With the financial upheaval and unemployment introduced by the coronavirus illness 2019 (COVID-19) pandemic, observers anticipate a big inflow of recent members into Medicaid applications. We spoke with Russ Fendley, former Medicaid commissioner for Kentucky, and Patrick Sturdivant, president of the Amerigroup Texas Medicaid plan, to learn how states and plans are getting ready for this problem and its lasting results.
At this time on MJH Life Sciences™ Information Community, The American Journal of Managed Care® (AJMC®) is diving into the function of Medicaid, the insurance coverage program for low-income people, within the coronavirus illness 2019 (COVID-19) disaster. With unprecedented numbers of individuals shedding their jobs and healthcare protection, Medicaid plans are getting ready for an enormous inflow of beneficiaries, which would require info know-how (IT) readiness, social service coordination, and naturally monetary sources.
We spoke with Russ Fendley, former Medicaid commissioner for Kentucky, concerning the monetary and know-how pressure of COVID-19 on state Medicaid applications. He mentions the significance of communication to maintain new enrollees knowledgeable about their advantages and the sources accessible to them. He cautions that the still-unknown aftereffects of the virus will result in further demand for companies that can stay even after new infections stage off.
We additionally spoke with Patrick Sturdivant, president of the Amerigroup Texas Medicaid plan, concerning the options, each new initiatives and ones which are already in place, to welcome new members into Medicaid and assist them navigate the healthcare system. Key efforts embrace telehealth platforms, on-line portals, and member service coordinators who stand prepared to assist with healthcare wants and social determinants of well being.
Keep tuned for our full conversations with Russ and Patrick.
AJMC®: Welcome to the MJH Life Sciences™ Information Community. Are you able to introduce your self and inform us a bit about your work?
Russ Fendley: Certain. My title is Russ Fendley, I’ve been within the healthcare area for 30 plus years working MCOs [managed care organizations], working hospitals for HCA; I used to be Medicaid Commissioner for the Commonwealth of Kentucky and served as a fellow with the Nationwide Governors Affiliation and the Middle for Well being Transformation on public well being coverage and Medicaid.
AJMC®: Nice. In order we’re seeing these huge job losses from COVID-19, what would be the monetary pressure on state Medicaid applications?
Fendley: Actually, you’ll be able to’t calculate it but. It’s going to be vital. The closest factor I can come to as an analogy was, I reside in Kentucky, and our expertise right here was after we did the Medicaid growth, that added about 425,000 lives at about $2 billion a yr in complete value. Don’t have any concept although, with this new inhabitants, we don’t know what preexisting medical situations they’ve. We don’t know, in the event that they’re becoming a member of right into a managed care program, which eligibility classification they’d be in, so there could be totally different premiums related to that. And we don’t know what prices could be from any COVID-19 associated. So it’s arduous to calculate that proper now. We’re estimating, I’ve seen a number of estimates, about wherever from 10 to 20 million individuals nationally, tough estimate, will be part of Medicaid. Clearly, that varies from state to state primarily based on their employment numbers. Right here in Kentucky, I can let you know we’re taking a look at about 300,000, 350,000 individuals, so it’s gonna have a big affect.
The larger affect although, Christina, isn’t just on Medicaid, it’s going to be downstream. Because the state tries to stability the price range, which is a requirement, and despite the fact that the federal authorities’s rising the match by 6.25%, the FMAP [Federal Medical Assistance Percentage], you’re nonetheless gonna have that hole within the present budgets, and even subsequent yr’s price range, from this medical expenditure. And so they’re going to must take from different applications to fill that hole or enhance taxes, which you actually can’t do when there’s extreme unemployment. So you’d count on there to be impacts on transportation, hopefully not however probably training, parks, pensions. Exhausting to say.
AJMC®: Proper. We’ve lately realized that HHS will probably be reimbursing hospitals for the care of uninsured sufferers with COVID-19. How do you suppose this may have an effect on Medicaid signups?
Fendley: I don’t suppose it can. If it does, at the very least not considerably. Most people who’re going to have or have COVID, or have turn out to be Medicaid eligible, they could produce other healthcare situations that require house well being, medical doctor companies, so despite the fact that it’s good that they’re gonna pay the hospital portion of this, which is able to alleviate a giant a part of the burden, you’re nonetheless going to must, the individuals are nonetheless going to wish that medical protection for different companies, pharmaceutical companies, these sorts of issues. I don’t suppose it’s going to affect it.
AJMC®: Okay. What variations do you count on to see in states that expanded Medicaid in contrast with states that didn’t?
