Most of the attention on IT development has been focused on eligibility and enrollment systems, those customer-facing websites and online applications that collect data from the applicant and other electronic sources to determine eligibility. But behind the scenes, Medicaid Management Information Systems (MMIS) support the “backend” administrative functions such as provider enrollment, prior authorization, medical claims processing and payment, beneficiary eligibility checks and more. These systems are just as essential for the efficiency and accurate functioning of Medicaid, particularly to the provider community, as the front-facing eligibility and enrollment systems. And yes, they are just as complicated and expensive to design and deploy.
For some time, the federal government has supported MMIS systems with an enhanced federal match. And that’s why CMS was able to extend the 90% match to eligibility systems by expanding the definition of claims to include “claims of eligibility.” And although some states are still scrambling to bring their new systems online, I can only imagine where we might be without the enhanced match.
But one thing has perplexed me. Why does every state need its own system when these systems perform essentially the same functions from state to state? So I was excited to see that Michigan and Illinois plan to share an MMIS system. Just like its decades-old Medicaid eligibility system, Illinois’s MMIS system is more than 30 years old, and replacing it came with an estimated $190 million price tag. However, by sharing Michigan’s system, the cost will be cut in half saving both Illinois and federal taxpayers lots of money. Michigan will also save money because of the economies of scale in operating a shared technology environment.
Kudos to Michigan and Illinois for setting a new standard for states. I’m sure it’s the kind of approach that CMS would like to see more of and will be actively encouraging with states moving forward. I only wish more states had taken this approach in building their new eligibility and enrollment systems.
[Related Content: Please see the Say Ahhh! Tech Tuesday blog series for more blogs on this topic.]
