Multiple states have been working toward a transition to managed Medicaid from the traditional state-run program, but there have been concerns about reimbursement timing and insufficient payment amounts due to the change. And that’s just the first layer of challenges.
Payment portals unique to each managed Medicaid contractor is another hurdle to overcome, in addition to the Medicaid revalidation process currently underway. But, nursing home operators are striving to get a bigger seat at the table from the very beginning, with a strong advocacy force behind them.
Operators can’t help but think of how Medicare Advantage has evolved since its inception when considering how managed Medicaid will grow in the future.
The payment gap between Medicare Advantage and traditional Medicare has widened over the years, with administrative burdens as well as denials of care complicating the matter. More advocacy and a bigger presence at the start of managed Medicaid will hopefully give operators more favorable contracts in the long run.
Going from one Medicaid payer to three
Some states have larger Medicaid populations, and the transition to managed Medicaid will come with added wrinkles.
Indiana, for one, has a high Medicaid population. About 80% of nursing home residents in the state are Medicaid beneficiaries, according to Wesley Rogers, CEO for Indiana-based Brickyard Healthcare.
Indiana recently decided to join the ranks of Illinois, Iowa, Ohio and Arizona, in outsourcing Medicaid plans to three different managed Medicaid providers – Anthem, United Healthcare and Humana.
“We’ve been able to work with the providers that have been selected to get contracts in place that have been favorable, because we’ve got a strong coalition of providers that are active and an advocate for what our needs are and what our expectations are,” said Rogers.
Still, the payment cycle has been affected, said Steve Van Camp, CEO for fellow Indiana-based American Senior Communities. And that just touches the surface of the challenges, he said.
Indiana was already planning on moving from a cost-based system to price-based system, according to Van Camp. Operators in the state weren’t only living through Covid-19 but also transitioning from FSSA administering Medicaid to having the three managed care entities administering the program.
“We went from one portal to three portals, and they’re all unique,” Van Camp said of the managed care providers. “It’s been a little rough for the first 60 days.”
On top of that, providers are seeing the reimbursement cycle go from 28 days to about 50 days – and that’s once the process normalizes a bit, he said. It’s been taking even longer than that as the state transitions from one payer to three as part of the managed Medicaid program.
Revalidation and managed Medicaid transition
The managed Medicaid contractors will be validating residents, ensuring they qualify for Medicaid as well, said Van Camp. Redetermination for eligibility stems from the moratorium placed on redeterminations during the pandemic, and redetermination time frames vary by state.
It’s an issue Skilled Nursing News reported on in February, with the redetermination process causing serious cash flow problems and anxiety for residents. Montana’s Medicaid redetermination documents have been sent to incorrect addresses, or family members.
Recipients don’t understand the significance of the paperwork, Montana Health Care Association Executive Director Rose Hughes said at the time. If the redetermination process is already causing confusion among residents and family members, the shift to managed Medicaid will only make the situation more confusing, operators said.
And, both issues happening at the same time means a longer wait for reimbursement.
If an Indiana operator was already having issues with Medicaid reimbursement due to the redetermination process, the additional month’s wait tied to the managed Medicaid transition means an even longer wait while operating on razor-thin margins.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) more recently mandated an off-cycle revalidation process for Medicare as well. Operators risk losing billing privileges if they are unable to comply within a 90-day window. The revalidation notices will be dispatched by Medicare Administrative Contractors (MACs), with one-third of SNFs expected to receive them in October and the remainder in November or December, according to Clifton Larsen Allen (CLA) analysts.
Companies featured in this article:
American Senior Communities, Brickyard Healthcare, Centers for Medicare & Medicaid Services