Fendley: What’s actually going to be attention-grabbing is people who didn’t have it. There’s been such a contraction within the corporations which are promoting by the change, I don’t know what’s accessible. I haven’t stored up with what’s accessible within the exchanges now or what the fee could be. It is determined by who’s going to be eligible for the revenue help by the change. So for these states which have expanded their Medicaid, a giant chunk of these individuals are going to fall inside that 138% of federal poverty stage, it’s not going to be all people, so that you’re nonetheless going to have some that don’t meet that revenue standards as a result of your unemployment insurance coverage counts in the direction of your revenue. So we don’t know but, however I believe it’s gonna be far simpler for these states that expanded Medicaid than people who didn’t.
AJMC®: How will an inflow into Medicaid affect the applications’ IT methods and workflow?
Fendley: Approach again once I was Medicaid commissioner, all the pieces was primarily based on these outdated COBOL hardwired methods. I shudder to suppose what it might have been prefer to make the modifications which are being made proper now to accommodate this new disaster in that outdated system. A lot of the new methods which are which are on the market now, you understand, are all SAS and modular they usually’re simply configuration; there’s not a number of coding that must be achieved. However there’s nonetheless going to be a big quantity of change that must be made. You may’t simply implement the change, you’ve obtained to implement it after which take a look at it and ensure it really works proper. So I do know the eligibility methods are going by a serious reconfiguration change for the eligibility guidelines which are being loosened. You realize, claims fee methods are being modified. And so there’s a heavy elevate there for the IT division, nevertheless it’s a a lot simpler—and that is simple for me to say as a result of I’m not an IT particular person—nevertheless it’s a a lot simpler elevate now than it might have been 15 years in the past.
AJMC®: What do states must do to guarantee that they will accommodate all the brand new Medicaid beneficiaries?
Fendley: Yeah, there’s numerous issues, and many of the states I’ve talked to up to now, they’ve all obtained entry factors up for his or her potential new enrollees, numbers to name, nevertheless it’s going to be a matter of, you’re going to must have nearly a continuing line of communication along with your MCOs. The suppliers are going to be an enormous key, as a result of a number of eligibility comes from the hospital admission course of. That’s the place a number of Medicaid enrollees wind up within the system. After which some communication forwards and backwards, otherwise you’ve obtained to have a number of exterior distributors who’re positioned right here, individuals who provide issues to the Medicaid program. You realize, name facilities are going to must be arrange or working and possibly further workers placed on, so there’s going to be a number of a number of factors of contact which are going to must be made with these new enrollees, not solely to establish, allow them to know what their protection is, what their advantages are, who the suppliers are, what the foundations and laws are, what they need to and shouldn’t do with COVID-19—there’s a number of that type of communication. In order that’s going to be the important thing, simply entry. Simply the communication with quite a lot of sources, from the MCOs to the members to the suppliers.
AJMC®: Proper. Effectively, that’s the top of my questions. Was there the rest that you simply wished so as to add concerning the state of affairs?
Fendley: Effectively, you understand, the one of many issues that’s going to be a key going ahead, we’re nearly to a degree within the curve now the place, you understand, identification of recent instances remains to be essential as in case you consider COVID-19 as an accordion. I did a conflict recreation train with the CDC about 15 years in the past on a viral pandemic like this in america, and it’s like an accordion beginning with both coast and dealing inward. So we’re not over by any stretch of the creativeness, however individuals want to understand this doesn’t finish after we see the an infection leveling out, since you’re going to have lots of people with the lingering results of this illness, far past their preliminary illness. In the event that they’re on a ventilator or in critical medical situation, they’re going to have lung injury, probably coronary heart injury, different organ points; they’re going to must be adopted for years. So there’s going to be a number of that, and there’s a lot we do not know concerning the illness but, and what the recurrence fee is and the reinfection fee, these issues we don’t know. So what individuals must know is we’re solely in part 1; part 2 will probably be type of taking a look at the way you deal with the individuals going ahead and in preparation for what we’re being informed would be the subsequent part of the pandemic, which will probably be this fall, if all the pieces’s right within the modeling up to now. So, this isn’t over by any stretch of the creativeness. That is simply, for lack of a greater approach of claiming, that is simply the top of the primary starting, and we’ve obtained an extended strategy to go till we get to the purpose the place there’s a vaccine and different methods to forestall a recurrence.
AJMC®: All proper. Effectively, thanks for taking the time to talk with us.
Fendley: Oh, you’re welcome. Thanks.
AJMC®: Keep wholesome!
Fendley: Alright, thanks!
AJMC®: Are you able to introduce your self and inform us a bit about your work?
Patrick Sturdivant: Certain. I’m Patrick Sturdivant. I’m president and CEO of Amerigroup Texas, one of many many Anthem affiliated well being plans throughout the nation. We have now the privilege to serve greater than 760,000 Texans in our well being plan. We began in 1996, and now we serve 230 of the 254 counties in Texas, which covers 236,000 sq. miles of this stunning state.