver
In December 2019, the Centers for Medicare and Medicaid Services (CMS) approved South Carolina’s Section 1115 Waiver requesting Medicaid recipients to work before obtaining benefits. The approval increases the FPL for the parent caretaker populations from 67% up to 100% but requires proof of community engagement to the population.
The waiver also provides more resources for patients with Substance Use Disorder and the chronically homeless population. An implementation date has not been published yet.
In December 2019, the Centers for Medicare and Medicaid Services (CMS) approved full Medicaid expansion for Utah, allowing childless adults up to 138% of the FPL to obtain Medicaid. The approval includes work requirements and requirements for adults to enroll in an employer-sponsored plan if applicable.
In December 2019, the ARTS 1115 Waiver was approved but includes significant changes from its original submission. The approval includes funding for the Addiction and Recovery Treatment Services Delivery System Transformation (ARTS) program. The ARTS program provides access to substance abuse disorder benefits and treatment services.
The waiver will not include participation in community engagement activities, premium requirements/associated consequences for non-payment of premiums, healthy behavior incentives and employment and housing support services for Medicaid beneficiaries with high needs.