Even as states across the country continue to evaluate their options for implementing the Affordable Care Act (ACA), almost all states are moving to take advantage of significant federal funding to modernize their Medicaid information technology (IT) infrastructures in response to the new law. The decisions being made now and in the months ahead will have far-reaching implications for the success of the ACA. If people feel welcomed and are encouraged to apply for health insurance through a sleek, simple-to-navigate website which easily connects them to coverage, it will have an enormous impact on their first impressions of health reform and, ultimately, on the ability of the law to meet its goal of expanding health care coverage.
New consumer-friendly IT systems, linked to electronic sources of data to verify eligibility more efficiently, accurately, and timely than paper-driven processes, also hold the promise of revolutionizing the Medicaid eligibility and enrollment experience. These IT systems will often replace decades-old technology and create efficiencies by minimizing the paperwork burden on both consumers and eligibility workers in state, county, and local government offices; reducing processing delays and backlogs; improving client communications; and producing data to assess how well our health coverage programs are performing.
Not only will the systems be the primary gateway to coverage for millions and shape consumer opinion about the ACA, a large number of important policy decisions will be embedded in new systems as many of administrative tasks that intake and eligibility workers currently perform are automated. For example: how will states define when information provided by the consumer and electronic data sources, although different, are reasonably compatible and require no further review or explanation? Which data source will trump another? How will the system count a pregnant woman in the household size of her children for Medicaid? In some instances, these and many other policy questions are not being addressed in advance of the system development and may be rushed to maintain the fast pace at which states and their vendors need to meet critical deadlines for IT deployment. Key policy decisions may not be considered in public but rather in small workgroups or advisory committees, thus it is critically important that consumer advocates call for the creation of, and participate in, IT stakeholder advisory workgroups.
The reality for many consumer or policy groups, however, is that IT systems advocacy represents new and potentially daunting territory, particularly for those with limited IT technical knowledge. And that’s where the Advocates IT Toolkit comes in. Julie Silas of Consumers Union and I teamed up to create the toolkit to arm advocates with background information, key questions to ask about the system’s functions and features, and strategies that advocates can use to ensure that IT systems are well-designed for consumers and promote the objectives of streamlined, simplified access to health coverage. The toolkit is designed to be useful for advocates in states that are operating their own exchanges, as well as those in states where a federally-facilitated exchange (FFE) will be operating alone or in a state/federal partnership model.
Even if your state is well on its way to developing its new eligibility and enrollment system and has not embraced a process for involving stakeholders, it will still be important to monitor system performance when it is launched. A crucial role that advocates can play in the early months is to provide critical feedback to their state on what is working and what needs attention and improvement. From taking the online application for a test-drive to reporting consumer experiences that could indicate there is an underlying system problem, advocates will help ensure that these systems not only address the shortcomings of the legacy systems they are replacing, but truly make it easier for consumers to enroll and retain coverage going forward.
[For more on this topic, view the Tech Tuesday blog series by Tricia Brooks.]
