The Quick Win in Medicaid Expansion for Missouri Hospitals and Patients

Missouri Hospitals will soon be able to provide real-time Medicaid coverage to a greatly expanded number of uninsured Missourians. Following a lengthy legal battle, the Missouri Supreme Court recently decided to uphold the state’s planned expansion of Medicaid – a year after voters approved the program. The battle was the result of the expansion’s not being included in the state’s $35 billion dollar budget. Now, with criteria for program eligibility set to finalize in October 2021, the expansion is expected to cover an additional 275,000 low-income Missourians. This marked increase  presents a huge opportunity for hospitals in Missouri’s Hospital Presumptive Eligibility program. 

What is Hospital Presumptive Eligibility?

In January of 2014, the Affordable Care Act broke new ground by extending Medicaid decision making directly to hospitals. This program, called Hospital Presumptive Eligibility (HPE) gives participating providers autonomy to make real-time eligibility decisions and temporarily provide patients with full Medicaid coverage, ensuring qualifying patients have access to immediate coverage of their healthcare expenses.

Missouri’s Medicaid expansion means that more patients will now be eligible for HPE. Hospitals positioned to take advantage of HPE coverage opportunities can look forward to substantial reductions in uncompensated care and bad debt. But first, a hospital must enroll with the state’s HPE program, then maintain compliance standards for processes and performance.

Every state sets its own HPE program standards for Medicaid Coverage. In Missouri, in addition to checking for existing MO HealthNet coverage, providers are expected to make point-of-service eligibility determinations based on household and income data from patients, and assist in the substantial completion of Medicaid applications. 

For participating hospitals, the HPE program assures full Medicaid payment for qualifying patients, with coverage beginning as soon as the hospital determines eligibility, but manually managing an HPE program can be very difficult. Juggling compliance standards, complex calculations, documentation, and real-time requirements keeps many hospitals from accessing the full benefit of the program. 

Despite its complexities and protocols, HPE is a tool that can bring success to hospitals and patients alike. With CoverMe’s automated HPE screening, just one of the many programs supported in CoverMe’s customizable marketplace, the daunting process for HPE providers can be overcome without compromising accuracy standards or burdening staffing resources. CoverMe guarantees HPE compliance, verifies identity, residency, citizenship, income and household building calculations, and autofills all forms. Medicaid applications are completed in minutes instead of weeks or months. 

By removing the manual burden of the program, decisions can be made with efficiency, objectivity, and uniformity.  

With more potential enrollees than ever before, CoverMe is an absolute must have for Missouri hospitals. 

You can learn more about CoverMe’s Healthcare Finance Marketplace here.