The Health & Human Services Department has proposed dramatically boosting funding available to all states to streamline and upgrade their Medicaid eligibility computer systems in preparation for operating the state health insurance exchanges called for in the health reform law.
State Medicaid systems will potentially be eligible for an increased federal matching rate of 90 percent for design and development of new IT systems, as well as a 75 percent federal match for system maintenance and operations, according to Cindy Mann, deputy administrator of the Centers for Medicare and Medicaid Services.
The matching rate currently is 50 percent.
CMS released the notice of proposed rulemaking Nov. 3 in the preview area of the Federal Register, outlining how states can qualify for the funding increases for Medicaid eligibility determination and enrollment activities.
HHS also announced guidance to help states design and establish the information technology needed to develop state health insurance exchanges. These systems will help enroll individuals who qualify for Medicaid or the Children's Health Insurance Program (CHIP), tax credits or cost-sharing reductions available through the Affordable Care Act.
Mann, who is also director for the Center for Medicaid, CHIP and Survey and Certification, said the moves would help states prepare for a simple and seamless enrollment experience for consumers who qualify for Medicaid or who are shopping for health coverage through the exchange marketplace.
"Building a smooth customer experience requires a foundation of integrated eligibility systems for health insurance assistance at both the state and federal levels," she said in the announcement.
When completed in 2014, the exchanges will be a single destination where consumers and small businesses can shop for, compare and purchase health insurance plans. They will be designed to operate like airline, banking and other consumer e-commerce systems, HHS has said.
As states prepare for the exchanges, they have requested early guidance and funding assistance for their technology projects, particularly for their eligibility and enrollment systems, which historically have been not been connected.
Individuals will seek health care coverage without necessarily knowing whether they are looking for one of the marketplace insurance plans, a Medicaid or a CHIP plan, said Joel Ario, director of the Office of Health Insurance Exchanges.
"Effective and efficient data exchange between state and federal health programs is critical to achieving this one-stop shopping experience and today's guidance establishes the framework and approach that will make this seamless coordination possible," he said.
CMS and the Office of Consumer Information and Insurance Oversight are issuing initial technical guidance that will help states decide how they will design, develop, and establish new or improved IT systems for the health insurance exchanges, Medicaid and CHIP.
To be eligible for the federal matching funds, states must meet a set of performance standards and conditions, including seamless coordination with the exchanges. Under the proposed rule, the 90 percent matching rate will be available for eligibility systems through 2015. Subsequently, a 75 percent match will be available.
The announcement today complements another one Oct. 29 to fund "early innovator" grants for up to five state insurance exchange IT models that all states will be able to use.
The state exchange grants will provide 100 percent support for exchange IT infrastructure and today's announced 90 percent matching rate will be available for the exchange-related Medicaid eligibility system changes, as well as for those Medicaid system changes not directly related to the exchanges.
