Ohio seeks to overhaul Medicaid eligibility system

COLUMBUS, Ohio (AP) — Ohio is closer to replac­ing an out­dated com­puter sys­tem that’s known for reject­ing eli­gi­ble peo­ple from the Med­ic­aid pro­gram and accept­ing oth­ers who don’t meet the criteria.

Offi­cials said Wednes­day the state will con­tract with Accen­ture LLC for a new sys­tem that will help deter­mine who’s eli­gi­ble for pro­grams across Ohio’s health and human ser­vices agencies.

The move comes as the gov­er­nor says he plans to expand the Med­ic­aid pro­gram to cover more low-income peo­ple under Pres­i­dent Barack Obama’s health care law. Gov. John Kasich unveiled his deci­sion on Med­ic­aid expan­sion in his two-year state bud­get pro­posal on Monday.

The Kasich admin­is­tra­tion antic­i­pates that almost 366,000 Ohioans will be eli­gi­ble for cov­er­age begin­ning in 2014 by expand­ing Med­ic­aid, the health pro­gram for the poor that already pro­vides care for one of every five res­i­dents in the state.

The state also is brac­ing for 230,000 eli­gi­ble Ohioans to sign up for Med­ic­aid once the fed­eral law requires most peo­ple to have health insurance.

Kasich’s pro­posed bud­get includes $230 mil­lion for the eli­gi­bil­ity sys­tem upgrade, though the fed­eral gov­ern­ment would reim­burse the state for most of the cost. The state’s share of the bill is expected to be $26 mil­lion over the two-year budget.

The state’s cur­rent eli­gi­bil­ity sys­tem, known as CRIS-E, was launched in 1978. The admin­is­tra­tion says it’s “so frag­ile and tech­ni­cally obso­lete that it is no longer prac­ti­cal or cost effec­tive to invest in enhanc­ing the system.”

The state esti­mates that 60 per­cent of CRIS-E’s eli­gi­bil­ity deter­mi­na­tions for Med­ic­aid are inac­cu­rate and must be man­u­ally over­rid­den to pre­vent appli­cants from being denied cov­er­age or remove those who weren’t eligible.

Offi­cials say the move will make appli­cants’ lives easier.

“This new sys­tem will allow more Ohioans to apply for ser­vices online, instead of wait­ing in line,” said Greg Moody, direc­tor of the governor’s Office of Health Transformation.

Ohio Med­ic­aid Direc­tor John McCarthy said most who fill out the online appli­ca­tions would find out quickly whether they’re eli­gi­ble for the Med­ic­aid pro­gram, with­out hav­ing to leave their home and go to a county office.

The state also wants to use the sys­tem to deter­mine whether appli­cants are eli­gi­ble for food or cash assis­tance programs.

“We’re all work­ing together to make it as seam­less for a per­son as pos­si­ble,” McCarthy said.

The sys­tem will begin enrolling peo­ple in Med­ic­aid by Jan. 1.

Posted by Matt Echelberry on Feb 6 2013. You can follow any responses to this entry through the RSS Feed. Both comments and pings are currently closed.