Looking back on the first month of 2012, health insurance exchanges (HIXs) continued to consume media outlets and fill legislators’ and lawmakers’ agendas nationwide. In Florida – the state leading the legal battle challenging the legality of the Affordable Care Act (ACA) – two bills were presented introducing legislation to create a statewide HIX. Thus far, Florida lawmakers have made no effort to begin planning for such an exchange. However, pending the outcome of this March’s Supreme Court hearing on the law, the state may have to succumb to creating the exchange or letting the feds do so on their behalf. It will be interesting to see how things pan out for the state and other states that hold a similar stance on the federal mandate.

Hopefully you caught one or all of last week’s blogs in our series highlighting Deltek’s newly-released report, “Evolving Health Insurance Exchanges.” Whether you have had a chance to check out the report yet or not, mark your calendars for February 26, 2012, from 2:00 – 2:45 p.m. EST. Deltek Analyst Amanda White will help you, the vendor community, answer the question: How will the Supreme Court ruling affect states’ efforts with the health insurance exchanges? To register for the free webinar, please click here. 

Other January happenings included the release of Arkansas’ long-awaited revised procurement strategy for its replacement Medicaid management information system (MMIS). Also progressing in replacing its Medicaid system, Indiana released a request for proposals (RFP) for its core MMIS. Meanwhile, the state continues to solicit proposals for the related Medicaid Data Warehouse Decision Support System/Business Intelligence (DW/DSS) Solution.

On the social services front, New York released an RFP for the Common Benefit Identification Card (CBIC), which transfers benefits for the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance to Families (TANF), and the Medicaid (MA) program. Florida’s Department of Children and Families (DCF), which is in the midst of overhauling many of its social services benefit programs, released an invitation to negotiate (ITN) for identification verification services.

The coming months will continue to see controversies surrounding the ACA. States already making headway on HIX implementation will likely continue to do so, even if the Supreme Court decides to overturn the law. Meanwhile, state Medicaid offices will keep chugging along at Medicaid reform efforts and will look to the vendor community to assist in reforming or replacing outdated core systems. As previously mentioned, states like Arkansas, that have struggled with Medicaid reform plans, will continue flushing out plans and drafting solicitations that strive to meet the technological requirements set by the Medicaid Information Technology Architecture (MITA) 2.0 and future 3.0 guidelines.

Once again, don’t forget to register for February’s “Evolving Health Insurance Exchanges” webinar!

As always, stay tuned to this blog for more analysis as the year progresses. You can also follow our team on Twitter @GovWin_HHS, or connect with us through LinkedIn.

Continuing this week’s blog series recognizing Deltek’s recently-released report, “Evolving Health Insurance Exchanges,” we’re drawing attention to an element of health insurance exchanges (HIXs) that has thus far received little attention: quality assurance (QA) services. The lack of focus on these services can be easily pinned to the early nature of HIXs and delayed implementation efforts of many states. However, as more states implement state, federal or hybrid exchanges, they will need to start considering and implementing quality measures.

States further along in HIX planning efforts such as Colorado, New York and Mississippi may have a clearer vision of needed QA practices than those that continue to delay planning and implementation. Similarly, states that have made progress in modernizing eligibility determination systems into integrated eligibility determination engines may already be planning for or have existing QA contracts in place.

As vendors continue to see more exchange-related opportunities arise as the 2014 deadline approaches, they will likely see an influx of quality-related opportunities. Though still in its draft stages, once released, federal guidance on the exchanges will hopefully contain concrete QA-related direction for states. Meanwhile, many states are anxiously awaiting the March 2012 Supreme Court verdict on the Patient Protection and Affordable Care Act (PPACA) before taking any additional steps toward HIX implementation.

