GAO: Some States Still Struggle With Medicaid Eligibility IT Systems

December 18, 2014 in News

Some states still are struggling to upgrade their Medicaid eligibility IT systems, despite spending a total of about $1.8 billion over the past three fiscal years to do so, according to a Government Accountability Office report, FierceHealthIT reports (Hall, FierceHealthIT, 12/17).


Under the Affordable Care Act, states’ Medicaid eligibility IT systems help to coordinate enrollment and eligibility processes for the Children’s Health Insurance Program, Medicaid and the insurance exchanges. However, many states’ systems did not have the technical capacity to carry out those tasks and handle the millions of additional projected enrollees.

CMS provided states with a 90% federal matching rate to upgrade their systems. The agency also required states using the funding to implement “critical success factors” for their systems by Oct. 1, 2013.

Report Details

For the report, GAO examined states’ use of the federal funding by examining state-reported expenditures from June 30, 2011, to Sept. 30, 2014. GAO also conducted an audit of six states reporting large expenditures from the funding.

Report Findings

The report found that over the last three years the total reported spending across all 50 states and Washington D.C. was $1.6 billion in federal funding and $200 million in state funding (GAO report, December 2014). The report found that 34 states had used the funding to replace their Medicaid eligibility systems, while 17 states had used the funding to upgrade their existing systems.

GAO found that five of the six states audited had previous Medicaid eligibility systems that were 20 to 30 years old.

The report also found that the most difficult critical success factor for states to implement was “[t]he requirement that states transfer — send and receive — applications” with the federal insurance exchange.

GAO said that none of the 36 states using the federal health insurance exchange was able to meet the requirement by the Oct. 1, 2013, deadline. One year later, the report found that four of the states still had not met the requirement and that CMS was still working with the states to “ensure implementation as soon as possible” (FierceHealthIT, 12/17).

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