Making Medicaid Work Better: Lessons from States on Implementing Ex Parte Renewals

This brief focuses on states’ experiences in implementing data-driven renewals in Medicaid through a process called ‘ex parte’ – using third party data sources to confirm ongoing eligibility. We interviewed officials in eight diverse states to identify the challenges states face in automating the renewal process and summarize their experiences in overcoming these barriers to achieve high rates of ex parte renewals. The authors also drew on their deep knowledge about the state processes and input from stakeholders who are familiar with the federal rules and have first-hand experience with how implementation of data-driven renewals is playing out in the states.

The brief highlights some of the challenges that states have faced in implementing ex parte renewals and offers tips in overcoming them. It was clear that states have different perspectives  in both defining ex parte renewals and in state philosophy toward using federal flexibility to achieve high rates of automated renewals. We also found evidence that states have learned much since the days of patching up their legacy-based mainframe eligibility systems. These lessons include hiring IT professionals who can aptly manage vendor contracts, getting the design right on paper before starting to build the system, phasing in system functionality, fixing problems rather than using workarounds, and making a concerted effort to facilitate agency culture change.

Support for this technical brief was provided by a grant from the Robert Wood Johnson Foundation.

A special thanks to the Robert Wood Johnson Foundation for its support of our work on providing feedback to HHS and highlighting how ACA implementation is impacting consumers.

Tricia Brooks is a Research Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.