Tech Tuesday – A New Blog Series Highlighting Technology and its Potential to Transform Eligibility and Enrollment

I frequently marvel at the deep Medicaid and CHIP policy expertise of so many of our state and national partners. And when someone’s knowledge doesn’t run as deep, they often make up for it in their passion for expanding health care coverage. Whether you’re a seasoned advocate or new to public health coverage, it doesn’t take long to learn that efforts to improve public coverage programs are often stymied by the prevalence of outdated IT systems. From the inability to implement eligibility simplifications to issuing confusing and often conflicting notices, from lost eligibility records to inadequate data to measure program performance; the computer system gets much of the blame. And, rightfully so.

Given the state of technology and web-based services that we use daily at home or work and on the go, it’s sometimes to hard believe that Medicaid eligibility systems are still in the dark ages. But they are; some are more than 30 years old, older than many of the young health policy or public health professionals joining our circle of friends.

Advanced technology can support consumer self-service and program evaluation and will make government work better – more efficiently and cost-effectively. States have a huge incentive to move now to develop new systems. Not only are they required to implement new data-driven Medicaid rules and procedures (regardless of whether they expand Medicaid), but also CMS is offering a time-limited (through 2015) and unprecedented federal match equal to 90 percent of the cost of these new systems. They’ve even sweetened the deal by allowing other programs such as SNAP and childcare assistance to take advantage of functions that will be required of Medicaid eligibility systems going forward.

Although CMS has stepped up to accelerate the pace with which states are harnessing technology to simplify eligibility and promote enrollment and retention, these systems take time to build and fine-tune. According to this chart posted on the National Academy of State Health Policy (NASHP) State Refor(u)m website, a quarter of the states are still at the procurement stage, that is, they haven’t actually awarded their IT contracts yet. And even at the federal level, we know that the IT infrastructure for the federally-facilitated and state partnership exchanges in 34 states won’t include all the bells and whistles on day one of open enrollment.

There are several important reasons for health policy stakeholders and advocates to understand how the eligibility and enrollment systems will work in their state.

  1. Many of the administrative tasks that are associated with processing applications and verifying eligibility will be automated.
  2. We can make the application and enrollment experience work better for real people.
  3. We expect the new systems to report data that will give us a much better sense of how our public coverage programs are performing.
  4. Last but not least, we need to pay attention to make sure these systems are working as intended. Keeping our ears to the ground and providing feedback to state and federal administrators will be an essential aspect of making these systems be the best they can be.

Tech Tuesday will dig into these issues. We’ll explore ten top consumer issues in the new eligibility systems that Julie Silas of Consumer’s Union and I wrote about in our Advocates IT Toolkit. We’ll look behind the scenes at how state verification plans will reveal the data sources that are used to verify eligibility. We’ll look at the federal data services hub and promising practices in the states using IT effectively. We’ll tackle how the FFE’s IT system and the state Medicaid system need to talk to each other to ensure seamless, coordinated enrollment across the insurance affordability programs. And we welcome guest bloggers writing about your experience with IT systems from around the country. So stay tuned for Tech Tuesday. It’s already begun!

[For more on this topic, view the Tech Tuesday blog series by Tricia Brooks or download the CCF-Consumers Union IT Toolkit.]


Tricia Brooks
Tricia Brooks is a Senior Fellow at the Center for Children and Families