Mon, 8 August 22

Medicaid Monday: Managed Care Organizations Partnering with HHSC To Address Eligibility Issues After the Public Health Emergency

By Jessica Lynch

As the end of the COVID-19 Public Health Emergency approaches, the Texas Health and Human Services Commission (HHSC) is actively preparing to complete a large number of eligibility and enrollment actions. Beginning as soon as mid-October, an estimated 3.7 million Texans will need to have their Medicaid eligibility redetermined. For those individuals who found themselves needing Medicaid for the first time during the pandemic, this will be their first experience with the redetermination process. 

The large number of redeterminations needed, coupled with those members new to the process, means millions of Texans might get caught in a bureaucratic backlog that could leave them frustrated and without access to care. Together, HHSC and managed care organizations are proactively working to mitigate these issues.

Texas Medicaid managed care plans and dental contractors are in a unique position to partner with HHSC to communicate with these Texans, conduct outreach and assistance, and ultimately, help Texans maintain health insurance coverage (including facilitating transitions to the Marketplace). As a part of this unprecedented eligibility coordination, HHSC has created a new designation called “Case Assistance Affiliates” so that Texas Medicaid plans can assist HHSC with this massive eligibility redetermination undertaking. 

The new Case Assistance Affiliate program is an enhanced version of the existing Community Partner Program, which provides an opportunity for community-based organizations to receive training and designation as a partner to educate Texans about various programs, including Medicaid and CHIP, and assist them with certain enrollment activities based on the level of their designation. The new Case Assistance Affiliate designation provides managed care plans and dental contractors with additional tools to assist their members navigate renewal challenges including the ability to virtually assist members access the YourTexas Benefits eligibility website, submit online applications and upload required documents, reset passwords, and update contact information.

The Case Assistance Affiliates program provides additional assistance to existing Medicaid members manage their medical, nutritional, and cash assistance benefits outside of HHSC eligibility offices. The program also helps Texans apply for or renew their HHSC Program benefits online. Together with HHSC, Medicaid managed care plans and dental contractors can access reports that enable them to track case assistance services provided, ensuring Texans continue to have access to needed health care benefits. 

If extended beyond the public health emergency, the Case Assistance Affiliates program has the potential to permanently address state workforce challenges, alleviate exceedingly long wait times to reset forgotten passwords that require reset over the phone, and help Texans who lack access to or are unfamiliar with eligibility verification documents. Although the last few years have been unprecedented, the COVID-19 Public Health Emergency highlights the power of the public and private sectors working together to lower costs, improve efficiencies, and provide high-quality health care that Texans deserve.

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