Best Benefits™ for Medicaid Managed Care Plans

  • Helping disabled members get the benefits to which they are entitled.
  • Helping their health plans secure captitation to match the increased risk. 

Why Best Benefits is Relevant

America's Health Insurance Plans Medicaid Health Plans of America In 2010, the Social Security Administration reported that over 5.5 million Medicaid recipients under the age of 65 had qualified for Supplemental Security Income (SSI).1  That accounts only for about 60% of the disabled, under-65 Medicaid population.  That means there are millions of people on Medicaid who are eligible for SSI but who have not been converted to that category.  Vulnerabilities of the population and the complexity of the SSI application process make it extremely difficult for individuals to successfully navigate it themselves.

Depending upon age, location and program, managed care plans are capitated at higher rates for their increased risk in covering the higher medical costs incurred by the disabled.  The increase due to SSI enrollment can vary from $3,000 to $13,000 annually per member, which can easily translate to millions of dollars in incremental revenue each year.

SSI direct benefits to the disabled vary, but they can exceed $7,400 per year of incremental cash payments for individuals.  In some cases, with the addition of state supplements, this amount can be even higher.

Human Arc’s Best Benefits SM   is the only complete solution for Medicaid managed care plans to the challenges of SSI enrollment.  Best Benefits is proven to:

  • Efficiently identify and locate disabled members of Medicaid managed care plans and those with disabled dependents.
  • Help disabled members get the SSI benefits to which they are entitled.
  • Deliver significant incremental capitation right to the bottom line to help address the added risk of insuring the disabled.
  • Protect plans’ annuity income and the ongoing wellbeing of their disabled members through systematic SSI re-determination.

The Human Arc Edge - the Right Technology

Over our long history, Human Arc has developed innovative, proprietary tools and industry best practices to help healthcare plans and providers. Our leading-edge information systems and HIPAA-compliant data mining techniques give us advanced, web-based tools and client reporting capabilities. We not only resolve your problems; we also optimize your decision making information and, at the same time, minimize your time involvement, allowing you to focus on your core areas of expertise.

For Best Benefits clients, Human Arc’s medically-driven, third generation Precisionsm predictive modeling quickly identifies the likeliest disability candidates, strictly in accordance with government and medical standards.

  • Compliance with exacting government disability definitions is optimized because Precision is based on the Social Security Administration’s own 14 body systems of adult (and 15 pediatric) disability criteria.
  • You are assured the most effective data mining results.  Precision has received significant input from state Disability Determination Unit physicians and PhD’s who rule on SSI applications within Social Security Administration guidelines.

Our technology doesn’t just identify who the optimal candidates are.  Human Arc’s information processing systems also identify quickly and economically where these members are. 

The Human Arc Edge - the Longest Experience

For 26 years, our focus has been revenue enhancement and recovery for providers and plans. Our clients include some of the most prominent hospitals and managed care firms in the country. Hospitals refer literally thousands of uninsured and under-insured patients per month to us for assistance with Medicaid program enrollment. About half of the patients we successfully help are enrolled in eligibility programs requiring disability determination (such as SSI), so we process many thousands of disability applications every year.

  • You can have confidence in Best Benefits’ expertise.  Our management has depth in both government disability determination and industry operational perspectives.
  • You’ll get more SSI applications approved… faster… due to our long, successful relationships with government agencies.  We pre-notify agencies of our actions, perform pre-adjudication work for them, and provide them with “cleaner,” more viable application packages. 
  • Your members have trained experts working with them on their behalf.  Best Benefits specialists are disability-experienced.  They have passed the Social Security Administration Non-Attorney Demonstration Project exam to qualify to represent plan members.  They are expert in compassionate, respectful screening and application support.  And, since SSI impacts food stamp allocations, housing assistance and other programs (which can have real consequences if ignored or misunderstood), Best Benefits specialists help members to carefully weigh all their options.
  • Tested resources assure better outcomes. Best Benefits outreach is proven to educate members and elicit interest and active participation from them.  We have special skills with the aged, the communications-challenged and the transient.  Human Arc maintains multi-lingual depth and 24/7 access to a national translation service, and we have proven methods for locating difficult-to-find individuals. 

Controlling Member Churn: Reducing Coverage Interruptions

  • Controlling Member Churn - Reducing Coverage Interruptions and Gaps in Care is the very timely and fact-filled presentation made by Ms. Jill Spencer, Human Arc Vice President of Business Development, to attendees of the February 24 - 26, 2010, Third Annual Medicaid Managed Care Summit held in National Harbor, Maryland, and sponsored by the World Research Group (New York, NY).  This presentation focuses on the financial and quality measurement impacts of churn and how to take action to control it.  To view Ms. Spencer's presentation visuals, please link here.

Finding and Engaging the Medicaid Plan Member

  • Finding and Engaging the Medicaid Plan Member is the insightful presentation made by Mr. Glen Lair, Human Arc Executive Vice President, to attendees of the February 24 - 26, 2009, Second Annual Medicaid Managed Care Summit held in Washington, D.C., and sponsored by the World Research Group (New York, NY).  Mr. Lair's presentation focused on key ways that Medicaid health plans can optimize their initiatives to find, contact and enroll new plan members. To view Mr. Lair's presentation visuals, please link here.

Case Studies

Nothing speaks like proof, so here's how Best Benefits has actually helped its clients.

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1. SSI Monthly Statistics, February 2010, Table 2, SSA Office of Retirement and Disability Policy.