Social Risk Factors Identify Those Needing Help Navigating the Medicaid Redetermination Process with Ashley Perry Socially Determined TRANSCRIPT
Download PDFJul 17, 2023
Ashley Perry, Chief Strategy and Solutions Officer at Socially Determined, highlights the problems created by the Medicaid redetermination process. Building on their SocialScape social risk intelligence platform, Socially Determined is providing a new risk score that will help state Medicaid agencies and Managed Care Organizations identify and prioritize members needing help navigating the redetermination.
Ashley explains, "As many of your listeners will know, on April 1st of this year, we started redetermining eligibility for the 95 million Medicaid beneficiaries nationwide. And that's a year-long process during which we expect that up to 15 million of them may be disenrolled from the program. So far, we've seen that as of June 16th, we've had about 1.3 million Medicaid beneficiaries nationwide disenrolled across the 22 states that have reported data to date."
"What's notable about that, though, is on average across those 22 states, 74% of those who've been disenrolled have been disenrolled for procedural reasons. This means one of two things: either number one, they did not return the paperwork period, or number two they did, but they did not include some of the required documentation. So overall, a very high percentage of those who've been disenrolled to date are not necessarily no longer eligible for the program but have not been able to navigate that recertification process on their own."
"We've done that for the entire United States community level across a number of different domains, so things like the food landscape and the housing environment. We've also done it for hundreds of millions of Americans at the individual level for similar domains. And so all of that data and insights around the SDOH and social risk factors that influence healthcare utilization costs, outcomes and equity was built into our social state platform. We've been working with organizations to use that data to inform their strategies for years."
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