Medicare Advantage plans face substantial challenges in signing up additional Medicare Advantage plan members for Medicaid coverage as a dual eligible member:
- Medicare Advantage plans may have analytical tools that can identify which of its Advantage plan members could potentially qualify for Medicaid benefits, but do not have access to all of the income, family, and other information on its Advantage plan members that is needed to determine which members are actually eligible for Medicaid coverage under one of Medicaid’s programs.
- Although they have office-based staff for handling inquiries from its members, Medicare Advantage plan do not have the “boots on the ground” needed to meet in person with their members who may be dual eligible, in order to: (a) explain the benefits to the member of signing up to receive Medicaid coverage as a dual eligible, (b) gather the information needed to complete the Medicaid application, (c) get the member to sign the completed application, (d) submit the completed application to the local Medicaid office, and (e) follow-up with staff at the local Medicaid office to answer questions and secure approval.
- Language is also a barrier, since the enrollment staff must also be able to speak the language spoken by the Advantage plan member and his/her family.
- After a Medicare Advantage member is initially approved for Medicaid coverage as a dual eligible, that person must re-apply each year and be re-approved by the local Medicaid office in order for that person to continue receiving Medicaid benefits. Members who fail to be re-certified each year will lose their Medicaid coverage, even if they continue their coverage in a Medicare Advantage plan.
Sierra provides Medicaid MCOs and Medicare Advantage plans with a comprehensive package of Medicaid eligibility, enrollment, and follow-up services that overcome the challenges discussed above and that enable Sierra to successfully secure Medicaid coverage for persons insured by a Medicare Advantage plan who can also qualify for Medicaid coverage as a “dual eligible”:
- Sierra works with information provided by Medicare Advantage plans and/or Medicaid MCOs, as well as using its own data sources and analytical tools, to identify Medicare Advantage plan members that may potentially be dual eligible;
- Sierra’s staff provide the personnel needed to meet in person, one-on-one with their members who may be dual eligible, in order to: (a) explain the benefits to the member of signing up to receive Medicaid coverage as a dual eligible, (b) gather the information needed to complete the Medicaid application, (c) get the member to sign the completed application, and (d) submit the completed application to the local Medicaid office,
- Sierra’s personnel then follow up with staff at the local Medicaid office, with whom Sierra has developed close working relationships, to answer their questions and secure their prompt approval of the Medicaid applications submitted by Sierra.
- Sierra has enrollment staff members who speak multiple languages so that our staff are able to speak the language spoken by the plan member and his/her family.
- Sierra also works to complete the annual renewal applications needed to continue Medicaid insurance for dual insured members.
Sierra’s Medicaid enrollment services and its methodologies have been developed, refined, and proven over the past twenty years because Sierra’s CEO and principals have been successfully providing Medicaid eligibility and enrollment services for hospitals for more than two decades.