House Budget Chairman, Rep. Tom Flanigan first asked why Missouri saw such a dip in Medicaid enrollment from the spring of 2014 to the jump we have seen in the spring of 2015. In 2014 the state had a Medicaid enrollment of 819,000 and as of May 2015 the enrollment was above 950,000.
Director Kinkaid explained that in January of 2014, the Affordable Care Act took effect. This meant totally new eligibility standards for women and children, which makes up the largest portion of Missouri’s Medicaid program. Also, in that same month the state went live with their new Medicaid Eligibility Determination and Enrollment System (MEDES), which replaced the Family Assistance Information Management System (FAMIS). Kinkaid admitted both of these changes made the department slow and inefficient in processing new applications, so caseload dropped off. In the peak of the issues in April, there were as many as 50,000 pending applications. He further noted that what Missouri has been experiencing in caseload growth, is similar to what has been seen across the country.
Rep. Donna Lichtenegger inquired of Director Kinkaid if these problems have stemmed from issues in the past with the call centers. Kinkaid said that there could be some bleed over. He did add that under the new leadership of Julie Gibson who is the new Family Support Division Director, income maintenance programs like food stamps’ call centers will be brought back in house versus being contracted out. Rep. Genise Montecello took issue as she elluded the department has relied too heavily on new technology over increasing FTE within the department.
Chairman Flanigan then questioned why we used to have over 20,000 Modified Adjusted Gross Income (MAGI) cases closing a month, but that number has dropped to just over 4,500 last month. Kinkaid said that due toa shift away from reinvestigations to getting pending applications down, there have been less and less closures. This trend is expected to continue.
Rep. Sue Allen then inquired about the third party eligibility verification language that was included in HB 11. Director Kinkaid responded by saying that he is hopeful when a contractor is brought on board, they will have much more data to complement the state’s new call center operations and IT systems. The RFP is being written now, but when pressed on a date, all he would add is that he is hopeful something will be on the street by the end of the year.
Chairman Flanigan then inquired of the panel about the history of the new eligibility system. Commissioner Doug Nelson responded. The Commissioner stated that funds for the new system were first requested in fiscal year 2013, but not appropriated, then appropriated in FY 2014 for $68.9 million, mostly federal funds. The RFP was released in February of 2013, awarded in June of 2013 and work began in July of 2013. It was determined that the project was to be completed in three phases. First, MAGI population, second was to be non-MAGI and lastly Supplemental Nutrition Assistance Program (SNAP) / child care.
The first contract with Engagepoint, a software integrator, was for phases 1 & 2 for $150 million. Since issues and departure of Engagepoint, phase 2 will be re-bid and switched for the SNAP / child care cases. Now phase 3 will be non-MAGI. Nelson added that phase one is expected to be completed by end of 2016 and they are drafting RFP for phases 2 & 3 now. It was also announced that the Center for Medicare and Medicaid Services has extended their 90 / 10 match rate indefinitely.
Nelson continued as he said Engagepoint had been fired as of May of 2015 and they will be suing the state for damages. While they were able to deliver the citizen and caseworker portal delivered on time, they failed at providing full circumstance functionality.
Other questions from Flanigan centered around the IBM Curam solution specifically. Nelson told the committee that CMS did not recommend them or any other solution. South Carolina, Arkansas and New Jersey are abandoning IBM Curam, while other states are doubling down.
Nelson led this into a discussion on the need for updated procurement statutes. He said that lowest and best is not working for the state of Missouri and they need the ability to do face to face negotiations are needed.
See below to view the document distributed by the Department of Social Services.