How Medicaid can improve its IT systems and manage uptick in enrollment

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The economic effects of the COVID-19 pandemic may lead to a sharp increase in Medicaid eligibility and enrollment this year, but information management systems that states have in place are not properly equipped, according to Health Affairs.

Eligibility for Medicaid is expected to increase by 5 million to 18 million people by the end of 2020, depending on how high the U.S. unemployment rate rises, according to a recent Health Management Associates study.

To avoid IT issues that may arise with an influx of enrollees, states should consider switching from their legacy systems to more modern, state-based information systems, according to the report.

Here are five features and capabilities of modern Medicaid IT systems: 

  • Ability to manage a surge in claims and enroll newly eligible individuals quickly
  • Can combine Medicaid data with the state's health information exchange
  • Embraces outcomes-based certification, which CMS is supporting to help achieve business outcomes and reduce burdens on states
  • Ability to track quality of care, patient safety and health outcomes in addition to pay claims
  • Allow providers to receive real-time alerts when patients go the emergency department or are admitted to the hospital

Click here to view the full report.

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