The coronavirus pandemic has impacted nearly all areas of our lives. This is especially the case with the insurance industry. One especially relevant outcome is the uptick in Medicaid and Children’s Health Insurance Program (CHIP) members that poses new concerns for insurance providers who may be struggling to keep up. Total enrollment between February 2020 and July 2020 increased by 6.1%, or 4.3 million members.
This large-scale change has also been seen on the local level, as almost every state has recorded an increase in new Medicaid and CHIP members since February 2020. This makes for a total of 75.5 million Medicaid and CHIP members who need local health care from primary providers, specialists, federally qualified health centers (FQHCs), and emergency care professionals.
Such increases are in stark contrast with trends over the past few years. While there was a boost in enrollment immediately following the implementation of the 2014 Affordable Care Act (ACA), Medicaid and CHIP enrollment declined between 2017 and 2019. In order to keep up with recent demand, insurance companies must work diligently to avoid network inadequacy concerns. Network inadequacy results when insurance companies do not have sufficient numbers of in-network providers in geographic areas that are accessible to their members. This forces members to seek care from professionals who are out-of-network, meaning contracts for these services may be negotiated at different, lower rates.
At least until the end of the pandemic, this surge in new members is predicted to continue. The ongoing need for state-funded services is due in part to the job market and the amount of individuals who have experienced unemployment and decreased wages from a loss of work. This change in financial status means that more individuals and their families are becoming eligible for Medicaid and CHIP. The Families First Coronavirus Response Act (FFCRA) further contributed to the rise in enrollment numbers by guaranteeing continuous coverage for those enrolled as of March 2020.
While there is a direct relationship between the COVID-affected job market and Medicaid/CHIP enrollment, the correlation related to each individual typically presents itself several months later. This means that an individual who loses their job in September 2020, for example, may not become eligible for and enroll in a Medicaid plan until November or December 2020. This gap between loss of wages and beginning a new government-funded health plan also has an impact on the state budget, meaning lawmakers have minimal time to approve and provide funding for the rapidly-increasing enrollment numbers. The lag also means it is too early to make quantitative or qualitative observations on how each state and the nation as a whole is responding to this increase in enrollment.
Regardless, planning plays a large role in avoiding fines and other issues associated with network inadequacy. Planning and the use of resources such as telemedicine help insurance companies track trends and prevent issues like network inadequacy before they occur. TOG Network Solutions provides cost-effective resources to help you manage the rising number of Medicaid members. As an industry leader in network relations, TOG Network Solutions offers contracting services, negotiation, and provider network analysis along with a Provider Data Management platform to meet your individual needs. Work with TOG Network Solutions to keep your provider network strong and withstand any industry changes that may impact your company’s compliance.