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Medicaid expansion, insurance exchanges taxing state health agencies

John Moore | Aug. 30, 2013
Dual deadlines for implementing new health insurance exchanges and enrolling Americans now eligible for Medicaid is leaving IT departments at state health agencies scrambling to update legacy systems while integrating them with new applications. Not surprisingly, some are opting for phased rollouts.

States Tackling Medicaid Expansion, Insurance Exchanges Simultaneously
California anticipates an estimated 1.4 million new enrollees for Medi-Cal, the state's Medicaid program. The California Healthcare Eligibility, Enrollment and Retention System ( CalHEERS) is the umbrella project for the expansion. To develop the system, the state last year awarded Accenture a contract valued at about $183 million for the initial development and deployment phase and about $176 million for "continued development and initial operating costs."

States such as California are tackling Medicaid expansion and health benefits exchange projects in tandem. The two initiatives are closely tied: Since someone who qualifies for Medicaid can't purchase insurance on an exchange, a state needs to first determine whether an individual qualifies for Medicaid. If the person does quality, he or she is directed to the government health program; if not, it's to the state's health benefits exchange. That coordination calls for the integration of Medicaid eligibility systems and exchanges.

California is pursuing integration in a CalHEERS subproject called the Health Exchange and Medi-Cal Interface/Integration (HEMI) project, notes Anthony Cava, a spokesman for the California Department of Health Care Services.

HEMI covers "the integration touch points" between the state eligibility system, called the Medicaid Eligibility Database System, and Covered California, the state insurance exchange. A status report from the California Health Benefit Exchange notes that CalHEERS is slated to launch Oct. 1 but adds that testing is a few weeks behind schedule.

Arizona, meanwhile, is replacing three legacy systems that support Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance to Needy Families (TANF), CHIP and local health programs. The state is deploying a new Web application that will support the insurance-affordability programs ACA requires.

Bobbie Wilbur, director of Social Interest Solutions, which is serving as the systems integrator working on the State of Arizona Eligibility and Enrollment System replacement project, said its scheduled Oct. 1 implementation will include expanded Medicaid determination.

While the state builds this application, it plans to tap the federal government for its insurance exchange. Arizona is among the states that will leverage a Federally Facilitated Marketplace instead of building its own exchange.

The way the project is unfolding, a person who thinks he or she might qualify for Medicaid, CHIP, SNAP, TANF or other local health programs submits an application to Arizona's Web-based eligibility and enrollment system, known as Health-e-Arizona PLUS. A qualifying individual would be determined, hopefully in real-time, for one of these programs, Wilbur says.

If the person doesn't pass the means test, his or her data would then be transferred to the Federally Facilitated Marketplace. Here an individual can be assessed for eligibility in the ACA's insurance affordability programs, Wilbur explains.

 

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