Medicaid Eligibility and Enrollment Services Case Study

This case study details the collaboration between a Midwest medical center and Optum to streamline Medicaid eligibility and enrollment processes. The medical center, which has a long history of serving underprivileged patients, faced challenges due to limited staff expertise and increasing demands from a growing uninsured patient population. The partnership aimed to improve patient satisfaction by simplifying the enrollment process and ensuring that eligible patients received necessary coverage. Optum's services included proactively identifying and enrolling self-pay patients in government funding sources and educating patients about their financial responsibilities. Over a decade, the medical center successfully enrolled over 15,000 patients, achieving a 96% approval rate for Medicaid coverage and generating more than $934 million in gross charges. This initiative not only enhanced patient satisfaction but also reduced bad debt and uncompensated care, ultimately benefiting both the organization and its patients.