Forrest General Hospital in Hattiesburg, Miss., has a program to determine if uninsured patients may be eligible for healthcare coverage which has helped several thousand get insurance since 2008.

In 2013, as implementation of the Affordable Care Act was in full swing with the pending launch of the Healthcare.gov enrollment website, the hospital contracted with the Chamberlin Edmonds unit of Emdeon, which provides outsourced eligibility determination and enrollment services in more than 300 hospitals, and got more than 100 patients signed up for insurance during the first ACA open enrollment period.

Now, Forrest General Hospital is starting to have five partner community hospitals refer patients to the main hospital to determine their eligibility and enroll those who can get coverage, said Pat Riley, director of insurance operations at the 512-bed hospital and a social worker for three decades. Riley talked with Health Data Management during the HFMA Annual National Institute in Las Vegas. The hospital holds town hall meetings to explain the opportunities under ACA to get insurance coverage. “When they come and we explain how they may qualify for help, they start asking questions,” he added.

Some have been denied coverage in the past and didn’t try again; others have gotten a letter from the federal program explaining the enrollment process but don’t understand the bureaucratic language, so there is a lot of hand-holding and walking them through the process that must be done. But the rewards are substantial, Riley said.

For example, a 58-year-old single female with no children and low income enrolled in a policy with a premium of $21 a month, and the coverage was as good as a policy with a $500 monthly premium without an ACA subsidy. A 57-year-old female got a policy for 50 cents per month with no out-of-pocket costs because her income was so low.

The uninsured rate is high in southeast Mississippi and assisting residents in getting coverage reduces bad debt for Forrest General and its partner hospitals. The state did not expand its Medicaid program, but the enrollment program has shown that up to one-quarter of admitted patients already are eligible for Medicaid but have not enrolled, according to Gwynne Mesimer, vice president of operations at Chamberlin Edmonds.

Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access