From Crisis to Normalcy for Medicaid

The critical role of the Digital Workforce in the PHE Unwinding

In response to the COVID-19 pandemic, the federal government declared a Public Health Emergency (PHE) in 2020, which is expected to end in 2023 (currently on May 11). During the pandemic, states had to maintain Medicaid for all enrolled citizens, regardless of their change in status. They now have one year to return to normal eligibility operations, and must re-certify every enrollee. This represents the most substantial transition event in healthcare since the Affordable Care Act. The unwinding process for the Public Health Emergency is a complex and challenging task that involves reinstating regular eligibility and enrollment operations for Medicaid after the PHE has ended. This means that State Medicaid overseers will need to re-evaluate eligibility for nearly all enrollees in these programs.

To ensure that only eligible individuals receive Medicaid coverage, the task at hand is enormous, and it requires significant effort and coordination among various agencies and stakeholders. States have to review millions of cases, send notices, process changes and terminate coverage for those who are no longer eligible. Therefore, it is crucial that States plan and prepare adequately to manage the process effectively and minimize any potential disruptions to Medicaid beneficiaries.

Robotic Process Automation (RPA) can assist with the PHE unwinding for Medicaid by automating repetitive and time-consuming tasks involved in the process. RPA is a software technology that can simulate human actions, such as mouse clicks, keyboard inputs and data entry to perform tasks automatically. Here are some ways RPA can help with the PHE unwinding:

• Eligibility determination: RPA can review Medicaid enrollees' data and cross-check it with various databases to determine eligibility. It can also perform income verification, asset assessment, and other checks to ensure that individuals qualify for Medicaid coverage.

• Notices and communications: RPA can generate and send notices and other communications to Medicaid enrollees regarding eligibility changes, renewal deadlines, and other important information such as ineligibility. It can also handle incoming inquiries and respond to them automatically.

• Data entry and processing: RPA can automate data entry and processing tasks involved in updating Medicaid enrollee information, such as changes in income, household size, and other factors that affect eligibility. Document Understanding allows bots to “read” information and process handwriting and check-boxes to reduce the burden on the manual staff. This can help reduce errors and ensure that information is updated promptly.

• Reporting and analytics: RPA can generate reports and analytics to provide insights into the PHE unwinding process, such as the number of enrollees who lost coverage, reasons for eligibility denials, and other metrics that can help improve the process. State and Federal Compliance reporting can also be considered.

In addition, Konica Minolta can also help with the PHE unwinding through Business Process Outsourcing (BPO). With BPO, Konica Minolta can receive the anticipated in-pouring of mail, cleanse the incoming data, and deliver the high-quality information back to your operations. This service can increase your processing speed, and help you cleanse and maintain your Medicaid rolls as part of the PHE unwinding. Together, RPA and BPO can help streamline the PHE unwinding process for Medicaid by reducing manual efforts, increasing accuracy, and improving efficiency. It can also help free up resources and staff time to focus on more complex tasks and provide better support to Medicaid enrollees and handle the overwhelming influx of volume that is anticipated.

We recognize that the PHE unwinding process for Medicaid may significantly increase the amount of work for your staff, but with the right solutions and processes in place these solutions can help you in so many ways. RPA and BPO can help to alleviate the burden on your staff, plus automate repetitive and time-consuming tasks. These solutions can help you manage the process more effectively, ensure that only eligible individuals receive Medicaid coverage, provide better support to Medicaid beneficiaries, and so much more! Learn more about Konica Minolta’s RPA offering.