Driven partly by the Affordable Care Act and partly by advances in administrative IT, most states are set to offer online Medicaid and CHIP applications and most are making Medicaid information system upgrades, a Kaiser Family Foundation survey has found.
Forty-five states are now using the Social Security Administration's citizenship verification interface for Medicaid, and 37 states offer online Medicaid and CHIP applications, researchers from Kaiser and the Georgetown Center for Children and Families found.
"Nearly all states are pressing forward with information technology and process improvements to develop faster, streamlined Medicaid enrollment systems," even states that may not be expanding Medicaid coverage.
Under the ACA, all states have to follow the "no wrong door" enrollment model, letting residents applying for public health insurance assistance enroll in Medicaid, CHIP or subsidized private insurance, regardless of where they apply.
Kaiser researchers say the fact that so many states are interfacing with the Social Security Administration's identify verification system is significant, since the SSA is the sort of precursor to the federal data hub that's going to be used for income verification. State health officials using the SSA verification system told Kaiser researchers they've so far seen increased administrative efficiencies and successful match rates.
All but three states -- Michigan, Pennsylvania and Utah -- have submitted or received federal approval for advanced planning for Medicaid system upgrades, with CMS covering 90 percent of the cost, and 42 states are working on system development.
States' IT systems are also starting to make progress on interoperability, with 11 state governments using a state data hub that offers access to multiple databases.
"However," the researchers wrote, "paper still remains the predominant method currently used by states to verify income. As such, movement to electronic verification under the ACA will represent a major procedural and cultural change for many states."
Indeed, the ambitious health insurance coverage goals of the ACA depend in large part on consumer-friendly and administratively flexible enrollment and data management systems.
In Virginia, the Department of Health and Human Resources is leading an interagency interoperability update and building a shared citizen identification service, using a mix of traditional IT and new enterprise data management systems.
As 18 states prepare for expanding Medicaid and as 10 remain undecided, the Kaiser report does show Medicaid policy still varies across the states. In the last year 11 states expanded Medicaid eligibility and four decreased member costs, while three states decreased eligibility and 9 increased cost-sharing.