Maine is having trouble with interoperability between its decade-old Medicaid IT eligibility system and its one-year-old claims system, Maine Department of Health and Human Services Commissioner Mary Mayhew said Friday. It's trouble that could result in the state having to pay back claims to the federal government for as many as 19,000 people who are not eligible.

The state became aware of the interoperability problem and began trying to solve it in 2010 when it implemented the new claims system, said Mayhew, who was appointed to head the Maine DHHS in 2011.

According to Mayhew, during the IT transition, the state discovered that 19,000 beneficiaries of Maine's Medicaid system were no longer eligible. Letters were sent to the individuals, notifying them of their ineligibility, but interoperability problems kept the claims side of the system from knowing about the ineligible Mainers.

[See also: States put tech to work on Medicaid enrollment.]

Maine must now discover just how many of the ineligible individuals may have inadvertently received treatment paid for by Medicaid, Mayhew said. She could not say how much the claims might total. She said that paying back the money would be a budget challenge for the state.

Maine's Medicaid system has been plagued with difficulties for the past 10 years, Mayhew said. In addition to the interoperability problem, the state has also had problems with anticipating its IT needs when it came to an increased volume in beneficiaries and claims.

Maine launched its Medicaid claims management system in January 2005, according to John Martins, communications director for Maine's DHHS.  In 2007, the state began working toward hiring a fiscal agent to develop and manage its system. In May 2008, Maine awarded Unisys a seven-year $179 million fixed-price contract, and in January 2010, Molina purchased Unisys.

[See also: Medicaid enrollment to swell in 2014.]

Maine's problems will be compounded if the state does not get its Medicaid IT system running smoothly by 2014. The Affordable Care Act is expected to largely increase the number of Medicaid beneficiaries qualifying for coverage. To help with that burden, states are now able to get a 90 percent federal match under the ACA to help with their Medicaid IT system upgrades. Mayhew said she is in the process of applying for that money now.

Follow Diana Manos on Twitter @DManos_IT_News

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