90/10 Rule is Final: Time to Upgrade to a More Reliable & Efficient Model

Remember driving an older model car that generally got you from point A to point B but not without stalling at a traffic light or having the heater cut out in the dead of winter? Thats a bit like the old, tired legacy systems currently being used to determine eligibility for Medicaid (and other programs) in many states today. The good news is that states now have a strong financial incentive to replace or upgrade those systems to bring them in line with 21st century technology.

Yesterday, CMS issued a final rule that will provide 90 percent of the cost for states to develop and upgrade their IT systems to help people enroll in Medicaid or the Children‘s Health Insurance Program (CHIP), and 75 percent of ongoing operational costs. The rules also establish performance standards for the improved eligibility systems to promote greater efficiency and a more consumer-friendly enrollment process.

There is a lot of techie detail in the rule, as well as CMSs responses to comments, regarding the requirements that these systems must meet in order for system design, development and implementation costs to be qualify for 90 percent federal financial participation. Im not sure that readers of Say Ahhh! want to dig into that kind of nitty gritty on a Friday afternoon, so I’ll try to stick to the highlights. 

The rule emphasizes the need for a modular, flexible approach to systems development that promotes both the ease of maintenance as well as the sharing, leverage and reuse of systems within and among states. Whats really important to most of us is that these systems are expected to improve enrollment and renewal by:

  • Supporting accurate and timely processing of eligibility decisions and effective communications with providers, beneficiaries and the public,
  • Producing transaction data, reports and performance information that contribute to program evaluation, continuous business improvement, and transparency and accountability
  • Ensuring seamless coordination with the Exchange and allow interoperability with health information exchanges, public health agencies, human services programs and community organizations providing outreach enrollment assistance services.

It’s important to keep in mind that this is a time-limited opportunity. To qualify for the 90 percent funding, states must incur costs for goods and services furnished no later than December 31, 2015. But to help states get started right away, the rule waives both the 30- and 60-day delay in effective date.

In the coming weeks and months, we’ll continue to dig into the technology-related issues to help advocates understand the opportunities for them to have input into system development as states move forward. While it may not be as easy as shopping for a new car, driving it off the lot will be every bit as exciting as we see the emergence of enrollment and renewal systems that deliver on the promise of a 21st century, customer-focused experience.