Eligibility and enrollment solutions for Health Care Reform
Implementing universal coverage requires extraordinary efforts to reach families and individuals without insurance and to guide them through complex options, enabling them make the best choice for health care coverage.
Why? Medical insurance plans can be complicated and confusing for people who are trying to select the best plan for them and their families. Managed care is most successful when individuals make their own choices because they use the health delivery system more effectively, which improves health outcomes.
MAXIMUS helps government improve effectiveness and efficiency by connecting families with the health plan that best meets their needs.
Reducing health disparities through Health Care Reform
Effective health care reform must reach families and individuals who don't have health insurance. Information about coverage options must be clearly communicated, whether in plain English or in the consumers' native language.
Why? Individuals with low literacy rates and people whose primary language is not English may experience negative health outcomes when health-related materials are difficult to understand or not written in their native language.
The MAXIMUS Center for Health Literacy communicates health options in an easy-to-understand manner and in over 120 languages. This improves choice rates and helps individuals make the best decision for their or their family's health care.
Ensuring evidence-based solutions for Health Care Reform
If consumers, providers, or insurers disagree on insurance coverage for a specific health service, the dispute should be resolved quickly through a cost effective, independent evidence-based appeals process.
Why? A comprehensive, impartial and evidence-based appeal process protects patients' rights and health without exposing the health systems to unnecessary utilization or costly lawsuits.
Since 1989, the MAXIMUS team of doctors and attorneys has made over 750,000 independent appeal decisions for Medicare, Medicaid, state insurance programs, the Federal Employee Health Benefits Program and employer plans such as ERISA.
Independent health plan quality oversight for Health Care Reform
Whether health plans are public or private, consumers, providers and payors benefit from the knowledge that a health plan is complying with standards.
Why? Many features of health plan design and performance influence patient health outcomes, consumer satisfaction and health care costs. Independent oversight produces transparent, consumer-friendly information leading to higher quality.
MAXIMUS extends the reach of government and private sector managers responsible for health plan quality oversight - whether the focus is on clinical quality of care, benefits, and coverage, outreach and enrollment, payment systems or grievance and appeals.
Consumer outreach
Health reform legislation must include mechanisms to find the uninsured…
Consumer education
Health reform legislation must help consumers make informed decisions…
Patients' rights
Health consumers need an effective appeals process…
Health disparities
Developing culturally competent approaches to health delivery...will help combat health disparities.
- Nearly 80,000
Chart reviews per year for Medicare Part D appeals nationwide.
- 468,000
Virginia consumers are enrolled in Medicaid managed care administered by MAXIMUS.
- 300,000
Independent reviews of appeals covering Medicare Part A, B, DMERC, SNF, hospice, transplant, and home health services.
- 165,482
MassHealth Medicaid customer service calls answered by MAXIMUS on average each month in 2008.
- Over 325,000
Healthy and Well Kids in Iowa (hawk-i) eligibility determinations completed through 2008.
- More than 4 million
Medi-Cal applicants and beneficiaries served by MAXIMUS managed care education and enrollment services.
- 2.5 million
CHIP enrollees MAXIMUS serves in the United States.
- 6.1 million
CHIP eligibility determinations managed by MAXIMUS.
- 200,000
Health care appeals completed each year by MAXIMUS for Medicaid and Medicare participants.
- 1 million
Independent coverage appeals decisions completed since 1989.
- 61 million+
Calls MAXIMUS has answered at Medicaid Customer Service Call Centers since 1996.
- 1 million
State of Texas Access Reform (STAR) members that MAXIMUS has worked to enroll and educate about health care services.
- 14.2 million
Medicaid managed care participants MAXIMUS currently serves in the US.
- 44 million
Individuals MAXIMUS has successfully enrolled in Medicaid managed care.
- 92.7% of 500,000
MAXIMUS-enrolled New York Medicaid CHOICE beneficiaries who made an informed choice of plan in 2008, improving health outcomes.
- 1975
Year MAXIMUS was founded.
- 6,000+
MAXIMUS employees located in more than 300 offices in the U.S., Canada and Australia.
- 33
Years MAXIMUS has worked in partnership with government clients to effectively administer health and human services programs.
