SKYGEN Helps Medicaid Programs Prepare for the End of the PHE

During the COVID-19 pandemic, millions of American lost their jobs and health insurance. The Department of Health and Human Services (HHS) declared a public health emergency (PHE) measure in January 2020 which enabled millions of Americans to get health coverage through Medicaid and limited state’s ability to drop individuals from coverage. The Act has helped uninsured rates stayed low, but Medicaid enrollment skyrocketed. Currently, about 50% of children in the U.S. are insured under Medicaid or CHIP. When the PHE expires, an estimated 13 million to 16 million adults and children could lose their Medicaid coverage.

The final expiration date of the PHE is uncertain, though. It has been renewed every 90 days since the Act took effect, with the latest expiration date projected to extend at least through late July. When it does expire, state Medicaid programs and MCOs could face the need to redetermine which Medicaid beneficiaries are still eligible. The potential for program disruption is huge.

SKYGEN Will Help Minimize the Disruption

As a trusted partner to MCOs and Medicaid programs nationwide, SKYGEN is preparing to help clients minimize the disruption when the PHE ends and ensure that all eligible members have continuity of benefits.

Here’s how SKYGEN will help:

Translating new requirements into action steps. SKYGEN’s compliance team continues to monitor the situation. We are preparing to help our clients understand the requirements and the program adjustments that will be needed as their state Medicaid offices make decisions.   

Facilitating communication with members and providers. SKYGEN can help members understand their eligibility through multiple SKYGEN communication channels that are already in place and trusted by members. These include the member portal and SKYGEN’s fully-trained, multi-lingual contact center. 

In addition, SKYGEN’s Medicaid Member Mobile App displays up-to-date eligibility information. Medicaid programs can push it out as an “eligibility card” to assist their members as they access care. Members can also use the app to view their benefits snapshot, covered and non-covered services, claims and pre-authorizations and track annual claims. Information is presented in clear language with an intuitive, user-friendly interface, helping overcome barriers of limited health and information literacy. In addition, if a member’s phone is set to Spanish the app will automatically present in that language.

SKYGEN can also continue to communicate with providers on behalf of Medicaid programs through direct mailings and information made available on the provider web portal.

Managing program changes and compliance in the changing Medicaid environment. SKYGEN’s dental benefits automation software and APIs make it fast and simple to accurately add and update member eligibility information so benefits are quickly available and providers have easy access to current eligibility information. SKYGEN also eliminates manual workflows with ICD-10 codes by integrating the codes with enrollment and eligibility files. SKYGEN’s Client Experience team will be reaching out to clients as the expiration occurs and states start to make adjustments.