Hawaii Med-QUEST on upcoming eligibility redetermination: “It’s our kuleana”

With the federal public health emergency (PHE) declaration and subsequent Medicaid disenrollment freeze set to end as soon as mid-January 2022, Med-QUEST is working to ensure the one in three Hawaii residents it serves will receive continuous health coverage. 

 

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Med-QUEST enrollments have increased 32% over the pandemic, bringing total enrollment to about 450,000 members. According to Deputy Director Meredith Nichols, the rise in enrollment is directly tied to the state’s economy. 

“We have a tourist-based economy. With our closure and keeping our population safe, there were a lot of people who were first out of jobs and then lost their employer-covered health insurance. So this dramatic [unemployment] spike led to an upward increase in enrollments that has continued. We haven’t seen a downturn yet in the overall enrollment numbers.”

Beneficiaries under Medicaid are currently protected from being disenrolled due to the Families First Coronavirus Response Act, which lasts through the PHE. Conditions that may lead to ineligibility for Medicaid include turning 65 and needing to transfer to Medicare, pregnant people reaching the end of the postpartum coverage period, and changes in circumstances, such as increased income.

The Centers for Medicare and Medicaid Services (CMS) have released guidance for states as they begin the redetermination process, but have not announced exactly when the PHE will end. The most recent PHE renewal will expire on Jan. 16, 2022.

State Medicaid agencies will receive a 60-day notice prior to the end of the PHE declaration. After that, according to Nichols, they will have 12 months to complete the redetermination process. Of the 430,000 beneficiaries currently on Medicaid, Nichols estimated about 20%-30% will need to have their eligibility reassessed. 

A key part of the Med-QUEST redetermination process, according to Nichols, will be ensuring that member transitions are as seamless as possible. 

“We’re coming out of a pandemic. People’s lives have been changed. People have been through trauma and stress. The last thing we’re interested in doing is adding to anybody’s stress. Our goal is to really dig into how to maintain people’s enrollment if they’re eligible in the least stressful way to the member. We’re really putting in a lot of effort to make sure that our efforts are not disruptive to the people we’re here to serve. 

Yes, we have to make sure that folks continue to be eligible to keep them on, but we want to be thoughtful and planful about how we go about that work. We are taking five layers of effort before you terminate anyone’s case.”

This includes making calls to the member and checking in with their health plan to ensure they are still eligible, and developing a transition plan if they are not. Two of Med-QUEST’s contracted health plans — HMSA and Kaiser Permanente —  also have marketplace coverage, and may work to transfer their patients from Medicaid coverage to marketplace coverage, so members do not have to switch plans entirely. 

Med-QUEST also has its health care outreach branch, which focuses on meeting the coverage needs of underserved communities, such as those who are incarcerated. 

Members who are no longer Medicaid-eligible will also be automatically transferred to the federal insurance marketplace. Open enrollment for the federal marketplace for plan year 2022 kicked off Nov. 1, and will continue until Jan. 15, 2022, the day before the PHE declaration expires. Participants who sign up by Dec. 15, 2021 will have coverage take effect on Jan. 1, 2022. 

Nichols said the agency’s ability to pivot during the pandemic, as well as keeping a community-based mindset, could ensure a successful redetermination period.

“It’s Aloha. Our base approach is founded in Aloha for the people we serve, and a genuine caring for the wellbeing of the people we serve. While we’re not blind to tracking numbers, or budgets, or policy or regulations, undergirding for all of that is always this approach of, ‘We are here to serve our people.’ For us, it’s our kuleana, it’s our responsibility. To provide that service in a way that supports people not just with the actual service, but somehow, in whatever [way] we can that conveys our Aloha for the people.”