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. 2024 Mar:295:530-539.
doi: 10.1016/j.jss.2023.11.038. Epub 2023 Dec 11.

A Qualitative Study of Emergency Medicaid Programs From the Perspective of Hospital Stakeholders

Ana C Boncompagni  1 , Thomas J Handley  2 , Marzena Sasnal  1 , Arden M Morris  3 , Lisa M Knowlton  1
Affiliations

A Qualitative Study of Emergency Medicaid Programs From the Perspective of Hospital Stakeholders

Ana C Boncompagni et al. J Surg Res. 2024 Mar.

Abstract

Introduction: Uninsured patients often have poor clinical outcomes associated with lower access to care. Hospital Presumptive Eligibility (HPE) provides up to 60-d emergency Medicaid coverage for uninsured, low-income patients. After obtaining 60-d HPE, patients must file for ongoing Medicaid to sustain coverage; however, navigating HPE approval is complex. We conducted a qualitative study to understand (1) stakeholder perspectives on the application process and workflow and (2) facilitators and barriers to HPE approval to understand process improvement opportunities.

Material and methods: We conducted semi-structured interviews between September-December 2021 with key stakeholders (social workers, financial counselors, case managers, and private third-party vendor representatives) involved in HPE coverage determination, screening, approval, and Medicaid sustainment at our institution. We performed a team-based thematic analysis to elicit factors influencing HPE screening and approval, and recommendations for process improvement.

Results: Study participants described the HPE application and Medicaid approval processes. Patient-level barriers included information disclosure and immigration status, inability to contact patients or next-of-kin, and knowledge gaps about insurance acquisition and sustainment. System-level barriers included technical challenges with the state HPE application portal, inadequate staffing for patient screening, and short emergency department stays that limited opportunities to initiate HPE. Stakeholders proposed improvements in education, patient outreach, and logistics.

Conclusions: This qualitative study reveals the process of HPE approval and outlines barriers within HPE and Medicaid processing from the perspective of direct hospital stakeholders. We identified opportunities at the patient, hospital, and policy levels that could improve successful HPE application and approval rates.

Keywords: Access; Disparities; Health policy; Hospital presumptive eligibility; Medicaid; Trauma.

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Figures

Fig. 1.
Fig. 1.
Process for screening uninsured patients for hospital presumptive eligibility at the time of hospitalization.
See this image and copyright information in PMC

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