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Oklahoma has modernized its Medicaid eligibility and enrollment system so that applicants can apply online anytime and receive a determination immediately. Few states, if any, are as far along as Oklahoma – which went live with its system in 2010.
Most states are still plotting how they will overhaul their systems and procedures to prepare for the streamlined enrollment of millions of individuals in 2014 under health reform. State Medicaid and Children’s Health Insurance Programs (CHIP) must be able to integrate with health insurance exchanges.
[Related: An inside look at Maine's MMIS implementation.]
For Oklahoma Medicaid, 70 percent of the applications are now performed online, said Tracy Turner, applications and operations manager for online enrollment for the Oklahoma Health Care Authority.
“We want people to be able to apply whenever they want, like at night and at home,” she said, adding that 20 percent of the online applications come in between 5 p.m. to 12 midnight, so the site has to be available 24/7.
“We do real-time eligibility decision and enrollment. The decision comes back in less than half a second from the time they submit. Then they can hand that print out of eligibility to a pharmacist or a doctor to have a claim paid at that time,” Turner said at the June 19 State Healthcare IT Connect conference.
Oklahoma has taken on a massive modernization, executed it and proven that it works well, said Ben Walker, a specialist from the eligibility and enrollment team, at the Center for Consumer Information and Insurance Oversight (CCIIO) at the Centers for Medicare and Medicaid Services.
“They stand as an example to other states to know that you can take on a big chunk of work, get it done, modernize your eligibility process, reduce your administrative burdens, and increase your accuracy rate,” he said, also at the conference.
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Oklahoma’s Medicaid agency uses a business rules engine to determine eligibility. A business analyst at the agency “who already knew eligibility inside and out” put in place the coding for the rules and scenarios, Turner said.
Besides using a business rules engine, Turner shared other steps that helped her agency scale its streamlined process, including:
1. Start small and simple. Oklahoma had recently simplified eligibility for families with children and pregnant women, so started with that population.
2. Verify through electronic data exchange. Oklahoma Medicaid has a matching system set up with the vital records agency to confirm citizenship of those born in the state. Also, about 80 percent of Oklahoma’s Medicaid applicants are already known in the system from other agencies, so citizenship may have been verified in one of the state’s human services programs.
3. Don’t wait to start modernizing. Start with baby steps, such as automating a notice that is done manually now or scanning paper documents. Find processes to automate that will add value to the system with or without health reform. Oklahoma started with a small online app that hospitals used to add a newborn to an active Medicaid mother's membership.
4. Encourage transparency with partners at all levels so that when information is published, or leaked, it does not create fear, worry or confusion, which will be more difficult to deal with later. Try to make sure that information is pushed down to frontline staff in whatever organization is involved.
5. Create focus groups made up of target users to make sure that the technology is user friendly. The online app needs to be easy to use, logical and well designed for the customers at which they are aimed, not just the IT staff.
Related Medicaid modernization coverage:
Oklahoma Health Care Authority CEO Mike Fogarty's Top 5 tips for achieving 'health care, not welfare