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Older IT systems can cause gaps in eligibility and coverage, insufficient coordination across programs separated by silos, and chronic underfunding, Meyer noted. And it is easy to overwhelm “legacy” systems.
“Applications for unemployment benefits are long, complicated, and sometimes entirely analog…. Some states lack mobile responsive websites, which constrains low-income residents who don’t own computers and cannot access desktop computers in locked down public spaces such as libraries,” said he wrote.
“Back-end processing is often manual, labor intensive, and fraught with bottlenecks. Mailers to verify loss of employment delay processing by at least a few days.”
Over the rest of 2020, Medicaid is expected to increase by 5 million beneficiaries to reach a total of 18 million enrollees, according to a Health Management Associates study.
But with the outdated IT, are states equipped to handle the influx of new enrollees? And will the healthcare system see a repeat of the unemployment insurance experience, with systems crashing and individuals eligible for Medicaid remaining uninsured, Meyer posited.
In order to successfully handle the influx, CMS encouraged states to fully upgrade their IT systems and also improve and standardize the Medicaid Enterprise System data, processes, architecture, and transaction specifications.
In turn, this improves program management and ensures broader interoperability.
“Imagine if the more severe scenario in the Health Management Associates (HMA) analysis unfolds, and some 18 million people become newly eligible for Medicaid over the next several months, or over the next year. The systems need more than an ‘upgrade,’ which implies keeping the main system but adding some new features to it,” Meyer said.
So far, Maryland, Delaware, and Kentucky have made the steps to modernize Medicaid IT infrastructure. But,many other states are far behind.
Meyer mentioned key features of modern state-based IT systems to help guide states as they attempt to implement more modernization in their systems.
Some key features include using modern hardware and software systems that can handle an increase in claims and enroll newly eligible people quickly, as well as tying Medicaid into a state’s Health IT exchange.
Additionally, Meyer urged states to move away from the old MMIS systems toward Outcomes-Based Certification and develop the capacity to track quality of care, patient safety, and health outcomes rather than just pay claims.
The last suggestion is to enable providers to get real-time alerts when patients go to the emergency department or are admitted to the hospital for any reason.
The Kaiser Commissions on Medicaid also offered steps to help individuals apply for Medicaid through a user-friendly application approach.
A few of the steps Kaiser Commissions suggested were to offer sufficient assistant training and support, expanding call center capacity quickly in times of demand, allow potential applicants to pre-screen their eligibility and electronically upload information, offer mobile-based options for enrolling.
Developing updated IT systems may take time, but the improvements are vital for both patients and providers.
“Antiquated IT systems should be scrapped rather than patched, and replaced by modern hardware, software, and coding systems. Further progress toward achieving universal access to WiFi would also help to make eligibility determination and program enrollment quicker and more accurate,” Meyer concluded.
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