States still experiencing problems with Medicaid IT system upgrades

States spent $1.8 billion in Medicaid 90/10 funds to upgrade their eligibility information technology systems over the past three fiscal years, but still face implementation challenges, according to a new report from the Government Accountability Office.

The Congressional Budget Office estimated that through the Affordable Care Act, 12 million more people could be enrolled in Medicaid and the Children's Health Insurance Program by 2016, but many states IT systems lacked the technical capacity to handle that level of enrollment. Among six states reviewed in the report, five had enrollment systems that were 20 to 30 years old.

The Medicaid funds for upgrades consist of 90 percent federal match and 10 percent state share. In this case, the federal government contributed more than $1.6 billion and states put in about $200 million, according to the report.

Thirty-four states used 90/10 funds to totally swap out their eligibility systems, while 17 states used the funds to modify existing systems.

The Centers for Medicare and Medicaid Services required states to implement certain requirements--known as critical success factors--by Oct. 1, 2013, though auditors noted that states historically have had difficulty meeting these requirements.

"The requirement that states transfer--send and receive--applications with the federally facilitated exchange (FFE) was the most challenging factor for states to implement, and none of the 36 states using the FFE was able to do so by October 1, 2013," states the GAO report. "One year later, 4 states remained unable to transfer applications one or both ways, but CMS continues to work with them to ensure implementation as soon as possible."

This difficulty led to enrollment delays in all states, according to the report.

Meanwhile, overpayment continues to make headlines.

Massachusetts overpaid hospitals for the Medicaid electronic health record incentive program by $2.1 million over a two-year period, U.S. Department of Health and Human Services Office of Inspector General reported.

Both Texas and Florida have come under recent fire for Medicaid overpayment. Texas must ramp up its Medicaid fraud efforts, according to auditors who found more than $1 billion in overpayments in 2012 and 2013. And the federal government says Florida owes $267 million in Medicaid overpayments that occurred over an eight-year period.

To learn more:
- read the report