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COMMENTARY | States that take the time to strategically adjust their staffing, processes and technology could ultimately speed up the Medicaid redetermination process.
Sometimes, you have to slow down to speed up.
The Theory of Constraints suggests that organizations are only as fast as their slowest resource, and any constraint in the process manifests as a bottleneck. For state Medicaid agencies navigating a years-long backlog of eligibility redeterminations, slowing down to identify and remove choke points may be the key to successfully ensuring millions of Americans don’t lose their health insurance coverage.
States are taking widely divergent paths for eligibility redetermination. Some are already speeding through the process, resulting in millions being disenrolled. Others are choosing to manage the massive redetermination workload by pausing or slowing down the process to help mitigate the impact of lost coverage. Just months after redeterminations began, it’s apparent that Medicaid agencies need a multi-dimensional approach—encompassing people, processes and technology—before the current window closes and millions are shut out from coverage.
With redeterminations, agencies are facing an unprecedented workload with finite human resources. Renewals can only be processed as fast as the team of eligibility workers can determine whether an applicant qualifies—making workers the constrained resource.
A Medicaid application or renewal is supposed to be processed within 45 days. Typically though, that 45 days—the maximum time—becomes the normalized target turnaround time. Unsurprisingly, no one is happy with that timetable, but now, with the end of the pandemic-era Medicaid continuous enrollment provision and the millions of additional redeterminations that must be processed, a 45-day turnaround will seem like a dream.
So how can agencies free the constrained resource?
Imagine a four-lane highway that gets congested during rush hour. Now picture one lane shut down for road maintenance. Traffic backs up because there were already too many cars traveling on the road, and now there’s one less lane.
There are several ways to reduce road congestion. Adding a lane could provide long-term improvements, but at a significant cost. Creating a detour could divert traffic, but at least keep vehicles moving. Each has its drawbacks, but the ultimate goal of reducing traffic on the highway is achieved.
The same concepts can be applied to the workload an eligibility worker faces each day. Agencies can add “lanes”—although that means adding staff, which can get costly and time-intensive. Agencies can also create a detour, routing customers to places such as a website, call center or mobile app.
Another option is finding ways to reduce the demand on the system and provide the same outcome without the existing processes, products and resources.
The ex-parte Medicaid renewal process is a prime example. It cross checks electronic data from reliable sources to verify applicants’ eligibility. Those that the process deems eligible are not required to complete a renewal form or submit new documentation. If the automated process cannot verify eligibility, enrollees are sent a renewal form. This method of redetermination significantly reduces the administrative burden, and it lowers the risk of human error.
If done correctly, ex-parte redeterminations take much-needed work off the backs of eligibility verification staff. The result is both efficient data matching and better utilization by the state.
Through Oct. 2, 2023, ex-parte renewal rates nationwide were running at 55%. But 17 of the reporting states were doing less than 50% percent of their renewals electronically, with some as low as 2%.
Leveraging existing technology can help quickly identify individuals who are no longer eligible for coverage, immediately reducing the workload. Additionally, implementing technology solutions that increase accurate ex-parte rates can eliminate the need for workers to touch each redetermination case individually.
If ever there were a time for Medicaid agencies to deploy an all-of-the-above approach, this is it. By adopting a multi-dimensional approach encompassing people, processes, and technology, agencies can effectively address the current challenges and those that lie ahead. Slowing down and taking the time to implement strategic solutions could ultimately speed up and improve the redetermination process, ensuring that coverage is delivered to those who need it most—and reducing the unnecessary negative impacts of preventable coverage losses.
Blake Shaw is president of the Change & Innovation Agency (C!A®), a firm dedicated to increasing government's capacity to do more good. In early 2000 Blake served in the Missouri Governor’s office, where he oversaw the improvement efforts for Social Services, Mental Health and Senior Services.