Effective Data Sharing is Key to Unwinding Emergency COVID Benefits


The COVID-19 public health emergency has been extended through mid-July, and states will depend on their technology to ensure that those covered by the Medicaid and Children’s Health Insurance Program exemption (CHIP) from PHE can still get the benefits they need, says expert.

The PHE came into effect on January 31, 2020 and has since been renewed nine times in response to the lingering pandemic. Its expiration means states must re-determine whether the record of more than 80 million beneficiaries is still eligible for Medicaid and CHIP — a task that will be daunting without systems capable of sharing data, said Heather Korbulic, senior policy officer. and strategy at GetInsured and former executive. director of the Silver State Health Insurance Exchange of Nevada.

“The public health emergency has taught us how siloed our systems are,” Korbulic said. There is an opportunity for states “to find synchronicity and find common areas of data and to pool and connect each other’s systems,” she said. “In an ideal world, a Medicaid agency could [use application programming interfaces to connect] to an unemployment system and automatically compare contact data.

Some states will be in better shape than others due to their technology, she added, but all should ensure recipients’ most up-to-date contact details are recorded, whether by comparing data across multiple systems. or through awareness raising.

This administrative work now will pay off later in reducing turnover, Korbulic said, adding that 80% of people who lose benefits will do so because they did not participate in administrative processes, while 20% will lose them because they are no longer eligible for Medicaid or CHIP. In the latter cases, states should have a way to automatically direct them to a state-based health insurance exchange or to HealthCare.gov, the federal health insurance exchange website.

For example, when the Nevada Medicaid agency sends an account transfer for someone who is no longer eligible due to their assets, their information is automatically populated into a health exchange application and they are notified of their new options.

“Not only do we actually have connection systems, but we also have better partnerships in the state than we’ve ever had before. We are able to divide and conquer and solve problems holistically rather than trying to do it with HealthCare.gov, which was rigid in a way that would not allow state flexibility,” said Korbulic about his work with the state exchange.

Last month, the Centers for Medicare and Medicaid (CMS) released guidance to help states “develop a comprehensive ‘operational rollout plan’ to restore routine operations of their Medicaid, CHIP and [Basic Health Program] programs” within 12 months. CMS requires states to transfer to a state- or federal-based health insurance marketplace the electronic accounts of beneficiaries that the state assesses as potentially eligible for coverage. “This transfer must include all eligibility information available to the state,” according to the guidelines.

This means that “states must commit now to efforts to update their roles, data, and contact fields because everyone recognizes that when someone is not participating in the administrative part of Medicaid. .. that means they have to go back”. said Korbulic. It’s more work “not to retain someone who is eligible than to retain them, so the goal right now is to update that contact information.”

While it’s too late to remove and replace eligibility systems, she added, there are opportunities for integration that would allow for greater automation. In addition, funding exists to help States in their future technological modernization efforts. For example, CMS will cover up to 90% of the costs of Medicaid eligibility systems, and states can use American Rescue Plan Act funding for Medicaid information technology. Virginia and Washington, DC have formulated plans to use ARPA funding for computing.

Additionally, last June, CMS announced $20 million in ARPA funding to support state-based markets.

“I’m cautiously optimistic” about PHE’s transition, Korbulic said. “There is a spectrum of who will perform best and who is likely to do worse. It has a lot to do with the technology involved.

Stephanie Kanowitz is a freelance writer based in Northern Virginia.


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