The end of the Public Health Emergency is coming at a time when Medicaid agencies across the country are already facing a staffing shortage, further fueling a capacity crisis.
Despite the best intentions and resolve of Medicaid and social safety net agencies to redetermine health care coverage for 96 million people, even the most efficient agencies are finding – or soon will – the PHE unwinding workload to be overwhelming.
To effectively prepare for, navigate, and manage redetermination and associated program backlogs that will undoubtedly develop in the coming weeks and months, here are five, critical steps your agency can take:
- Define backlog. It is important for your agency to establish a common understanding across your agency as to what backlog consists of (e.g., is backlog all work that is 10 days old? 30 days old?) and communicate it. Establishing such an understanding will ensure that the entire team understands the amount of work before them and is focused on working the same workload, and it will give you a baseline by which you can monitor your progress in working down backlog.
- Identify severity of your backlog and needed staff capacity to adequately prepare. To determine the size of your challenge and the level of effort needed to overcome the backlog, you have to take various factors into consideration, including:
- Workload: How much backlog exists? Be sure to take into account the various case actions, including outstanding applications, renewals, and changes.
- Time: What is the average time to process redeterminations, applications, and changes?
- Staff: How many staff do you have who are trained in processing redeterminations? As you calculate staff availability, be sure to take into account absenteeism, unplanned leave, and PTO.
- Timeline: How quickly do you need to work down backlog, particularly due to political or other budgetary pressures?
- Determine if backlog is growing. To determine if workload is growing, you must monitor total workload each day. While some agencies have access to data they need to determine overall workload, many agencies only have access to reports on a weekly – and even monthly – basis. Unfortunately, not having access to this workload data puts agencies at a disadvantage – preventing them from taking corrective action in a timely manner.If you do not have access to the data and workload reports you need on a timely basis, there are other leading indicators you can monitor. For instance, are you getting an increase in calls to your call center or visits to your lobby where customers ask “What is the status of my application?” When customer calls and inquiries increase to check the status, it typically means that there is an uptick in days to decision, meaning you are closer to days 30 and 45 than you are to day 1.
- Create a backlog plan. Once you know how much backlog you have to tackle, it is time for you and your team to craft a plan. As part of this planning effort, isolation of the backlog work is key. You will need to identify a team of workers who will be dedicated to solely working the backlog. Additionally, consideration to how the workers will tackle the backlog (i.e., tackle backlog work by program and activity or consider all backlog-related action as one big bucket of work.) While working down backlog is important, equally as important is committing to staying current with incoming work and not growing additional backlog. Therefore, your plan should take into consideration staffing needs to process incoming work.
- Measure performance daily and celebrate success. As the team begins working backlog, it is important for you to monitor performance each day. As backlog declines, customer phone calls and lobby visits should decline, as well. By monitoring backlog and progress in working down backlog-related work, you will be able to determine when/if staff can be reassigned. Additionally, sharing the results with the team each day will allow them to see the progress that they are making in the backlog and the number of lives they are touching – further reaffirming their commitment to redetermining health care benefits for those in need as quickly as possible.