High-performing, technology-enabled eligibility and enrollment systems are unequivocally at the heart of the vision of streamlined, real-time access to health coverage under the Affordable Care Act (ACA). New systems offer the promise of remedying many of the consumer issues that advocates have worked on for years including eliminating unnecessary paperwork, making notices clear and understandable, reducing churning, increasing administrative efficiency and producing data to assess program performance.

But as many of the nation’s policymakers continue to debate how to respond to the ACA, the clock is ticking and the deadline for deploying new systems draws closer day-by-day. States are moving forward (some quietly and behind-the-scenes) so it’s difficult to gauge their progress. However, a new report, “Establishing the Technology Infrastructure for Health Insurance Exchanges Under the Affordable Care Act: Initial Observations from the Early Innovator and Advanced Implement States” sheds some light on the progress of states leading on the technology front.

The report very clearly articulates one critical point. No matter a state’s decision to create a state based exchange and/or take advantage of the opportunity to expand coverage to more low-income adults through Medicaid, ALL states must upgrade or replace their Medicaid eligibility systems to align with new eligibility and enrollment procedures. Neither the Supreme Court’s ruling nor a state’s decision of whether to expand Medicaid changes this fact.

The report is based on interviews with policy and technology leaders in states that have made significant progress in designing and developing their Exchange IT infrastructure and/or modernizing Medicaid and CHIP eligibility systems. The authors coalesce their findings in these key themes:

1)   Agreeing on a vision, strategy and realistic plan is essential.

2)   Determining a state’s approach to IT requires a careful assessment of internal and external resources.

3)   Navigating policy and technology is a complicated and pressing challenge.

4)   Leveraging federal resources, reusing technologies developed by other states and federal agencies, and participating in multi-state collaboratives may accelerate development and minimize costs.

5)   To meet deadlines, implementation efforts must proceed despite federal and state policy, technology and political uncertainties.

The report points to a growing body of work that other states can draw from in moving forward. It discusses how IT components developed by leading states can be reused from sharing documents and knowledge to adapting IT code and commercial off-the-shelf software to jointly procuring hardware or software. While the report stops short of answering the question posed in the title of this blog, it does advise states to seek out lessons learned from leading states, to reuse products and to explore opportunities for collaboration with other states and/or the federal government to accelerate the timeline and leverage their resources.

Given that critical policy decisions are embedded in these IT systems, state health policy analysts and consumer advocates should seek opportunities to engage with state officials as they move forward. Later this fall, CCF will release an IT toolkit to identify the top consumer issues and suggest strategies to ensure that these systems deliver on the promise of health reform in a way that meets the needs of consumers.