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The state of the Medicaid tech stack and readiness for upcoming eligibility changes
Health Tech Nerds
31:11
Overview
This video discusses the upcoming changes to Medicaid eligibility requirements, particularly focusing on HR1's new work and community engagement requirements for able-bodied adults. Experts Luke Ferrell and Nikita discuss the immense technical and administrative challenges states face in implementing these changes by January 1, 2027. They highlight the burden on beneficiaries, the complexity of updating state systems, and the need for better technology and in-house technical expertise within government agencies. The conversation also touches on the role of private vendors, the potential for corporate capture in the Medicaid tech space, and the importance of procurement reform and innovative solutions to improve user experience and administrative efficiency, such as increasing ex parte renewal rates.
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Chapters
- •Introduction of Luke Ferrell (University of Michigan, Tech Talent Project) and Nikita (Fortuna Health).
- •HR1 introduces new requirements for Medicaid expansion populations (able-bodied adults).
- •Focus on 80 hours of work/community participation per month, with exemptions for caregivers, medically frail individuals, and those with children under 12.
- •New requirements are in addition to existing income and medical eligibility criteria.
- •Tight timeline for states to update systems before January 1, 2027.
- •Complexity for states in interpreting and implementing CMS guidelines.
- •Significant communication challenges to inform beneficiaries of new requirements.
- •Beneficiaries face learning costs and risks of losing coverage due to administrative burdens or incorrect actions.
- •Household composition changes can complicate eligibility.
- •States need to update eligibility enrollment systems, front-end portals, and caseworker training.
- •Fortuna Health partners with health plans and health systems to help beneficiaries navigate Medicaid.
- •They see a wide range of issues beneficiaries face, including complex household permutations.
- •Additional complexity arises in states with county-level Medicaid administration.
- •Fortuna provides insights to states and caseworkers based on large-scale beneficiary interactions.
- •Emphasis on leveraging existing networks (health systems, CBOs) for communication and support.
- •Luke Ferrell's article on the 'means testing industrial complex' highlights corporate capture in Medicaid administration.
- •Pledges by companies like Deloitte and Equifax regarding Medicaid technology.
- •Noteworthy absence of Equifax from recent CMS pledges.
- •CMS's call for pledges is a positive step towards a more consolidated federal approach.
- •Potential for $600 million in savings through work requirement implementation.
- •CMS is working to bring innovation and use market power to help states.
- •Procurement is a significant barrier, with CMS acknowledging the need for accelerated pathways for smaller innovators.
- •States are often locked into contracts, requiring legal expertise to navigate.
- •Importance of in-house technical staff (software engineers, data scientists) in government to interpret contracts and system designs.
- •CMS 9010 matching funds can be used to hire technologists.
- •Opportunity for states to build in-house technical capacity during this 'generational challenge'.
- •Despite the negative impacts of work requirements, there's an opportunity for innovation.
- •Procurement reform and new innovations are causes for optimism.
- •Improved communication infrastructure (e.g., texting) is being developed.
- •Potential positive outcomes from resources supporting work and community engagement, touching on social determinants of health.
- •Ex parte renewals (automatic renewals using administrative data) have significantly increased post-unwinding.
- •Rates have risen from 10-20% to over 50% nationwide.
- •Higher ex parte rates reduce burden on beneficiaries and state caseworkers.
- •States can increase ex parte rates by utilizing more data sources (e.g., state wage data, education data).
- •Some states achieve ex parte rates as high as 80%.
- •Data schema design and data freshness impact the accuracy of ex parte renewals.
- •Challenges exist with data sources that are not real-time.
- •Continued investment in automation and ex parte renewals is a CMS priority.
- •Increased automation frees up capacity for complex cases and improves beneficiary experience.
- •Hope for continued progress in making renewals more automatic and less burdensome.
Key Takeaways
- 1HR1 introduces significant new work and community engagement requirements for certain Medicaid beneficiaries, creating a complex implementation challenge for states.
- 2States face immense technical hurdles in updating eligibility systems and administrative processes by the January 1, 2027 deadline.
- 3Beneficiaries are at high risk of losing coverage due to administrative burdens, communication gaps, and the complexity of new rules.
- 4There is a critical need for increased in-house technical expertise within government agencies to manage complex IT contracts and systems.
- 5Procurement reform and the introduction of new, innovative technology vendors are essential to improve the Medicaid tech stack.
- 6Increasing ex parte (automatic) renewal rates is a key strategy to reduce administrative burden and improve the beneficiary experience.
- 7Leveraging diverse data sources and improving data freshness are crucial for maximizing automatic renewals and ensuring accurate eligibility.
- 8While challenging, the current moment presents an opportunity to build more robust public infrastructure and improve the dignity and efficiency of the safety net.