Hello PASCO family! Welcome to “Ask the CEO,” our monthly blog series that brings you closer to the “why” behind PASCO initiatives, policies, and offerings. As a company committed to transparency and community building, we strongly believe in fostering open communication with our PASCO family.
By providing you with insights into our thought processes, we aim to build a stronger bridge of understanding and collaboration. If you have questions you would like answered in an upcoming blog, please do not hesitate to fill out the form below. We’d love to hear from you.
Q: What effects would the upcoming potential government shutdown have on my pay and the services I provide as a caregiver?
A: In the midst of uncertainty surrounding a potential government shutdown, it’s understandable for our families to be concerned about their income and ability to continue care through Medicaid. In the last week I’ve received several questions about what a potential government shutdown may bring for PASCO families.
I’d like to ensure that your loved one’s care and your compensation as caregivers are covered in the event of a short-term shutdown for various reasons:
- Programs like Medicaid are considered “mandatory spending” which means that these services are required to remain open even during a shutdown. This requirement reduces the risk of staffing shortages with these programs which can lead to delays and lapses in funding.
- The services that caregivers provide through PASCO are funded by the State of Colorado and our state budget. While our state receives a significant portion of its Medicaid dollars from the federal CMS program, this division provides additional protections for Medicaid funds. However, since Medicaid is considered “mandatory spending”, these funds are protected at the federal level. This means that our funding is well protected at both the state and federal level in the occurrence of a shutdown.
- At PASCO, we are well-prepared to navigate potential disruptions caused by emergencies such as a shutdown. Agencies providing Medicaid services are required to keep services active for their clients for three months, even if funding is not received through the state during that time. This is why it’s critical to partner with a reputable agency like PASCO to provide services.
As new developments arise regarding the shutdown, we will be sure to communicate these changes with our families. If you have any questions or concerns regarding these changes, please do not hesitate to connect with our support team at firstname.lastname@example.org or by calling (303) 233-3122.
Q: How has PASCO managed the end of the Public Health Emergency and the start of Medicaid redeterminations? How are our families faring?
A: I’m excited to share that less than 1% of PASCO families have lost state plan benefits to date as a result of the PHE ending and we’re actively working with these families to get coverage reinstated while they continue to provide care to their loved ones through PASCO. I’m incredibly proud of this. HCPF has stated they estimated 315,000 Colorado Medicaid Members would lose coverage through this process (~18% of Medicaid Members). We are nowhere near that percentage, which I believe is a testament to the ethical billing standards we uphold, our knowledge of the Colorado Medicaid system, our proactive communication with families ensuring they were aware of what was happening and when responses were needed and our commitment to advocating for our families.
I understand that the end of the Public Health Emergency and the urgency of Medicaid renewals can seem stressful and overwhelming to navigate. I want to assure you that you’re in good hands with your PASCO team and that we’re with you every step of the way. We’ve been preparing for these changes starting long before they were announced to ensure we mitigated as much risk as possible of our clients receiving an unnecessary gap in coverage. Our overall goal is to allow you to continue focusing on the care you provide for your loved ones day in and day out. If you have any questions about how to best prepare for the redetermination process, please contact your PASCO service coordinator or nurse. We’re with you!
Q: PASCO made significant changes to its health insurance program this year. Why were these changes made and what can I do to find affordable coverage?
A: In prior years, PASCO contracted with Kaiser to provide health insurance to its employees and their loved ones. Like other insurance providers, Kaiser sets its price based on our organization’s insurance claims in the prior coverage period and the rising cost of medical and pharmaceutical services in our area.
Despite our best efforts, our health insurance plan – like plans across the country – continues to face significant challenges due to cost inflation and the impact of Affordable Care Act regulations which do not account for our unique business model (specifically what the employee premium contribution can be and which household members the plan is required to cover). Our plan also faces additional burden due to uncharacteristically high plan utilization, which has caused its costs to dramatically outpace national medical inflation over the past years.
We did everything we could to avoid having to make this decision, but ultimately the rate increases that Kaiser was pushing on us (double-digit increases the last two years in a row) coupled with the Affordable Care Act’s coverage mandates and employee premium contribution limit decrease this year, made our current program unsustainable. We contacted other full insurers to provide offers and no other reputable insurer was willing to cover us.
Through significant effort, we did secure coverage though and were able to offer a plan once again. The objective of this plan is to lower our claims costs so we can hopefully have better options in the future. This new plan uses a few different tools to try to get there. First, our new plan does not have a network affiliation. It pays a multiple of what Medicaid would pay to the provider for any services rendered. It’s important for subscribers to verify with their provider in advance of the visit that they will accept this type of insurance to avoid balance billing. Secondly, while the cost of employee-only coverage went down, all other coverage options increased and spouses are no longer eligible for coverage.
At PASCO we believe deeply in Care for the Caregiver, and ultimately came to the conclusion that if we can help our caregivers evaluate all their options, we can help them find higher quality, more affordable care through other avenues including Connect for Health where they benefit from being pooled with the general Colorado population who have lower utilization. To this end, PASCO provided a Health Insurance Navigator free of charge to employees to support them in finding, understanding, and evaluating all options.
If you or a household member experience a qualifying event and would like to reevaluate your coverage options, please send a ticket to email@example.com so our team can help connect you with our Health Insurance Navigator.