Newly revamped Medicaid enrollment systems aim to meet 2014 requirements
Newly revamped Medicaid enrollment systems aim to meet 2014 requirements
The Oklahoma Health Care Authority has just gone live with a new enrollment system, which has laid the groundwork for the Health Insurance Exchanges (HIEs) that need to be in place by 2014.
"Right now, we are thinking that it will fit very well with the whole exchange process," says Garth L. Splinter, MD, Oklahoma's state Medicaid director. "It is very similar to the exchange needs, in terms of an electronic enrollment system and a way to sort people into the right category." The goal is to have a debugged, well-functioning system well before 2014.
Most of the Insure Oklahoma program's enrollees have private health insurance coverage. "So, we already have a process that looks very much like the exchange function," says Dr. Splinter. "Plans are qualified, and a website makes all that information available, so people can enroll online. They can be enrolled into private plans, with an attached subsidy. That is very much what the exchange envisions." With Insure Oklahoma, money is sent to the employer as a subsidy.
"We think that for some of the mechanisms, we have some of those things in place," says Dr. Splinter. "We already have the mindset necessary to go down that path to do similar things."
Timing is right
Speed and accuracy are expected to increase in the current online enrollment process. "Members are able to access it in multiple locations, and we don't have any worry about miscoding or handwriting," says Dr. Splinter. Information is verified in real time, and applicants are referred to other programs they might be eligible for, such as the Special Supplemental Nutrition Program for Women, Infants and Children.
This system of eligibility allows for more efficient use of state dollars. For instance, when the system processes the Department of Mental Health's claims for outside provider services, it also checks to see if individuals qualify for SoonerCare in order to use federal matching dollars.
"Previously, we had been paying 100% of state dollars for services for what would have been available for federal match," explains Dr. Splinter. "Now, we can get these people enrolled in Medicaid as we identify them."
Both of the recent implementations were being planned before health care reform, but the timing was clearly fortuitous. "There is plenty of time to debug it and educate users," Dr. Splinter says. "I fully expect that we will have some interest from other states about how we are doing the electronic enrollment."
Single point of entry
Connecticut now has a single point-of-entry service, which Michael P. Starkowski, commissioner of Connecticut's Department of Social Services, calls an "Exchange Light." This provides an array of opportunities for children and adults who need insurance, he says.
Clients are automatically screened for the Husky A program (which covers children, parents and relative caregivers up to 185% of the FPL, and pregnant women up to 250%), Husky B (Connecticut's CHIP program, which covers children over 185% of the FPL regardless of income, with those who hit 300% FPL paying the full premium that was negotiated with the managed care organizations), the Charter Oak program, traditional Medicaid, the new Medicaid for Low-Income Adults program and the pre-existing condition insurance plan (temporary high-risk pool).
"All of these are coming through that one single point-of-entry servicer. You have individuals being screened for the most affordable and appropriate product for them, based on their circumstances," says Mr. Starkowski. The system allows clients to select the most cost-effective product for them, based on their medical condition and what they can afford.
If an applicant isn't eligible for Husky A, for example, he or she is automatically screened for the Medicaid for Low-Income Adults program. If they aren't eligible for that program, they are screened for Charter Oak.
However, the applicant might choose not to enroll in the Charter Oak program because of its annual limitation on medical services of $100,000 and $7,500 for pharmaceuticals. "Someone might choose to join the high-risk pool if they have a severe pre-existing condition, and they know their medical costs will be significant during the year," explains Mr. Starkowski.
Massachusetts just replaced its core claims system, which went live in May 1999. "It is just a dream to work with," says Phil Poley, chief operating officer for MassHealth. "The reason we did this is to be able to make changes fairly rapidly, with a flexible, usable system," he says. "Making eligibility system changes is harder, because our eligibility system was built to older standards."
The eligibility system is a legacy system. "It is fine and it performs the way we need it to, but there are things about it that limit us, particularly in the design of notices to members," says Mr. Poley. "The physical hardware and software is older. Also, when you build a new MMIS, you build multiple environments that you can test before you get to a production environment."
Since older systems were not built with that multiple environment approach, it's necessary to bundle all software releases at once, because they can only get tested at one time.
"If CMS were smart, they would make 90% match money for states to redesign eligibility systems and also find a way to encourage states to collaborate on that," says Mr. Poley. "There's no reason why multiple states couldn't share a technology platform."
Contact Mr. Starkowski at (860) 424-5054 or [email protected].
The Oklahoma Health Care Authority has just gone live with a new enrollment system, which has laid the groundwork for the Health Insurance Exchanges (HIEs) that need to be in place by 2014.Subscribe Now for Access
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