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As states begin connecting technically to health information exchanges and unite stakeholders across a wide spectrum, integration with the state Medicaid platform becomes a key consideration. Coordination between state Medicaid plans and HIE efforts is a requirement for the approval of a state’s strategic and operational plans. State HIEs can leverage Medicaid resources and infrastructure to strengthen exchange capability. States are able to make the most of existing Medicaid claims data, as they prepopulate or bolster the information coffers of the HIE with information. Additionally, coordination between the state Medicaid agency and HIEs empowers providers to achieve Meaningful Use of EHRs, as outlined by the CMS Incentive Programs.
Helpful References:
A number of different approaches have been adopted by states as they build productive relationships between HIE and Medicaid, some of which have been described below. These examples demonstrate the potential of states to create value by coordinating HIE and Medicaid programs. By no means is this an exhaustive list of the approaches states can take in synchronizing these efforts.
South Carolina
The South Carolina Health Information Exchange (SCHIEx) integrates the past 10 years of Medicaid claims data into the HIE. Authorized Medicaid providers can access claims data on 800,000 beneficiaries via the HIE. Patients are able to opt-out of the exchange of claims data, although only 300 individuals have opted out at this time. This claims data includes both Medicaid and hospital-billing data, or the UB92 and UB04 forms. SCHIEx is also in the process of building a new Medicaid Management Information System (MMIS), and work is being done to integrate HITECH requirements as the current MMIS evolves. Finally, SCHIEx is offering a Medicaid Electronic Health Record (MEHR) to providers who may not have an EHR but would benefit from seeing a patients claims history.
SCHIEx
Alabama
The Alabama Health Information Exchange (AHIE) has identified connecting to Medicaid agencies in other states through Alabama Medicaid as a priority. Leveraging resources from other Medicaid agencies in the southeast region of the United States, AHIE intends to use collective bargaining power through this network as they contract for services (such as lab interfaces) and develop consent models. Additionally, AHIE and Alabama Medicaid will exchange information with these out of state Medicaid entities through NwHIN.
AHIE
Maryland
The Maryland Department of Health and Mental Hygiene is in the process of harnessing MITA 2.0 principles as it builds a new MMIS for state use. This new MMIS will greatly expand on the capabilities of the current system to manage workflows and benefit plans. Maryland will also integrate the Client Automated Resources Eligibility System (CARES) with the HIE. This interfacing of systems will allow providers to see a more comprehensive and accurate eligibility record and provide the most proper care for a patient. Overall, Maryland strives to generate a single patient record across agency lines with demographic information, in addition to health data.
CRISP
Nebraska
The Nebraska Health Information Initiative (NeHII) anticipates incorporating the state Medicaid agency into the HIE network as a fully capable member, sending and receiving robust patient data and documents.
NeHII
Texas
The Texas Health Service Authority approached the issue of Medicaid integration in a significantly different manner from the example states above. Texas has contracted with a large IT vendor to take over as administrator of the state’s independent Medicaid HIE. The vendor will spearhead creation of a provider web portal, granting access to patient data for any licensed Medicaid provider in the state.
Texas Health Service Authority (THSA)
CMIO Magazine Article regarding Texas Medicaid HIE
Medicaid Management Information System Integration
Many states are aligning efforts to build HIE capacity with the process of upgrading or replacing the existing Medicaid Management Information System (MMIS) with a new system. CMS provides the basic framework for an information system managing Medicaid claims processing and the provider procurement of patient Medicaid information. State Medicaid agencies then build upon this framework to create a customized MMIS to be used statewide. This framework, known as the Medicaid Information Technology Architecture (MITA), has evolved over the years and states are eager to employ the most current set of principles, MITA 2.0. The new foundational elements in MITA 2.0 focus on business processes to promote interoperability and workflow optimization. States upgrading or replacing existing MMIS infrastructures may choose to employ a Service Oriented Architecture (SOA) as the capacity for interoperability between numerous systems within a given state continues to grow.
Additional Links
Guidance on state Medicaid initiatives from the Office of the Inspector General at HHS
Providing Technical Assistance for Health IT and HIE in Medicaid and CHIP
States Roles in Health Information Exchange
Program Information Notice – Guidance for HIE Cooperative Agreements
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