Post-Public Health Emergency Maintenance of Eligibility Transition Services

PCG understands that Medicaid agencies are faced with unprecedented challenges as they approach the conclusion of the PHE. For this reason, we are leveraging existing PCG services which have been proven in Medicaid programs across the country to improve business processes, reduce workloads, ensure continuity of coverage for truly eligible members, and improve eligibility decision-making error rates, including:

Eligibility Operations Staffing Services

PCG understands that eligibility resources are scarce at a time when Medicaid redetermination efforts will place an unprecedented amount of pressure on State’s eligibility operations teams. PCG can provide needed resources at this critical time. Over the last 2 years, PCG has worked with HHS agencies to recruit, onboard, train, deploy and manage more than 10,000 contact tracers. This significant effort has been instrumental in supporting these States’ efforts to combat the spread of COVID-19. Now that those resources are less in need, PCG still maintains some of these talented individuals as employees with a large index of staff on whom we can call when needed to efficiently train and redeploy for other work within the state. PCG’s wholly owned subsidiary, Staffing Solutions Organization (SS0) specializes in recruiting, hiring and employing government contract workers at a competitive price. PCG can assist the State by quickly identifying qualified candidates and recruiting, screening, hiring and employing them either temporarily or permanently. Specifically, PCG can deploy eligibility operations staff who can complete every part of the enrollment and eligibility decision-making processes except "pushing the button" on eligibility decisions, allowing your eligibility workers to focus on the most important tasks of the associated with the eligibility redetermination process.

Member Locator Services

PCG understands that the State will undoubtedly encounter a significant amount of bad address and other member location issues throughout the course of their post-PHE Medicaid redetermination processes. PCG offers a low-cost National Change of Address (NCOA) data matching service, combined with a best address and best phone number (including cell) service, to prevent unnecessary disenrollment and churn following the PHE. This service includes, first, running a one-time batch of your members through the NCOA database and identifying any members' addresses which have changed. Second, for those members who have moved but aren't found in the NCOA database, PCG runs them through our best address and phone number service to find their best current addresses and phones. This service can be supplemented with PCG-operated phone texting campaigns to your members reminding them of key deadlines and/or the need to submit follow-up documentation or risk termination.

Member Eligibility Data Matching Services

PCG understands the State may have outdated and/or nonexistent information on its members creating a significant delay in processing each application. PCG has tools in place to assist HHS agencies in identifying characteristics and criteria that may make them eligible or not for Medicaid going forward. PCG leverages our configurable “Instant Eligibility Verification System & API Gateway” (IEVS) to provide HHS agencies with access to a comprehensive menu of superior verification data and a transparent, configurable menu of predictive analytics and data matches in a central location, the combination of which will ensure a faster, more efficient and more accurate redetermination of eligibility. Additionally, IEVS can also be configured to automatically identify any secondary coverage options available to those members who are likely to be ineligible for the Medicaid program they are currently enrolled in.

IEVS instantly consolidates these results featuring third-party verification data and internal data matches into a single, on-screen report, providing necessary information to agency eligibility technicians which will allow them to more efficiently process applications and reduce the unnecessary work that might otherwise exist without this information.

Regardless of your specific need as you approach the conclusion of the PHE, contact PCG today to hear more about our proven solutions.

Peter Cheesman, Manager
P: 207-861-1950