Medicaid CIOs Feeling Pressure

About a year ago I wrote a blog post describing how Rick Howard, CIO of the Oregon Department of Human Services, was determined to make incremental changes to infrastructure to provide a comprehensive view of clients and populations that Oregon DHS serves.

Howard said he was determined to break down barriers between applications for public health and child welfare, for instance. By shifting to a more modern architecture that involves a data warehouse and shared Web services, Oregon should be able to track common clients across multiple systems, integrate case management services and share common business processes.

I just finished up some reporting for Public CIO magazine that called my attention again to the challenges facing state-level IT leaders in the health reform era, including the creation of health insurance exchanges.

For the article, I interviewed Ivan Handler, CIO of the Illinois Department of Healthcare and Family Services, and Rich Campbell, director of systems and monitoring, and Medicaid CIO for the Washington State Department of Social and Health Services.

Handler told me his agency has to be prepared to handle a half million new Medicaid enrollees in 2014, yet the legacy systems that handle Medicaid, the Children’s Health Insurance Program and Child Support Services were developed in-house more than 20 years ago. He is considering acquiring business services hosted in the cloud instead of procuring and running systems in-house because he is convinced he doesn’t have the financial or staff resources to pull off the transition in time.

Campbell said Washington’s Medicaid Management Information System was recently upgraded to a Web service-oriented framework. But as the state begins moving toward health insurance exchange planning, he said he doubts the state’s legacy eligibility system would support it.
To help CIOs such as Handler and Campbell, the U.S. Department of Health and Human Services plans to offer an enhanced federal matching rate of 90 percent for the design and development of new systems and 75 percent for the maintenance and operation of Medicaid eligibility systems. But Campbell said that given his state’s financial constraints, it is difficult even to come up with the 10 percent.

“We have to fight for that,” he told me. “Also, we have had staffing cuts, so maintaining the expertise and bandwidth to make change is becoming more difficult. And there is so much change so fast, it is hard to absorb.”

But no matter how difficult the transition is, the federal government has gotten its act together and is clear about the direction it wants state leaders to go, noted Lynn Dierker, senior program director for the nonprofit National Academy for State Health Policy. “They are signaling how the state IT infrastructure pieces can be used to leverage each other,” she said, “and they are providing the funding to pull it off.”

Here is the full Public CIO story.