Will the mistakes of the pandemic release improved health technology?

President Joe Biden issued a decree in December calling for streamlining the enrollment of benefits. State lawmakers are calling for the use of unused COVID aid to solve the problem.

This is critical because outdated information systems can trigger ripple effects throughout the public service system, according to Jessica Kahn, a partner at consulting firm McKinsey & Co. and previously managed Medicaid data and systems at Centers for Medicare & Medicaid Services. An example: Non-user-friendly online benefit applications can get more applicants to call telephone guides. This can put a strain on call centers, which, like many industries, have difficulty meeting staffing needs.

Some states are already seeing improvements:

In Wisconsin, Democratic Gov. Tony Evers has directed up to $ 80 million to replace the state’s dated unemployment infrastructure.

Kansas is among the first states to work with the U.S. Department of Labor’s newly created Office of Unemployment Insurance Modernization, which will manage $ 2 billion in funds granted by the U.S. Rescue Plan Act last year.

In Missouri, a two-party Senate committee recommended using excess COVID aids to the Department of Social Services to update benefit computer systems. The department has also proposed spending federal pandemic money on artificial intelligence to process about 50,000 documents a week. That work is currently performed manually with an average of two minutes per. document.

Recent history suggests that these corrections may be easier said than done. More than 10 years ago, the Obama administration invested $ 36 billion to develop and mandate the national use of electronic medical records for patients. Despite the billions invested, the digitization of patients’ medical records has been plagued by problems. In order to be reimbursed by their insurance companies for the purchase of rapid COVID tests, a requirement imposed by the Biden administration, patients must actually fax or send claims and receipts.

The Affordable Care Act also offered a chance to improve the state’s technological infrastructure, according to Salo. From 2011 to 2018, the federal government offered to cover up to 90% of the funds needed to replace or update old Medicaid IT systems, many of which were programmed in COBOL, a computer programming language dating to 1959. These updates could have been to benefit other parts of the government safety net as well, as state-administered assistance programs often share technology and personnel.

But, Salo said, the ACA required that these new Medicaid computer systems communicate directly with the health exchanges created under the law. States faced varying degrees of problems. Tennessee applications were lost, leading to a class action lawsuit. Many states have never fully reviewed their benefit systems.

During the pandemic, technical problems have become impossible to ignore. In the midst of the early shutdowns, hundreds of thousands of people waited months for unemployment assistance as states such as New Jersey, Kansas and Wisconsin struggled to program newly created benefits into existing software. Local and state vaccine registries were plagued with so many problems that they were inaccessible to many, including the blind, a violation of federal disability laws.

Underfunding is nothing new for public health and safety net programs. Government officials have been reluctant to allocate the money needed to overhaul outdated computer systems – projects that could cost tens of thousands of millions of dollars.

Missouri’s safety net technology issues are well documented. A 2019 McKinsey assessment of the state’s Medicaid program noted that the system consisted of about 70 components, partially developed within a 1979 mainframe that “was not positioned to meet both current and future needs.” In a 2020 report for the state, staff in the Department of Social Services called the benefit enrollment process “siloized” and “built on solutions,” while participants called it “dehumanizing.”

Taylor has experienced that frustration. Eight years ago, a mysterious medical condition forced her out of the workforce, causing her to lose her job-based health insurance. At various times she has been diagnosed with ulcerative colitis, Crohn’s disease, gastritis, inflammatory bowel disease and gastroparesis, but without insurance and unable to qualify for Medicaid, she was forced to seek treatment in emergency rooms. She has been hospitalized repeatedly over the years, including for 21 days in total since July. She estimated that her medical debt exceeded $ 100,000.

When Taylor applied for Medicaid over the phone again in October, she received a rejection letter within days.

With losses because her family of sixty monthly income of $ 1,300 now falls within the state’s income limits since Missouri’s expansion of Medicaid in 2021, Taylor took out to state rep. Sarah Unsicker. The Democratic legislature represents a district 145 miles away in St. Louis. Louis, but Taylor had seen her proponent of the Medicaid expansion on Twitter. After inquiring about the department, Unsicker found that a standard application response had disqualified Taylor from receiving Medicaid because it mistakenly identified her as receiving Medicare – the public insurance policy designed for elderly Americans for whom Taylor is not eligible.

“Within 24 hours, I got a message back from Sarah that there was another letter on the way and I should be much happier with the response,” Taylor recalled.

Taylor, who is finally enrolled in Medicaid, is now struggling to get nutritional assistance, called SNAP, which in Missouri is treated through a separate eligibility system. The programs have similar income requirements, but Taylor was unable to confirm her income over the phone for SNAP as she could for Medicaid.

Instead, she received a letter on November 26, requesting her tax returns by November 29. When she was able to find and email these documents on December 1, she had been rejected. Each call to resolve the issue has been met with waiting times of up to four hours or queues so full that her call is interrupted.

Medicaid and SNAP applications are combined in 31 states, according to a 2019 analysis by the Advocacy Group Code for America. But not in her.

“It just does not make sense to me why Medicaid can confirm my tax income over the phone, but SNAP needs me to send them a copy of it all,” Taylor said.

Eventually she gave up and started the whole process all over again. She’s still waiting.

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with the Kaiser Permanente.

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