At the Medicaid Enterprise Systems Conference (MESC), held from August 12-15, 2024, in Louisville, KY, healthcare professionals gathered to explore innovative strategies for improving Medicaid and Human Services programs. A standout session, “Crossing the Enrollment Finish Line: Increasing TPL Benefits in Massachusetts and Michigan,” moderated by Jen Hartman from ForHealth Consulting at UMass Chan Medical School, highlighted the effective collaboration between state programs and consulting partners to leverage underutilized health insurance options for Medicaid beneficiaries.
The Importance of Third-Party Liability (TPL) in Medicaid
Third Party Liability (TPL) plays a critical role in Medicaid by ensuring that other available health insurance resources are used before Medicaid pays for services. This not only helps to maximize benefits for beneficiaries but also reduces costs and enhances recovery efforts for state programs.
Speakers Valerie Berger, Director of Third-Party Liability and Premium Assistance for Massachusetts, and Michelle Smith from the Third-Party Liability Division in Michigan, discussed how Massachusetts and Michigan have been implementing data-driven approaches to increase TPL usage, with a focus on overcoming barriers to enrollment. By tapping into inadequately utilized health insurance options such as Medicare, Employer-Sponsored Insurance (ESI), and TRICARE/CHAMPVA among Medicaid beneficiaries, these states have been able to implement effective cost avoidance.
Massachusetts and Michigan: A Tale of Two States
In Massachusetts, where over 2 million individuals are enrolled in MassHealth, 66% of the population is covered under Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), and Primary Care Clinicians (PCCs). Valerie Berger emphasized the state’s robust TPL program, particularly with regard to Medicare and commercial insurance coverage, which has led to substantial savings. Since 2014, Massachusetts has identified over 21,000 members for Medicare enrollment support, resulting in $115 million in new cost avoidance savings.
Michigan, with a Medicaid population of 2.6 million, has seen similar success. Michelle Smith detailed how the state has leveraged data analytics to identify Medicaid members eligible for Medicare and other insurance options, achieving a 97% Medicare enrollment rate among identified members. This initiative has resulted in over $41 million in cost avoidance savings since 2015.
Key Strategies for Increasing TPL Utilization
The session emphasized several key strategies that have been instrumental in increasing TPL success in both states:
Data-Driven Analysis: Both Massachusetts and Michigan utilize extensive data sets to identify Medicaid beneficiaries who are eligible for other insurance options but have not yet enrolled. This includes analyzing Medicaid demographic data, federal data, and claims data to isolate enrollment opportunities.
Targeted Outreach and Education: Direct outreach to beneficiaries through phone calls, mailings, and educational campaigns has proven effective in assisting members with the enrollment process. This is particularly important for populations such as individuals with disabilities or those with high-cost medical needs.
Collaboration and Relationship Building: Both states have built strong relationships with stakeholders such as the Social Security Administration (SSA), Centers for Medicare & Medicaid Services (CMS), and other relevant organizations. These partnerships are crucial for resolving issues, streamlining processes, and ensuring that beneficiaries receive the benefits they are entitled to.
TRICARE/CHAMPVA Enrollment: Massachusetts has successfully identified and enrolled over 2,000 members in TRICARE and CHAMPVA programs, resulting in $9 million in annual cost avoidance savings. This success was achieved despite challenges such as the lack of direct access to DEERS (Defense Enrollment Eligibility Reporting System) since 2017, which was overcome through the use of federal and VA match data.
Lessons Learned and Future Directions
The session concluded with a discussion led by Kristen Lightbody from MassHealth HICS eligibility system and Chris Siano, Associate Program Director at ForHealth Consulting, on lessons learned from these initiatives. The importance of using data to identify opportunities, the value of educating members about available benefits, and the necessity of direct contact and support were all highlighted as critical components of successful TPL programs.
Moving forward, both Massachusetts and Michigan plan to continue building on these strategies, with a focus on expanding their outreach efforts and further analyzing data to uncover additional opportunities for TPL benefits. Regular meetings with SSA, CMS, and other stakeholders will remain a priority to address specific member issues and improve overall processes.
How CITIZ3N’s VERIFY Platform Can Help
As states continue to innovate and improve their Medicaid programs, tools like CITIZ3N’s VERIFY Platform can provide invaluable support. VERIFY integrates multiple data sources to streamline eligibility verification processes, helping states use data to confirm eligibility in a cost-effective manner.
Contact CITIZ3N today to learn more about how the VERIFY Platform can support your overall Medicaid strategy.
Author: Josh Schultz, jschultz@citiz3n.com
