In under six months, VLBPO managed 305 Medicaid applications, submitted 205 cases, and achieved a 95% approval rate, delivering faster coverage, reduced backlogs, and recovered value from previously denied cases.
Client Overview
Senior Planning, operating under 100 Blvd, is a healthcare and benefits administration organization that provides Medicaid eligibility support and case management services. As demand for Medicaid access grew and case complexity increased, the team needed an experienced partner to manage eligibility workflows end-to-end.
VLBPO was engaged in February 2026 to take full ownership of the Medicaid eligibility journey from initial application through denial recovery and redetermination.
The Challenge
Before VLBPO’s engagement, Senior Planning faced several compounding operational challenges:
- A growing backlog of aged and stalled applications with no clear resolution path
- Complex applicant financial profiles requiring structured spend-down planning
- Previously denied cases from external handlers, many containing documentation and compliance gaps
- Inconsistent workflows across cases due to varying regulatory requirements
- Re-submission turnaround times that were slowing coverage access for patients
These issues were not just operational. They had direct financial consequences for the organization, including delayed reimbursements, write-offs on unresolved cases, and reduced patient access to coverage.
VLBPO’s Approach
VLBPO stepped in as a true operational extension of the Senior Planning team, taking ownership under Power of Attorney (POA). This meant full accountability for every case from intake to approval, not just administrative support.
End-to-End Eligibility Management
VLBPO handled every stage of the Medicaid eligibility process: financial eligibility reviews covering income, assets, and resource thresholds; spend-down strategy execution for over-resourced applicants; documentation collection, validation, and packaging; and direct application submission to the relevant state agencies.
Backlog Recovery
One of the first priorities was clearing the inherited backlog. VLBPO conducted a systematic review of all stalled cases, identified root causes, and prioritized cases by urgency and complexity. Within the first phase of engagement, the backlog was significantly reduced.
Denial Recovery Workflows
VLBPO implemented a rapid denial recovery process. Cases previously denied by external handlers were audited, gaps identified, and re-submissions packaged within a standardized 30-day turnaround window.
Workflow Standardization
Despite varying documentation requirements and regulatory differences across cases, VLBPO developed standardized intake and submission workflows that reduced friction and accelerated cycle times across the full caseload.
Case Example: Reversing a Complex Denial
The following example illustrates the level of case expertise VLBPO brings to high-risk, previously denied Medicaid applications.
Situation
VLBPO inherited a high-risk case that had been sitting unresolved following denial by a prior handler. The original submission failed due to improper income categorization and a misapplied transfer-of-asset analysis that triggered a look-back period violation and penalty flag.
What We Found
A full eligibility and financial compliance audit uncovered: gross vs. net income misrepresentation at submission level; incorrect allocation of income under patient liability vs. allowable deductions; informal transfers misclassified as disqualifying events; an unreviewed look-back window leading to unnecessary penalty exposure; and missing documentation to validate permissible transfers.
What We Did
VLBPO rebuilt the case using compliant income budgeting methodology, conducted a detailed look-back reconciliation to distinguish disqualifying from allowable transfers, provided supporting documentation to eliminate improper penalty flags, corrected patient responsibility calculations, and repackaged the case file with an audit-ready financial trail.
Outcome
The case was successfully reprocessed and approved within one review cycle. The penalty flag was removed and eligibility was established. Coverage that had been denied and delayed for months was secured.
Results
Within five months of engagement, VLBPO delivered measurable outcomes across every key performance area:
- 95% approval rate across all submitted Medicaid applications
- 305 applications managed with 205 successfully submitted and in-pipeline
- 100% case retention, with zero drop-offs at any stage of the process
- Significant backlog reduction achieved in the first phase of engagement
- Re-submission turnaround times reduced to under 30 days
- Strong denial recovery and redetermination success rate
Business Impact
Beyond the numbers, VLBPO’s engagement created structural improvements that benefit Senior Planning’s operations long-term:
- Improved approval yield and speed to coverage, directly supporting better patient access outcomes
- Reduced administrative burden on the internal team through true end-to-end case ownership
- Accelerated coverage activation, improving reimbursement timelines and financial performance
- Recovered value from previously denied or stalled cases, reducing write-offs
- Established a scalable, compliance-driven model capable of handling high-volume eligibility operations
Ready to improve your eligibility operations?
VLBPO partners with healthcare and insurance organizations to deliver measurable outcomes through expert BPO services. Contact us to discuss how we can support your operations.
