State Medicaid agencies need better eligibility, enrollment coding

By Anthony Brino
12:04 PM

Many states are lagging in how they measure and collect eligibility and enrollment information and could benefit from more streamlined coding sets, according to a policy brief by the Maximizing Enrollment project, led by the Robert Wood Johnson Foundation.

The study suggests that the time may be ripe for Medicaid agencies to update eligibility, enrollment and disenrollment information systems. With at least a handful of states committed to expanding Medicaid under the Affordable Care Act, the federal government is offering states funding for eligibility system improvements.

The study’s authors, from Mathematica Policy Research and the National Academy for State Health Policy, say the the current methods used by state Medicaid agencies have “complicated, cluttered coding techniques that may not produce reliable information,” such as understanding whether a person losing eligibility for a particular program has entered a higher income bracket, has gained insurance through work, or just doesn’t have proper documentation.

New coding and documentation systems could also help states design better metrics for measuring their outreach and communication to people enrolled in Medicaid programs, and could also be useful to tracking trends in enrollment.

In Virginia, the authors found, state officials created a new, more automated set of denial codes when the state revamped its Children's Health Insurance Programs (CHIP). The new CHIP coding systems has provided much more detailed insights into the program's trends, the authors wrote, while the Medicaid program continued to use broad, catch-all codes that made meaningful analysis of the data difficult.

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The $15 million Maximizing Enrollment project, led by the National Academy for State Health Policy, has worked with eight states, including Virginia, Alabama, Illinois and New York, to improve eligibility coding systems in preparation for the Affordable Care Act’s Medicaid expansion and new subsidized health insurance programs.