Over the past few years, Medicaid technology has slowly begun to join the movement of technological innovation. With the Centers for Medicare & Medicaid Services (CMS) announcing in 2016 that they are extending a “90 percent federal match for investments [in] Medicaid systems,” the push towards modernizing Medicaid systems has been initiated on both a federal and state level. Four years after that announcement, however, the outbreak of a global health crisis greatly affected the development of the healthcare industry. The impact of COVID-19 was felt deeply within the Medicaid program. With more individuals losing their jobs and, thus, their employer-sponsored health insurance, enrollment in the government program is expected to skyrocket. In a May 2020 update produced by the Health Management Associates, it was estimated that enrollment in Medicaid could increase by 5-18 million (according to a later report by the Kaiser Family Foundation, adult enrollment during the pandemic grew by 11.3 million). This increasing number combined with budget shortfalls due to the slowing economy all pointed towards an incoming storm for Medicaid and its technology.
Nevertheless, Medicaid withstood the chaos, with providers utilizing its information technology to address the COVID-19 pandemic. In April of 2020, CMS released FAQs “identifying certain strategies states could consider to enhance their IT capabilities and give
providers the tools they need on the ground” (State Health and Value Strategies). One recommended strategy included requesting federal funding to expand information exchange capabilities through electronic lab results, real time alerts, and HIEs (electronic health information exchange); these efforts would become vital once vaccination efforts began and were underway. Another strategy proposed was to “rapidly scale state telehealth technologies and infrastructure.” With increased federal matching of expenditures, states could use that widened opportunity to obtain “new or upgrade existing hardware or software programs for telehealth.”
Due to the virtual nature of the pandemic, this increased utilization of telehealth seemed to be popular among state governments. According to the non-profit organization, the Healthcare Information and Management Systems Society, Medicaid already “provides states with a great deal of flexibility to use telehealth services in their programs, including various methods of communication such as telephonic or video technology.” As a result, some states have been able to expand healthcare personnel and coverage by “temporarily waiving in-state licensing requirements for qualified medical personnel.” Other states did not completely waive the licensing but, instead, expedited the process of obtaining a license to provide out of state care. Overall, these actions allow for providers to offer telehealth to individuals outside of state lines, increasing the workforce during a time in which essential employees are required but short staffed. Besides telehealth, states have also been utilizing technology to create efficient transfers of important information. For instance, OCHIN, a nonprofit healthcare innovation center, partnered with 26 public health departments and launched an app “that enables patient screening and triage outside of a typical healthcare setting.” Another nonprofit, The Health Collaborative, “is working with local health departments [in Cincinnati, Ohio] to supply real-time data.”
These efforts during the height of COVID-19 have shown how flexible and innovative Medicaid — as well as general healthcare — technology can be. During times of crisis, expansions of federal funding to support telehealth services and technological improvements have allowed Medicaid to continue to provide coverage to the increasing number of individuals in need of quality healthcare.
The work is not yet over, however, as the pandemic has also shined a light on improvements that still need to be made for Medicaid technologies. One of the most serious problems is the outdated information technology (IT) that may hinder people from getting their deserved benefits. While an increasing number of people are getting enrolled in the Medicaid program during the height of COVID-19, states might not be able to handle such influx of new enrollees: many states are using antiquated Medicaid Management Information Systems (MMIS) for eligibility determinations, enrollment, claims processing, and information retrieval. Improvements are demanded: CMS have on the one hand improved Medicaid Enterprise System data, procedures, architecture, and transaction specifications for a more efficient program management and interoperability, and on the other hand espoused states to upgrade their information systems.. Nevertheless, situations among states vary. Some have modernized their systems for patients; some are still lagging way behind. Some archaic systems require way more than an upgrade: their current main systems - that rely on computers and programs that are relics from the 1980s - are a “hopeless old highway with mountless potholes” when “four brand-new lanes are also needed”. Overall, the country needs to help scrap antiquated IT systems and replace them by modernized software and coding systems, which will make eligibility determination and program enrollment as simple and seamless as possible.
The COVID-19 has brought dramatic changes to the healthcare industry in such a short period of time: as the unemployment rate rises, enrollment in Medicaid skyrocketed. With limited budgets, Medicaid still withstood the storm; it flexibly utilizes the telehealth service to provide coverage for the increasing number of individuals in demand of healthcare services. Yet current improvements on information technology are far away from fulfilling people’s needs. Many states are still utilizing outdated MMIS, which may create barriers to the bulk of people becoming newly eligible for Medicaid. Efforts are needed to envision a better technological future for the Medicaid system.