Louisiana’s state-of-the art Medicaid enrollment system goes live after years in the works

Dec. 05--Louisiana now has one of the nation's most modern Medicaid enrollment systems -- an undertaking that leaders say will help address concerns over potentially misspent funds in the health care program that covers more than a third of the state's population.

"We needed this system. This was something we knew was an issue at the very beginning of this administration," Louisiana Health Secretary Dr. Rebekah Gee said during a recent tour of the new enrollment management central hub in Baton Rouge. "It's a total transformation of what we had."

The upgrade is stark. Workers no longer have to key functions into an antiquated, circa-1992 disk operating system, (DOS)-based platform, which relied heavily on individual determinations and paperwork. Now, Medicaid enrollment counselors can guide people through a state-of-the-art website or those interested in Medicaid can go online on their own.

"It just wasn't functional like it is now," said state Medicaid deputy director Mitzi Hochheiser.

The effort to move to a more standardized enrollment portal has been in the works for years. It cost about $71 million, 90 percent of which was covered by the federal government, and required weeks of retraining employees.

But officials say the effort to bring the system into the 21st century will pay off in rooting out duplications, ineligibilities and other concerns that have been raised over the years.

And it's coming online at a time when the Medicaid program that covers nearly 1.7 million Louisiana residents has faced increased scrutiny.

Gov. John Bel Edwards, a Democrat, agreed to expand Medicaid through executive order shortly after taking office in 2016. Since then, more than 481,000 people, mostly the working poor, have been added to the state's Medicaid rolls.

The expansion applies to adults whose household income falls below 138 percent of the federal poverty level, which is about $16,600 a year for a single person or $33,900 annually for a family of four. Others on the Medicaid program include low-income children whose families qualify for the Children's Health Insurance Program, commonly known as CHIP; pregnant women; and children and adults with special needs.

The Department of Health has the largest budget in Louisiana state government at $14 billion -- more than 70 percent from the federal government. Its funding has ballooned with the expansion of Medicaid, which is nearly all covered by the federal government through the Affordable Care Act.

In the three years since the expansion took effect, the Louisiana Legislative Auditor has audited Medicaid at least nine times. According to the most recent one, LDH may have allowed up to $85 million to be spent on ineligible people during a 20 months period -- largely because of the self-reporting standards for employment under the old system and also worker errors.

"Without a sufficient process to determine recipient eligibility, LDH cannot ensure that Medicaid dollars are spent appropriately," auditor Daryl Purpera concluded in his overview, which was presented to legislators last month.

The audit has since been used to highlight the potential for waste in the program. But its release came just days before LDH announced its new system was up and running, so it doesn't reflect changes made.

"It felt like I was being judged on an old car I was sending to the junkyard," Gee said. "We would not defend the old system. We absolutely agree it had problems and needed to go."

The auditor's office expects the upgrade will address some of the issues raised, Purpera said in a recent legislative hearing.

"Ultimately, the report is designed to help the department understand the deficiencies and correct processes going forward," he said.

Gee, who previously served as the state Medicaid medical director, said the Jindal administration scrapped earlier plans to upgrade the system that was first put in place when Edwin Edwards was governor.

When John Bel Edwards tapped Gee to lead the Department of Health, she said, an immediate priority was to resume an attempted modernization.

"Our efforts to change it were paramount," she said.

Under the old system, LDH relied on manual entries that left it up to staff to independently judge which of the more than 100 programs someone may qualify for and input it using function codes on the old-school black interfaces with white block letters and numbers.

"It just was too bulky," Gee said.

Eligibility determinations also awkwardly stretched across multiple systems. A caseworker would shift programs to look up information and then have to manually input it into the main system, Hochheiser said.

The new system is streamlined into one and more automated.

"People were really anxious about losing the old system and moving to the new system," Medicaid director Jen Steele said.

The team worked simulations for a month, knowing that there would be just one shot at officially linking to the federal system or else health care coverage of people across the state could be put at risk.

On the day the system finally went live, Steele wore a cheerleader costume, while others donned "Mom-to-be" or "Dad-to-be" t-shirts.

"They were really, really impressed," Steele said of the official change-over.

Today, the results can be seen in the sprawling command center that houses tech support and customer support working alongside. There's a large screen at the front of the room that details how many people are logged into the system, their activity and any problems that may be popping up.

The command center was staffed around the clock in its initial days to ensure that any kinks could be immediately worked out.

Louisiana is now one of the few states with real-time eligibility and has one of the most modern systems in the country.

The system uses 160 different sources to automatically verify information that is submitted, and flags any issues for a individual review. It also has real-time analysis -- something the auditors said would be necessary to address eligibility issues that the most recent audit had raised.

"I'm sure there will be some times we have to work through the kinks," Gee said.

Gee said one of the perks of the new system is flexibility. If the department gets a recommendation from the auditor or other agency, it can immediately set out to address the issue.

"They've given us some good suggestions already," Gee said.

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