Updates to State Medicaid Eligibility and Enrollment Systems - CIOs Survey

This weekend, the final 100-day countdown to open enrollment begins. Will state Medicaid eligibility and enrollment systems be ready? Results from a recent survey published by the National Association of State Chief Information Officers (NASCIO) and the Healthcare Information and Management Systems Society (HIMSS) indicate that 72% of the 26 states and/or territories that responded report that their state or territory will be implementing a new system before 2014, when new eligibility and enrollment processes kick in.

States that participated in the survey overwhelmingly responded that most of the funding comes from the 90 percent federal match that is available for eligibility and enrollment systems development and implementation through 2015. Two-thirds (68%) of the state chief information officers (CIO) indicate they currently leverage the Medicaid eligibility system to benefit other social service programs. (Other programs can benefit from the Medicaid upgrade.

If the Medicaid system needs a feature, other programs can benefit and pay any additional cost for integrating the other program. Disappointingly, only 22 percent of states with state-based marketplaces (SBM) were definite about integrating Medicaid and the SBM systems. Over half (56%) were still undecided.

But let’s get back to the system readiness question. CMS is busily working with state Medicaid and CHIP agencies on contingency planning. To the extent that, even temporarily, states will be implementing “work-arounds,” it is important for navigators, assisters and other stakeholders to understand how any interim eligibility and enrollment processes will work. Some states are discussing their contingency plans in open door meetings, but others may be planning behind the scenes. As we get closer to open enrollment, it’s important for states to be transparent about how things will work on day one, and beyond as changes are introduced. By setting expectations openly, states may save themselves a lot of headaches even when things are working according to the contingency plan because stakeholders didn’t know what to expect.

Don’t know what your state is up to? Ask for a copy of the contingency plan, or better still, ask to participate in the contingency planning process so that the needs of consumers are well represented as key decisions are being made.

Source: Tricia Brooks

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