If this week’s blog series has sparked your interest in learning more about HIXs and state-by-state progress of exchange implementation, be sure to check out Deltek’s “Evolving Health Insurance Exchanges” report. In addition to providing high-level recommendations for vendors trying to get ahead in the game, the report examines the following components of the national HIX market:

• Background legislation and federally-mandated policy options
• Which states are 'in,' which are 'out,' and which are on the fence
• Links to project documents and opportunity profiles (where relevant) for all states
• Emerging implementation models and active vendors involved in planning, implementation, and call center functions

Don't forget to follow Deltek's Health Care and Social Services Team on Twitter @GovWin_HHS, or connect with us through LinkedIn!

Today’s blog marks day 3 of Deltek’s health care and social services team’s blog series centered on our recently-released report, “Evolving Health Insurance Exchanges.” The report provides an in-depth analysis of states and their steps toward implementing these one-stop shops. It also provides high-level recommendations for vendors trying to get ahead in the game.

With all of the hubbub surrounding the implementation of health insurances exchanges (HIXs), it is easy for the everyday citizen to forget that the Affordable Care Act (ACA) isn’t just about the creation of exchanges as a single, stand-alone system. Though it may seem a simple task to assemble an “Expedia-type” consumer experience that blends private insurance and Medicaid, states have an enormous undertaking ahead of them in integrating the back-end processes that will feed into the HIXs.

Think back to when you’ve tried to download a report or image that is not compatible with your current software. Frustrating, isn’t it? Now, think about the current health care and social services IT environment in the states. Eligibility for Medicaid is housed on a different IT platform than Temporary Assistance for Needy Families (TANF), which may be housed on a different platform than eligibility for child care, which is housed on a different platform than child support … you get the picture.

Most families eligible for one state service are eligible for another, therefore requiring (in many states) paper applications to be filled out several times to determine eligibility for each service. The ACA, with help from the U.S. Department of Health and Human Services (HHS), calls for the creation of a shared eligibility service that integrates the HIX, Medicaid, and Children’s Health Insurance Program (CHIP). Some states already combine Medicaid, CHIP, TANF, and Supplemental Nutrition Assistance Program (SNAP) eligibility, but many are scrambling to upgrade to an integrated eligibility system that is compliant with ACA requirements.

Some states are taking advantage of this opportunity and utilizing enhanced federal funding to create the core eligibility platform (HIX, Medicaid, CHIP), in addition to looking to integrate other service delivery programs in the future. The Illinois Department of Healthcare and Family Services is planning to release a request for proposals (RFP) in March 2012 for an integrated eligibility system covering Medicaid, CHIP, SNAP, TANF, and the HIX. Implementation costs are estimated to be between $50 million and $70 million – a hefty price tag on top of the already-estimated $57 million for the installation and management of the HIX. The new system will be implemented in two phases, the first of which will bring the state into full compliance with CMS (Centers for Medicare and Medicaid) standards by 2013, if all goes to plan. The second phase will include a complete replacement of legacy enrollment, case management, and benefits processing functions. Other states looking at integrated systems in the north-central region of the United States include Ohio, Iowa, Indiana, Missouri, and Minnesota.

Although the health insurance exchange is meant to help consumers choose health insurance, the mandate is helping drive the integration of fragmented and siloed human services delivery systems. The benefit assistance world has long grappled with how to best provide a one-stop shop to citizens in need, as stand-alone transaction processing silos can no longer effectively support the needs of states. So, while the constitutionality of the ACA continues to be battled in court, the act has required states to take a good look at how they currently provide services, and the ways in which state departments collaborate, or don’t collaborate, when creating assistance plans for families. This progress is great news for families dependent on state assistance.

Don't forget to follow Deltek's Health Care and Social Services Team on Twitter @GovWin_HHS, or connect with us through LinkedIn. We'll be tweeting and posting throughout the week with our expert analysis of health IT in the state and local market.

PTI recently hosted a presentation by Mark Greninger, Geographic Information Officer for the County of Los Angeles, who detailed the county’s implementation of a new land management system (LMS). On the surface this might not seem noteworthy. However, Mr. Greninger struck upon the profound notion of “authoritative crowdsourcing,” which holds tremendous value for vendors and government IT decision makers looking to find value from social media—in this case, a blogging tool transformed into a distributed GIS data collection point.

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