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Maryland HIE Expands Medicaid Redetermination Notification Project

The HIE notification project provides healthcare organizations with a secure report of patients facing Medicaid redetermination within the next 90 days.

CRISP, Maryland’s state-designated health information exchange (HIE), has expanded its Medicaid Redetermination Notification project to all interested providers and Managed Care Organizations (MCOs).  

The program aims to support care teams for nearly 1.6 million Medicaid members across Maryland who will face redetermination and possible loss of coverage on April 1st with the expiration of the Families First Coronavirus Response Act’s (FFCRA) continuous coverage requirement.

The provision required Medicaid members to stay continuously enrolled until the end of the public health emergency (PHE).

CRISP partnered with Maryland Medicaid (MDH) on the notification project to provide healthcare organizations with a secure report of all their patients who will face redetermination within the next 90 days. Care teams can perform outreach and navigate patients through the redetermination process with access to timely and accurate patient information.

CRISP launched the notification project as a pilot in February 2023 to help FQHCs navigate redetermination for their patients, who account for an estimated 10 to 15 percent of the state’s Medicaid population. The HIE intends to expand the notification project to all CRISP participants by May 2023.

“Medicaid is a lifeline for one in every five people and one in every three children in Maryland,” Craig Behm, president and CEO of CRISP, said in a press release. “It’s imperative that all care team members know when their patients are up for redetermination and who’s at risk of losing coverage. This project streamlines the process and is a safety mechanism for patients who depend on Medicaid.”

The PHE has lasted for more than three years, leaving experts concerned about the impact expiration will have on patients, providers, and healthcare organizations across the state. Many clinics have reported not having recent patient contact information for outreach.

The Medicaid Check-In Campaign is a statewide project to generate awareness of upcoming redeterminations.  

The campaign is a joint effort by CRISP, MDH, the Maryland Department of Human Services (DHS), Maryland Health Connection (MHC), and managed care organizations (MCOs).

“I worry about the parents of a child with an asthma exacerbation who may have to make a difficult choice between the best clinical care for their child and avoiding a bill they cannot afford,” said Marc Rabner, MD, MPH, chief medical officer at CRISP.

“Many of my patients and their families have never needed to go through redetermination and are likely unaware they’ll need to,” he noted. “There’s a real chance this could push families deeper into poverty simply because they missed a deadline.”

Behm emphasized the role HIEs can serve during redetermination:

“By leveraging the infrastructure and technology already in place, HIEs can modernize the process and significantly reduce the burden on providers, clinics, and state Medicaid agencies so they can instead focus on supporting patients,” Behm added. “The healthcare system as a whole must do everything we can to ensure these patients don’t fall through the cracks.”

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