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Louisiana Department of Health
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Message From Dr. Gee - New Medicaid Eligibility and Enrollment System

For Release On:

November 15, 2018

Baton Rouge - Effective this week, and after more than three years of planning, development, and testing the Louisiana Department of Health has launched a new automated system for Medicaid eligibility and enrollment. This updated IT infrastructure will improve customer service, boost efficiency, and increase the accuracy of Medicaid eligibility decisions.

After years of culling national best practices and iterative quality improvement, the new Medicaid eligibility and enrollment system uses modern technology to ensure recipients have a user-friendly experience and that Medicaid benefits only go to eligible recipients.

Our prior 20-year-old system could not readily access and use state and federal data available to verify eligibility. It was a labor-intensive, manual process for a Medicaid worker to gather from multiple databases the information needed to verify eligibility and the eligibility decision itself was also manual. The new system automatically collects information from these databases and verifies eligibility in real time. When someone is found ineligible, our new system provides timely, automated coverage terminations for non-compliance.

Recipients will benefit from a user-friendly design with faster response times. Applicants can now submit an online application and be notified of their eligibility within minutes – known as real-time eligibility verification. Previously recipients might wait weeks to find out whether they had much-needed health coverage.

When a recipient’s circumstances change, like a new job or new member of the family, they can use the self-service portal to update their information to maintain eligibility. The new system gives the  Department the infrastructure to better verify the information that recipients are reporting.

For instance, a recent audit from the Louisiana Legislative Auditor found that a sample of Medicaid recipients had wage data that exceeded the income limit for Medicaid eligibility at some point during their enrollment. According to the federally approved policy that LDH followed during the timeframe reviewed for this audit, no improper eligibility judgements or payments were made. The auditor’s point was that if we changed our policy to include more frequent checks on income we would have been able to find circumstances where some recipients may not have been eligible at some point during their enrollment.

The limitation was the outdated system wherein these checks were labor intensive and took additional, already-limited resources. Now that our new system is in place, the Department can and will implement quarterly wage checks with Louisiana Workforce Commission data. This is just one example of the many ways this new IT infrastructure will help to make sure that those who are eligible for Medicaid receive it, and those who aren’t eligible, don’t.

The entire Department of Health, and especially the Medicaid team who recently came off 24-hour shifts to stand up this system, are committed to the integrity of the Medicaid program. These are the foundational changes that are necessary to shoring up a program and department still feeling the bone-deep cuts of the prior administration. While it’s not flashy, this multiyear focus on the IT core of our program allows us to better focus on what matters – ensuring that every Medicaid dollar is benefiting recipients who utilize the program so they can access the right level of care at the right time.  


 
Original Article http://www.ldh.la.gov f;index.cfm/newsroom/detail&#x 2f;4987

Republished by LOUISIANA NEWS | www.louisiana.gov