Improving Medicaid Efficiency

In Alabama, Medicaid reform legislation to ultimately restructure the state’s healthcare delivery system for low-income citizens was approved in the Alabama Senate and delivered to the Governor for his signature. The legislation is based largely on the earlier recommendations of the Alabama Medicaid Advisory Commission’s recommendations that Alabama be divided into regions with a community-led network established to coordinate the healthcare of Medicaid patients in each region.

Care coordination for patients with high cost chronic health conditions has been the foundation for the early success of Alabama Medicaid’s four pilot Patient Care Networks. It is thought that with federal approval of a new health home program with extra funding and support, patients’ use of health homes will improve health outcomes while reducing overall expenditures to the state.

Qualifying Medicaid participants must have two chronic health conditions or one chronic health condition and be at risk of developing another condition. Approved conditions include asthma, diabetes, heart disease, cardiovascular disease, chronic obstructive pulmonary disease, cancer, HIV, mental health conditions, substance abuse disorders, sickle cell anemia, and transplant patients.

It turns out that the Alabama Medicaid Agency and the Alabama Department of Human Resources (DHR) share many of the same clients, so the two agencies joined forces to find ways to save money and remove barriers to care by streamlining and simplifying Medicaid enrollment and renewals.

The resulting effort between the two state agencies now makes it possible for Medicaid to determine eligibility by using verified data supplied by DHR. Referred to as the “Express Lane Eligibility” or (ELE), the process has determined eligibility for more than 350,000 residents in the state while maximizing the skills and time of eligibility workers. Today, 44 percent of cases are automatically renewed through ELE each month.

In February 2013, Medicaid implemented an automated renewal match with DHR. Now, instead of getting a packet of information that has to be mailed back, each family receives a letter explaining that their case has been renewed using information from DHR or Medicaid records and that no further action in necessary.

Share Button