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Missouri’s Medicaid sign-up system getting massive overhaul

Updated: 2013-07-01T12:16:57Z


St. Louis Post-Dispatch

— With a deadline looming, Missouri has signed a $147 million contract with a Florida-based firm to set up a Web-based enrollment system for Medicaid, the public health care program for the poor.

EngagePoint, headquartered in Ft. Lauderdale, beat out three other companies to win the lucrative contract. The company is designing similar eligibility systems for the states of Arkansas, Minnesota and Maryland.

That experience is important because part of the new system must be operating by Oct. 1, when consumers can start shopping for private health plans through an online marketplace called a health insurance exchange.

Under the federal Affordable Care Act, the information that a consumer types into the federal portal is supposed to transfer to the state website if the person is Medicaid-eligible.

The law’s drafters wanted people “to be able to do one-stop shopping,” said Ryan Barker, vice president of health policy at the Missouri Foundation for Health, a St. Louis-based nonprofit.

The federal government will pay about 90 percent of the Medicaid enrollment system’s cost.

Missouri is getting a late start on the computer upgrade, which has been a lightning rod for opponents of the Affordable Care Act. Last year, the Republican-controlled Legislature refused to accept the federal grant.

Critics contended it would have provided a back-door way for Gov. Jay Nixon to implement the exchange, where people will be able to buy health insurance policies, some with federal subsidies.

Missouri voters passed a ballot measure last November that prevents the governor from establishing a state-based exchange without approval by legislators or voters. As a result, Missourians will use a federally run exchange.

Even so, starting Oct. 1, the state’s Medicaid system must be able to “communicate with the exchange, because we’re going to have people who don’t know what they’re eligible for,” said Alyson Campbell, director of the state’s Family Support Division, which determines Medicaid eligibility.

More efficient process

Missouri currently uses an antiquated, paper-based process to verify eligibility for most Medicaid benefits. State workers must type the information into a 17-year-old program known as the Family Assistance Management Information System.

“It’s been a workhorse, but its time is long gone,” Campbell said.

With the new system, she said, fewer state employees will be needed and automated matches can be done to cross-check applicants’ incomes and citizenship with other government databases.

Medicaid currently covers more than 870,000 Missourians — low-income seniors, people with disabilities, pregnant women and some families with children.

The Affordable Care Act extended the program to include childless adults and others making up to 138 percent of the federal poverty level, or about $32,500 for a family of four. But the U.S. Supreme Court made that provision optional for states.

Nixon, a Democrat, dodged the issue during his re-election campaign last year. But after he won a new term, he came out strongly for the expansion. The federal government would pay the full tab for the new recipients for the first three years, phasing down to 90 percent after that. The state would cover the difference.

The Legislature rejected the plan.

Opponents said that the federal government can’t be trusted to pay what it promises and that the state’s eventual share of the cost would take money needed for education and other services.

They also said Medicaid must be revamped to be more efficient and encourage personal responsibility. Legislative leaders have appointed three interim committees to suggest reforms that could be considered next year.

While the expansion spurred bitter debates, the technology grant slipped through quietly.

Sen. Rob Schaaf, R-St. Joseph, led the opposition when legislators derailed an earlier grant they thought was linked to a state-based exchange. He said Friday he hadn’t noticed that the computer money was approved this year.

“To be honest, this is the first I know about it,” he said.

For the budget year that begins Monday, legislators appropriated $68.9 million, of which $7.2 million is state general revenue and the remainder is federal money.

Overall, EngagePoint is slated to receive $109.8 million to design, install and maintain the new system over the next five years. If five, yearlong extensions are added, the cost could reach $147 million.

Four bids received

EngagePoint won the contract June 6 after a competitive bidding process. The other bidders were IBM of Armonk, New York; Infosys of Rockville, Md.; and Wipro of East Brunswick, N.J.

A state evaluation team found Engagepoint’s bid to be “lowest and best.” Compared with EngagePoint’s $147 million bid, the others proposed to charge from $152 million to $356 million.

Subjective factors such as experience, technical capabilities and method of performance were taken into account. Companies also got points for subcontracting with firms owned by minorities and women.

Among the minority firms that will work on the EngagePoint project is a Chesterfield-based company, Rose International.

Getting the new system running in three months is an ambitious goal, officials acknowledge. Luckily, Missouri doesn’t have to start from scratch.

“The work that we’re doing in other states — in Maryland, Arkansas and Minnesota — is the key,” said T. David Smith, a senior vice president for sales and marketing at EngagePoint. “We can certainly leverage that to make Missouri a successful implementation.”

The Oct. 1 rollout is supposed to allow the state to electronically receive Medicaid applications and determine eligibility for priority groups: pregnant women, parents and children.

Eventually, the system also will handle Medicaid applications from people who are elderly and disabled, as well as requests for food stamps and welfare.

The state says that over the next five years, the technology will lead to the consolidation of dozens of state offices and the elimination of 708 state jobs. Officials hope to make the cuts through attrition.

How the changes will affect customer service is subject to debate.

Missouri has long operated family support offices in each of Missouri’s 114 counties and the city of St. Louis. Local caseworkers process applications, face-to-face with applicants.

After the reorganization, the state will handle cases out of 31 “processing centers” scattered around the state. One- or two-person “resource centers” will still be situated in every county. Applicants can drop off information there.

Bradley Harmon, president of Local 6355 of the Communication Workers of America, said that in areas of the state where the reorganization plan had already been implemented, applicants get stuck in a “vicious cycle” where they can’t get their questions answered or their applications completed in a timely manner.

The union, which represents social services employees, is fighting the state reorganization “tooth and nail,” he said. “The part of this plan that they’ve already implemented, we think it’s a miserable failure.”

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