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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.

Back East, West Virginia's integrated eligibility solution, eRAPIDS, will interface with the state's exchange, the latter running as a state-federal partnership. The interface lets West Virginia citizens "apply for expanded Medicaid through 'no wrong door,'" notes Edward Dolly, deputy commissioner and state health information technology coordinator for the West Virginia Bureau for Medical Services.

An eRAPIDS system upgrade is also underway; Dolly says upgrades are required to allow state systems to determine financial eligibility for Medicaid based on MAGI.

Other states are also upgrading systems, eying the fall open enrollment target.

In Illinois, where about 342,000 are expected to enroll in expanded Medicaid, the state is developing its Application for Benefits Eligibility System. Kelly Jakubek, a spokeswoman for the Illinois Department of Healthcare and Family Services, said the online system is scheduled to launch Oct. 1, when consumers will be able to apply for Medicaid and other social services. She says the Illinois Health Insurance Marketplace, the state's benefits exchange, will also have an online application system.

Finally, Colorado is upgrading its online application, called PEAK, to meet ACA and Medicaid expansion requirements, says Rachel Reiter, communications director with the Policy and Communications Office of the Colorado Department of Health Care Policy and Financing.

Reiter says application upgrades will be in place so Coloradans can begin applying for coverage beginning in October. The state plans to keep upgrading its platform over time to boost the user experience. For example, she says, by year's end the state will add the option for clients to receive communications through an electronic inbox on the PEAK website, rather than the U.S. mail.

Medicaid, Insurance Exchange Work Proving to Be Complex Transition
States have little time left to prepare systems and must confront a number of issues as they pursue the October and January 2014 target dates.

Wilbur cited the shift to the MAGI methodology as one of the main challenges of Medicaid expansions. MAGI uses federal income tax data to make an eligibility determination; the traditional approach uses the current income of people who share financial resources.

While states must account for MAGI, they must still handle eligibility in the traditional way for other Medicaid groups such as disabled people, Wilbur says. "We have essentially added a new Medicaid program on top of what was already there," she says. "It's very complex. Medicaid agencies are scrambling to understand it."

Integrating systems across different agencies presents another hurdle. Links between Medicaid systems and health insurance exchanges, for example, will often cross organizational boundaries. While Medicaid programs reside within health and human services departments, health insurance exchanges may operate as independent state agencies, nonprofit public entities or private/public partnerships distinct from state governments.


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