An estimated 5.4 million Americans lost their health insurance between February and May 2020 because of job losses due to the pandemic. This downturn in patient coverage occurred in spite of the fact that more patient encounters qualify for reimbursement than ever before due to the passage of the Affordable Care Act (ACA).

Expanding Medicaid services as authorized by the ACA carries immense benefits for patients, hospitals and the states. The states that have expanded Medicaid have made the greatest progress in increasing health coverage and are better situated to weather the COVID-19 pandemic. In states that did not expand Medicaid, hospital closures have spiked. States that have expanded Medicaid have seen their hospital closure rates decline.

An analysis of 235,000 uninsured patients revealed that in states that expanded Medicaid coverage, 81% of patients in the survey group qualified for Medicaid, and of that population 69% also qualified for additional benefits from federal, state and private programs. Of those who did not qualify for Medicaid, 67% still qualified for additional benefits. In states that did not expand Medicaid, 25%–50% qualified for Medicaid, and 96% of those patients also qualified for additional benefits. For patients who did not qualify for Medicaid in these states, 78% still qualified for additional benefits (Source: Pointcare.com).

The Solution — MedQualify^TM

While hospital staff typically are tasked with identifying and submitting patient data for Medicaid and other program approval, the work of interviewing patients, collecting and submitting documents, following up with Medicaid and other programs is time-consuming and complex. The advent of artificial intelligence (AI) has made it possible to combine the speed and efficiency of AI technologies with human expertise to connect patients with more resources faster in order to get them covered and maximize reimbursements to the hospital. Meduit’s MedQualify solution is one such technology.

Through MedQualify, Meduit partners with hospitals across the country to identify patients eligible for Medicaid and other enrollment opportunities. MedQualify is an end-to-end self-pay enrollment platform that leverages AI and automation for qualifying, verifying coverage, end-of-month reporting and more with web-based access and in-app reporting.

The process begins with a compassionate, caring representative conducting a five-minute interview at the patient’s bedside to collect information. The representative completes the Medicaid application on behalf of the patient, submits it electronically and collects all needed materials such as tax forms that may be needed. Representatives work one-on-one with patients, following up to ensure that all documents have been submitted. Once approved, the representative communicates that information to the hospital and the patient so the patient knows what benefits they can access.

Beyond Medicaid eligibility, the software technology utilizes the patient data to connect with all federal, state and private programs that the patient qualifies for and does so instantly, submitting forms and information on behalf of the patient and hospital. In many states, as many as 50 state and private programs may be available to the patient.

Most patients are not aware of the plethora of programs that they may qualify for that MedQualify automatically identifies. Some states offer programs that address social determinants of health such as electric bill assistance that MedQualify identifies. Including these types of programs encompasses patient whole health and goes above and beyond simply reimbursing hospital costs.

By identifying eligibility for dozens of programs and community services, Meduit’s MedQualify Solution acts as the liaison for driving total care for millions of patients, changing their lives for the better and ensuring maximum reimbursement for the hospital.