Medicaid Information Technological Architecture (MITA) 3.0 was introduced in 2006, and years later, CMS and states are continuing to shift the Medicaid world and its technology to implement better methods of serving their beneficiaries, and reducing overall spending.

It all started in…

In 1965, President Johnson signed the Medicare and Medicaid programs into law. Since then, these programs have served millions of American families and improved their economic security.

Nearly 45 years later, the Affordable Care Act (ACA) ingrained a new concept – Medicaid Expansion (ME). While originally intended for all states to implement, a U.S. Supreme Court verdict ultimately made ME optional, giving states the freedom to establish and administer their own Medicaid program (type, amount, duration, and scope of services within the federal guidelines).

States had an option to charge premiums and create out-of-pocket spending (cost sharing) requirements for Medicaid members through the Social Security Act’s §1115 demonstration waiver. Out-of-pocket costs can include coinsurance, copayments, and deductibles. Maximum out-of-pocket costs are limited; however, states can increase charges for specific groups, such as higher income individuals, while groups such as pregnant women and children are exempt from most out-of-pocket costs. These extra measures were consistently denied by the Department of Health and Human Services (HHS).

Now…

According to the Kaiser Family Foundation, more than one-third of people with traditional Medicare spent at least 20 percent of their total income on Health Care in 2013. As of October 2017, over 51.7 million individuals are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in the 33 expansion states. Twenty-five states (76%) and the District of Columbia have expanded Medicaid since the passing of the ACA. Eight states are expanding Medicaid using Section 1115 demonstration waivers. Some of the eight states include Arizona, Indiana, Kentucky, and New Hampshire.

States have come across a new strategy to allow individuals who are currently not eligible for Medicaid to buy into their programs with or without subsidies. While states are constantly working to improve marketplace access and competition, push for continuity and alignment, strengthen coverage, and strengthen the Medicaid purchasing power to consumers – states and Medicaid agencies must coordinate closely to align with federal policies.

The ACA’s individual mandate requires that every citizen must have insurance coverage through work, ACA, or Medicaid/Medicare, or pay a fee. This mandate zeros out the dollar amount and percentage penalties for Open Enrollment 2019.

CMS has proposed new programs to have more flexibility for short-term health plans, which might be cost effective and attract healthier and younger people. This can, however, create a higher risk for the older and sicker people who require more comprehensive coverage.

Uncertainty of the future?

The ACA has been a heavily debated piece of legislation since before its passing in March 2010. With the current political climate, there is much uncertainty about future federal policies, and which direction states will choose. With the many changes in policy that are being made by HHS and CMS, it is believed that there will be a larger drive by the states, regardless of political views, to develop a program that is best for their population.

Softheon Medicaid Administrative Cloud

Softheon’s Medicaid Administrative Cloud (MAC) is a commercial off-the-shelf (COTS), MITA-aligned and HIPAA-compliant platform that defines and understands the scope of the MITA culture. Softheon’s COTS solution is configurable to fit the states’ requirements and align with Medicaid expanded programs.

As a Medicaid vendor, Softheon’s approach and transition to MITA was a natural progression. Our long-standing corporate culture of embracing advances in technology, and leveraging the newest, brightest, and most cost-effective technology solutions, helped to provide cost effective and efficient configurable solutions to state and Medicaid programs.

The MITA initiative and principles provide guidelines and models which effectively form a layout to achieve the goals and objectives of the Medicaid states. Softheon is one of the few technology partners with products that are compatible with Medicaid expansion.

While MITA 3.0 established interoperability standards that were intended to be forward-thinking, the Softheon framework was designed nearly a decade early with the same basic technological tenets: Service-Oriented Architecture (SOA), Enterprise Service Bus (ESB) and Business Process Management (BPM).

To learn more about MITA and Softheon MAC, download our whitepaper: Medicaid Administration Cloud: The Transformation of State Medicaid Information Technology and Operations.

Sources:

  1. https://www.cms.gov/About-CMS/Agency-information/History/
  2. https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/
  3. https://nashp.org/states-stand-medicaid-expansion-decisions/
  4. https://www.kff.org/medicare/press-release/more-than-one-third-of-people-with-traditional-medicare-spent-at-least-20-percent-of-their-total-income-on-health-care-in-2013/
  5. https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/monthly-reports/index.html

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. Please direct any questions or comments to research@softheon.com

Reshika Mahase

UX Design Architect at Softheon
Reshika Mahase works with the Product Innovations team as a UX Design Architect, where she is responsible for new product development such as the Medicaid Administrative Cloud solution. Reshika has worked on a number of projects during her years at Softheon, including private health plans, Welltheos, and Marketplace Exchange UX/UI. She earned both her MBA in Information Systems Management and BBA from Dowling College.