CMS recently passed the 90/10 final rule, extending the 2011 regulation on federal funding for Medicaid Eligibility systems. The ruling is just one of the latest efforts by CMS to support states attempting to modernize and develop more effective Medicaid IT systems.

Specifically, federal funding is increased from 50 to 90 percent for new eligibility and enrollment systems and Medicaid Management Information Systems.

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This new funding will implement initiatives, such as automated applications and renewals, efficient claims processing and integrated human services programs. Perhaps one of the biggest changes is retiring outdated systems and transitioning into more modernized technology.

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Cognosante executive and former CMS CIO Julie Boughn, talked to Healthcare IT News about the ruling and its effects on Medicaid and the overall healthcare system.

"I feel this regulation is CMS saying, we don't think the way that we've done it in the past is effective. It's not getting us the results that we want," Boughn said.

"And CMS feels like Medicaid is really a key driver for what providers need to achieve Triple Aim and they want to support the states in this area," she added.

The 90/10 ruling permanently extends funding of Medicaid's E & E systems. But what's most important, Boughn says, is what CMS is accomplishing through its modular system. The system doesn't need to wholly function for changes to go into effect. Each department will establish its own system.

This is a significant departure from the past, Boughn noted.

"This final rule is crucial for the CMS' efforts to modernize state eligibility systems to make real-time, accurate eligibility determinations and promote enrollment of eligible low-income people in Medicaid and CHIP," she added.

Effective January 1, the ruling will also no longer approve the "big bang" or wholesale Medicaid Management Information Systems. In fact, CMS is putting that responsibility into the hands of the states to make the definitions for short-term changes.

Medicaid needs to focus on the short term rather than the long term, Boughn said. The modular system makes it possible.

"This is the CMS saying the rules have fundamentally changed and the states need to step up to the plate to get this to work because Medicaid is too important," she said.

The challenge will be getting states and vendors to work together to anticipate the right modular fit for the program. As Boughn sees it, it won't be a hard problem to overcome, given the short term focus – it will help define the right modules to direct suppliers and vendors to interface with the big data warehouses.

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