Integrating Hospital Financial Assistance: The Next Health Equity Initiative for ACA & Medicare Plans

By Nick McLaughlin, Strategic Advisor, Emry Health 

Healthcare organizations are increasingly recognizing the importance of advancing health equity for their members. Health equity involves creating a healthcare environment that acknowledges and respects the diverse backgrounds of its members, ensures equitable access to care and fosters an inclusive atmosphere where everyone feels valued and supported. While health plans have already implemented many health equity initiatives, one strategy they may not yet be considering is the integration of hospital financial assistance programs into their ACA and Medicare plans. This initiative tackles financial disparities directly, ensuring that all members, especially those from low-income backgrounds, have access to affordable care without the burden of overwhelming medical debt. Additionally, integrating these programs can significantly enhance member satisfaction and improve CMS quality ratings.

Supporting Marginalized Communities & Reinforcing Your Commitment to health equity

Medical debt is a significant issue among ACA and Medicare enrollees. According to the Consumer Financial Protection Bureau, nearly four million older adults with medical debt reported having health insurance, and 37% of all insured adults can’t afford a $400 emergency expense. 

By integrating hospital financial assistance technology into your health plan, you can alleviate this burden, particularly for lower-income families with multiple dependents or enrollees on fixed incomes. For example, a family of four earning up to $130,000 per year may qualify for free or discounted care at many hospitals. Proactively screening for financial assistance eligibility can zero out hospital bills for eligible members.

Directing ACA and Medicare members to hospital websites or campuses with hard-to-find applications is not enough. Health plans have an opportunity to integrate and streamline the FA application process. Innovative solutions are available that make the process simple, enabling quick completion from eligibility verification to application submission.

Health plans can integrate and offer technology that allows members to:

  • Instantly check eligibility at local hospitals
  • Apply for financial assistance online
  • Get human help when needed

These tools streamline the application process, reducing the bureaucratic barriers that often deter members from seeking assistance. This approach can significantly alleviate the burden of medical debt and enhance member satisfaction. 

Addressing financial disparities head-on through these initiatives allows health plans to reinforce their commitment to health equity. This approach promotes a culture that integrates health equity into plan operations, ensuring that all members receive the care they need regardless of socioeconomic status. This commitment will resonate with members, attracting new enrollees who are looking for plans that prioritize their well-being and financial stability. Moreover, it could enhance CMS quality ratings, as member satisfaction and care quality improve.

Meeting and Exceeding CMS Quality Ratings

Health equity initiatives are critical in achieving high CMS quality ratings. ACA plans must submit a Quality Improvement Strategy (QIS), which details how they plan to manage and serve their members with a focus on equity and inclusion. These submissions are mandatory for issuers that have been in the exchange market for over two years and are crucial for CMS evaluations. High ratings are influenced by member satisfaction and quality of care, both of which can be improved by integrating financial assistance programs​.

CMS also surveys enrollees to assess their satisfaction and quality of care. These surveys play a significant role in determining a health plan’s star rating, which can influence potential enrollees’ choices. Integrating financial assistance programs can enhance member experiences and satisfaction, leading to higher quality ratings and making plans more attractive on HealthCare.gov​. 

Integrating hospital financial assistance into ACA health plans is a powerful health equity initiative. It not only addresses financial disparities but also enhances the overall quality of care, member experience, and satisfaction. By simplifying access to financial assistance and proactively supporting members, health plans can improve their CMS quality ratings and attract new members. Prioritizing these initiatives ensures that all members have access to equitable and high-quality healthcare.


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