Medicaid software program has glitch
<p>FILE - In this Sept. 26, 2013 file photo, Laura Leon, project director for the navigator program at Sinai Community Institute of Chicago, speaks at a gathering of individuals seeking information on the new national health overhaul law that takes effect Oct. 1, 2013. Millions of Americans will be able to shop for the first time Tuesday on the insurance marketplaces. Whether consumers will be pleased with the experience, the premiums they will pay and the out-of-pocket costs of the plans offered to them will finally start to become clear. Tuesday's rollout comes after months of buildup…
HELENA — The rollout of an expensive, new computer program that will run complicated Montana Medicaid payments is behind schedule and has forced the lead contractor to seek an extension.
Meanwhile, state officials — based on experience with software problems — negotiated a contract stating they don’t have to pay Xerox until the $70 million program is finished and working.
The Medicaid Management and Information System is scheduled to replace a system that is more than 30 years old. The old system is unable to keep up with the increasingly complex payment rules and parameters.
The new program will have “millions of lines of code” to handle payments to thousands of Medicaid providers, said Ron Baldwin, state chief information officer. It will need to decipher proper payments for hundreds of millions of dollars in claims for various medical procedures, ensure that state and federal guidelines and parameters are met and run automated fraud detection systems, among other things.
The federal government is picking up 90 percent of the tab on the project as a way to help states modernize antiquated systems.
“They are the biggest system any state can implement,” Baldwin said.
The Legislature appropriated spending authority for the project in 2009, knowing that the old system couldn’t keep up and urged by the federal promise to pay for a bulk of the cost to meet new demands. A contract was awarded last year to Xerox, which had experience in other states.
But Montana officials were cautious. More than a decade ago, a failed software program in the Department of Revenue became infamous with lawmakers. The state was forced to abandon the project after spending $40 million and start again from scratch. Case studies have been written on the debacle.
That experience “absolutely” shaped the state’s computer projects ever since, Baldwin said.
Xerox won’t get any of its money from Montana until the state is satisfied with the project.