PHE/RTNO (AR) – Medicaid Redetermination, Sanders’ Healthcare $$$ Plans & AI for Mental Health

MM Curator summary

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[MM Curator Summary]: Axios points out that getting Medicaid cards converted to exchange-plan cards (subsidized by tax dollars) could mean higher payments to providers.


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Medicaid redetermination may result in a favorable payer mix for some providers if people switch to ACA and employer-based coverage that has higher payer rates. But that is a pretty big if.

Medicaid redetermination could be good for providers, hospitals | Axios

The Kaiser Family Foundation has estimated that 17 million people could lose Medicaid coverage as result of Medicaid redetermination and the end of the automatic re-enrollment into the public payer programs that was part of the government’s response to the COVID-19 pandemic. If people losing Medicaid coverage don’t switch to other kinds of coverage, the consequences could be dire for their access to healthcare. A growth in the number of uninsured Americans could also put a strain on health systems and providers, Axios reports this morning (full text available). But the news brevity website also mentions an alternative scenario whereby substantial number of people losing Medicaid coverage switch to employment-based and ACA coverage, which pay providers at a higher rate than Medicaid programs. “Redeterminations could change the payer mix in a revenue-positive way if patients for from Medicaid to employer-sponsored or ACA plans,” writer Axios’ Arielle Dreher.