When people don’t have health insurance, they’re much less likely to seek necessary care. Their health spirals downward, and treatment becomes much more expensive. This much we know.
The Affordable Care Act provided a litany of tools to remedy that problem, but many people are still uninsured. Now, hospitals have another way to help get people enrolled in coverage, particularly Medicaid. It’s called Hospital Presumptive Eligibility.
The Hospital Presumptive Eligibility (HPE) program enables hospital workers to quickly enroll eligible patients in Medicaid so the patients can receive necessary medical services on a timely basis. This program, included as part of the Affordable Care Act, went into effect in Maryland on Oct. 1.
With HPE, trained hospital staffers help enroll an uninsured individual in temporary Medicaid coverage, which is activated within a day or two and lasts for about two months. The staffer also helps fill out an application for permanent Medicaid coverage.
By granting temporary coverage, patients can fill prescriptions, schedule follow-up appointments with primary care physicians or see specialists after being discharged. Without the temporary coverage, patients wouldn’t be able to pay for needed medications or obtain other post-acute care.
By the time the temporary coverage runs out, the state will have had time to process the application for full coverage.
“Up until Oct. 1, we only had the option of going through the old process of getting [permanent] Medicaid coverage for certain patients,” said Bob Reilly, chief financial officer for Anne Arundel Medical Center. “Now, the process is accelerated. It allows folks with the most dire need — for coverage, for clinical support, pharmaceuticals and so forth — to get it quickly.”
Anne Arundel Medical Center is one of about 15 hospitals in Maryland which have begun to implement the program (at least 23 more have indicated their intent to participate). Hospitals must show they have enough trained staff and certain infrastructure capabilities in order to be certified by the state Department of Health and Mental Hygiene to participate.
Even though hospitals get paid retroactively for care provided to patients who are uninsured at the time of their hospitalization but get Medicaid coverage later on, the HPE program ensures more timely payments, Reilly and others said.
Jackie Powers, the director of patient financial services at AAMC, said she and half a dozen other staffers help identify uninsured patients who come to the hospital as potentially eligible for Medicaid. Powers said her team can also help people who are not eligible for Medicaid by helping them sign up for coverage through the state health exchange.
“So far it’s been a very positive experience,” Powers said. “…We were one of the first [hospitals] to take advantage of this, but I’m sure others will be getting on board.”
Reilly said Anne Arundel Medical Center has helped about 120 patients in the first month, or about four people a day, with the program.
“We just think it’s a great program for our community,” he said. “There are still a number of folks in Anne Arundel County who are not insured and who would be helped by this.”