States’ approach to modularity and MITA compliance 

With over 74,550,529 Medicaid and CHIP beneficiaries, these programs have evolved to become highly complex, multibillion-dollar enterprises. Initially, Medicaid Management Information Systems (MMIS) were designed as a financial and accounting system for paying provider claims accurately and timely. However, Medicaid programs have grown in complexity, and MMIS have developed to accommodate these new complexities.  

According to the Centers for Medicare and Medicaid Services (CMS), “MMIS – once defined as a single, integrated system of claims processing and information retrieval – is being redefined under Medicaid Information Technology Architecture (MITA) as the new “virtual MMIS” to most, if not all, of the additional non-financial Medicaid systems running on multiple hardware and software platforms.” 

Historically, these automated Medicaid functions, such as managed care, clinical support, data analysis, fraud management, non-emergency transportation coordination, and prior authorization, were combined with MMIS. However, they were unable to communicate directly or exchange information easily. MITA works to transform MMIS into a “central nervous system” that supports the entire Medicaid Enterprise in a standard way. It alters the way in which states design, build, and modify their Medicaid systems and perform IT investment planning.  

Sending Medicaid to the Cloud  

Today’s MMIS has come a long way since its creation in the 1970s. Because states have differing needs, MITA can assist states in refining MITA framework models to develop and deploy shareable, reusable IT components and business processes. Case in point: Wyoming, which became the early adopter when it became the first state to move away from an expensive custom-developed system to an MMIS-as-a-service approach, for its Wyoming Integrated Next Generation System (WINGS) project.

Prior to deciding on the cloud-based model, the state considered sharing a MMIS with Medicaid agencies of Michigan and Illinois. However, it later elected to adopt a hybrid software-as-a-service model, which permitted the state to host some MMIS components on the cloud, while allowing others to be state owned and operated. Wyoming is not alone. Michigan, Illinois and more than 10 others have also implemented cloud-based MMIS platforms. There are many reasons for this growing interest among the states. This includes:  

  • adaptability to evolve with technology year after year;  
  • scalability for growing programs;  
  • the avoidance of hefty investment and infrastructure overhaul;  
  • increased versatility; and  
  • fewer redundancies. 

Bottom line: The modularization of MMIS systems is an important step toward delivering benefits faster and more efficiently, bringing together the best-of-breed tools, and providing states with the flexibility to quickly adapt to changing policies while still maintaining daily operations. We examine this and the transformation of Medicaid IT and operations in our latest whitepaper: Medicaid Administration Cloud: The Transformation of State Medicaid Information Technology and Operations.

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon, Inc. 

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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