Data hygiene

As the Public Health Emergency (PHE) unwinds, the upcoming volume of Medicaid eligibility redetermination will be unprecedented — and could lead to the disenrollment of 15 million people from these programs.

Agencies need to safeguard beneficiaries and reduce inadvertent loss of coverage stemming from old, outdated data while saving money from excessive mailing or returned mail. Enrollee outreach will be critical to ensure that eligible people maintain coverage while the ineligible transition to a marketplace plan or other insurance.

New conditions require state agencies that claim increased FMAP during this time to meet additional requirements. These include using specified sources to ensure the state has up-to-date contact information for each individual and using a good-faith effort to contact using more than one modality before disenrolling that individual.

Government agencies face complex responsibilities that are even more challenging with competing priorities such as budget, statutory and regulatory changes, and political difficulties.

Identifying how unreliable data is a cost — for example, how returned mail can cost tens of thousands of dollars in expenses — can help create a case for making data hygiene a budget priority.

Instead of being overwhelmed by all the possibilities, tackling one data issue at a time can help achieve positive outcomes and catalyze efficiencies and cost savings for your programs.

If you don’t proactively manage data, it can quickly become outdated. Inaccurate, incomplete, and inconsistent data can result in fraud, waste, and abuse within your program or agency, taking valuable time away from your core mission.

Data hygiene tools can strengthen your program integrity and unlock significant value. They’ll also paint a clearer view of your constituents and help with vital activities such as updating addresses once someone has moved, verifying addresses for school districts, or ensuring food stamp benefits don’t go to deceased or incarcerated individuals.

Fraudsters always look for ways to exploit vulnerable systems and processes, especially those with siloed data and disparate systems. Fraudulent claims for Medicaid and Medicare programs alone cost the government billions of dollars annually.

Many agencies still rely on more manual processes and disparate systems that can result in a missed connection or other critical information.

Investing in the right data hygiene tools is crucial to combating fraud, waste, and abuse and building a foundation for governments to better serve their constituents for years to come.