By Ken Fody
The Supreme Court ruling on the Affordable Care Act in 2012 allowed states to opt into Medicaid expansion, leaving each state’s decision to participate in the hands of the nation’s governors and state leaders.
In April 2015, Montana Governor Steve Bullock signed the Health and Economic Livelihood Partnership (HELP) Act into law. This is a unique law that not only authorizes expansion of Medicaid benefits to all adults with incomes up to 138 percent of the federal poverty level, it also ties in training to help people find new and better jobs as well as benefits for veterans.
To implement this, the state needed to update the Medicaid Management Information System (MMIS) in order to administer the new healthcare benefits to an estimated 59,000 newly eligible residents without interruption to current members – in time for the expected January 1, 2016 launch.
Acting quickly, the state of Montana turned to Xerox to reconfigure its existing infrastructure. Xerox has provided fiscal agent services to Montana for more than three decades – this long-standing, trusted relationship made us a natural fit for this high-priority project.
More Montanans have health coverage than ever before. Here’s how: #ACA #Medicaid http://ctt.ec/xN86C+
Getting ready for launch
The first step was to deploy teams to modify the existing MMIS and the newly implemented Flexible Rx– the newest generation of Xerox’s pharmacy transaction processing system. Each of these systems were critical in order to administer expanded Medicaid benefits by the January 1 launch date, and to meet specific requirements embodied in the state legislation as well as the Centers for Medicare and Medicaid Services (CMS). For example, the systems had to be ready to perform tasks that are different for people who joined under the HELP act, such as the ability to impose premiums and dis-enroll members for non-payment.
We also updated a web portal that provides healthcare providers with information about newly enrolled patients, as well as the services and benefits to which they are entitled.
We then turned to contacting and communicating with new members after they enrolled to help them understand their new Medicaid benefits. This included developing and distributing welcome kits with all the program information new members must know, such as benefits, provider services and coverage eligibility.
Montana successfully launched its expansion program as scheduled on January 1, 2016. The enrollment support staff was prepared and the MMIS system was ready to process claims. Nearly 50,000 people have enrolled this year, to date.
One-fifth of Montanans lacked health insurance in 2012. Today, that percentage has dropped by nearly two-thirds – and there’s still room to grow. We’re happy to have played such a critical role in Montana’s success.