How Monitoring for Life Changes Can Help Government Agencies Deliver Benefits More Effectively

March 10, 2023

Equifax announced the launch of Instant Client Insights (ICI) Case Monitor™ to help government social services agencies make more effective and efficient benefit decisions in support of the individuals they serve, while reducing the impact unreported beneficiary life changes can have. 

The 13th annual State Healthcare IT Connect Summit converged in Baltimore, bringing together public and private sector thought leaders from across the nation to discuss the challenges and opportunities facing healthcare agencies, with a special focus on the unwinding of the COVID-19 Public Health Emergency (PHE). In a session titled, “Monitoring for Life Changes to Reduce Churn and Promote Continuity of Care,” Juan Cole, Vice President of Strategy and Solutions Consulting at Equifax Government Services, presented alongside representatives from the Missouri Department of Social Services and the Change & Innovation Agency (C!A) on the topic of monitoring useful data sets to help reduce churn and promote continuity of coverage. The following is a summary of some of the questions covered in the session. 

Although the COVID-19 PHE has been extended through May 11, 2023, Congress has terminated the Medicaid continuous enrollment provision, effective March 31, 2023. Why is this so important? 

Juan Cole (JC): Since the onset of the pandemic, the continuous coverage provision has required states to maintain Medicaid coverage for most enrollees and has essentially barred any coverage terminations. On April 1, 2023, states will resume reviewing all Medicaid enrollees’ eligibility—a process often called “unwinding”— which will result in the end of benefit coverage for those found to be ineligible. 

Recent estimates suggest that as many as 18 million people could lose Medicaid coverage as a result of the unwinding process, so trying to maintain coverage for eligible beneficiaries is critical. State Medicaid agencies now have an even greater incentive to ensure recipients’ contact and other information is up-to-date in order to ensure appropriate continuation or termination of benefits.

Having current address information is required to communicate with beneficiaries, but could you expand on the impact this has on improved service delivery?

JC: Checking for updated addresses prior to renewal can help prevent benefit churn caused by lack of response when applicants no longer live at the address on file. “Churn,” in this context, means beneficiaries becoming ineligible and falling off rolls, only to re-apply within a given period of time. Other reasons for churn include month-to-month or seasonal variation in pay or hours worked, or criminal justice facilities not notifying Medicaid of changes in incarceration status in a timely manner. Preventing churn not only keeps eligible beneficiaries on Medicaid and maintains their continuity of care, but also saves states the administrative burden and cost of unnecessarily re-adjudicating that beneficiary. 

What does it mean for a social service agency to monitor for life changes?

JC: In the context of Medicaid benefits, it involves regularly checking for beneficiary life changes to help ensure that benefits reach the intended recipients as effectively and efficiently as possible.  

Our new Instant Client Insights Case Monitor™ solution supports initial determinations and redeterminations by monitoring for changes related to income or employment, address, phone number, and death status, and by returning incarceration status tip-and-lead data. ICI Case Monitor compares the data provided to agencies by the beneficiary in their application or recertification materials to relevant data sources based on program policy, looking for any life change indicators as defined by the agency. The solution provides alerts to the agency when such a change is flagged against a specific, current list of beneficiaries and pre-defined criteria based on policy requirements. 

This takes the burden off of beneficiaries to remember what is reportable by automating the notification process with current data returned instantly. Equifax’s ability to deliver current data based on customer rules can help ensure that the individual or family is receiving right-sized benefits and the state is cost-effectively administering its programs. In addition to Medicaid, ICI Case Monitor can also support agencies providing benefits under programs such as the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) and more.

How can state agencies implement a case monitoring program successfully?

JC: The best practices we’ve seen involve taking a phased approach. The first step is adopting a proactive strategy to reduce churn while using applicable data sets for eligibility determinations with predefined criteria. Next, from a technology perspective, the keys to successful implementation revolve around using current data, returned instantly, through enhanced automation and integrated systems. 

Adopting an automated solution that leverages instant data-driven insights and is integrated with an agency’s existing system can help minimize the time caseworkers spend reviewing materials, conducting follow-up investigations, and confirming both initial and renewal beneficiary eligibility. 

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