Hospital Eligibility Programs In The Age Of COVID-19.

As hospitals absorb coronavirus victims in addition to their regular patient flow, a good percentage of admissions will be low-income, “self-pays”. A 2017 study by Crowe Horwath confirmed what most hospital administrators already know. Namely, that true self-pay patients, generally paid about 6.06 cents on the dollar. In the age of COVID-19, the hospital’s eligibility team acts as Revenue Cycle’s last line of defense against massive charity care write offs. They must, in a very limited amount of time, interview every self-pay patient, prior to discharge, to determine if the patient may be eligible for Medicaid – or some other form of health insurance.

Of course, economic and policy help is on the way. The $2.2 trillion COVID-19 economic stimulus deal promises to cut-out over a $100 billion to reimburse providers for pandemic related expenses and lost revenue. “The bill includes important provisions that will help us respond, including the creation of an emergency fund grant program, additional support for taking care of COVID-19 patients and relief from spending cuts, among other provisions,” according to AHA President and CEO Rick Pollack

Earlier, on March 22, CMS made available to states several tools “…making it easier and faster for state Medicaid agencies to get the regulatory relief and additional support they need to respond as rapidly and effectively as possible…” according to Seema Verma, Administrator, CMS. The new tools will permit states to access emergency administrative relief, make temporary modifications to Medicaid eligibility and benefit requirements, relax rules to ensure that individuals with disabilities and the elderly can be effectively served in their homes, and modify payment rules to support health care providers impacted by the outbreak.

For eligibility teams especially in non-expansion state hospitals, the crush of enrolling low income self pay patients into Medicaid may increase the possibility of “over-looking” potential “disability” candidates. Applying for “disability” with the Social Security Administration (SSA) is more difficult and far more time consuming than applying for Medicaid through local Social Services. But the two disability programs, (1) Supplemental Security Income (SSI) results in Medicaid coverage and (2) Social Security Disability Insurance (SSDI) provides Medicare benefits for the individual. Capturing these candidates for insurance coverage becomes imperative, when the only other option is to write-off service charges.

Following are some suggestions that you may wish to consider when interviewing self pay patients for SSI and/or SSDI eligibility:

  • Look carefully at low income patients who are adults with no children/dependents.

Aside from low income women who are pregnant or who suffer from cervical and/or breast cancer – this demographic will almost certainly not qualify for Medicaid in non-expansion states, unless you can identify a disability that keeps the applicant from gainful, substantial employment.

  • If you strongly believe an individual is qualified for SSI, but you don’t have the time to complete a formal disability application – be sure to submit a “Protected Filing.”

can be accomplished relatively quickly, and protects the “start date” for benefits. You have 60 days from the protected filing date to gather all the information necessary to file an SSI application. This is especially important in states that have waivers against retroactive eligibility. In these states, the hospital may only bill for services that were rendered during the same month as the Protected Filing or application. The seven states with such waivers are: Kentucky, Arizona, Arkansas, Florida, Indiana, Iowa and New Hampshire. Hospitals in other states can bill Medicaid up to 90 days prior to Protected Filing or application.

  • When applying for SSI, also apply for SSDI.

SSI is for low income US citizens, legal aliens who live in one of the 50 states or some Territories, and children of some military personnel stationed overseas. The individual claimant can’t have assets worth over $2,000 (not counting house and car) or $3,000 for a couple. Earning are more complicated to calculate, but with some exceptions the individual can’t earn more than about $780 per month, or $1,175 for a couple. The individual qualifies for SSDI by paying into Social Security and accumulating “work credits”. But a disability is a disability. If the individual qualifies for SSI and has accumulated enough work credits, he or she will also qualify for SSDI. And thus, become “dual eligible.” So the provider can bill Medicare for hospitalization and bill Medicaid for co-pay and deductible charges.

We hope this information has been helpful to you. The entire country appreciates the sacrifices you make every day for all of us.

Mike Vana
Healthcare Consultants
TEL: (626) 445-5092
Mobile: (917) 592-5802