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Fiscal Fitness: How States Cope
California's Medi-Cal modernizing enrollment
California's Medi-Cal Eligibility System (MEDS) will need to be completely replaced to accommodate the changes necessary to implement health care reform, according to Vivian Auble, a senior consultant at Health Management Associates in Sacramento and former chief of California's Medi-Cal eligibility division. This could cost up to $250 million, not including costs to establish and operate the state insurance exchange, or to develop a new application and enrollment portal.
"It will not be possible to build upon the aging infrastructure that exists today, which is an aging legacy system more than 30 years old," says Auble.
The state will need to develop an online enrollment and application process, simplify eligibility rules and documentation requirements, and integrate systems to allow sharing of information among the state, counties, and the insurance exchanges.
"California will need to modernize its enrollment process to make it less cumbersome for applicants," says Ms. Auble. "Outdated technology makes it difficult to make policy changes quickly, accurately, or share information among programs. Manual processes that currently exist are time-consuming and prone to error."
Currently, MEDS is the only statewide system that stores all information on the almost 7 million Medi-Cal beneficiaries. MEDS also is used by the Medicaid Management Information System (MMIS) to track eligibles, claims payment and services, and draw down federal dollars. However, California's 58 counties operate four different county automated systems. These determine eligibility based primarily on mailed-in applications.
"The county systems have no ability to quickly make policy changes, and do not share information among themselves," says Ms. Auble. "The state will need to decide what role the counties will continue to play in eligibility determination."
California's Children's Health Insurance Program (CHIP) operates a separate online or mail-in system for its Healthy Families program. "Any new statewide system will need to have the capability of allowing online application, enrollment, and screening for Medi-Cal/CHIP or health insurance subsidies," says Ms. Auble.
The system must be able to transfer cases that are not eligible for Medi-Cal to the insurance exchange, for enrollment in one of the health plans offered.
"The state will also need to develop a uniform application that can be used to screen for Medi-Cal, subsidized care, or insurance exchange coverage," says Ms. Auble. "System development costs will be enormous."
In addition, California's MMIS system will require modification to enable accurate federal claiming of new eligibles. "However, costs will be minimal compared to the funding necessary to establish the exchange or develop the new online enrollment system," says Ms. Auble. "Developing a streamlined approach will be challenging in an environment with so many interested stakeholders, complex labor issues, and competing vendors."
The legislature's approval is required to develop the feasibility study report and to procure a vendor to develop the statewide online application and enrollment system.
"The state Health and Human Services Agency has recently been involved in a project to develop an online screening/application portal that could be used for many public assistance programs," notes Ms. Auble. "Much of the work related to that effort may be salvaged or adapted for the new online application process."
California already uses more than 150 codes to track eligibility for Medi-Cal, since the program covers so many optional and state-only groups. The changes that will be implemented for health care reform will provide an opportunity possibly to consolidate some of those existing aid categories and/or replace them with new ones. "This will enable accurate tracking of the new eligibles for federal claiming," says Ms. Auble.
Contact Ms. Auble at (916) 446-4601, ext. 423 or email@example.com.