Under the terms of the new contract Xerox will continue to manage but also upgrade the system, known as the Medicaid Management Information System (MMIS). Currently, recipients have no self-service access to program information and functionality through the system’s portal. Under the new system, Medicaid recipients will now be able to view their own eligibility data, request replacement ID cards, and even search for providers up to 100 miles away from a specific ZIP code or address.

“Our continued partnership with the state means beneficiaries will have innovative health care tools at a time when government agencies are focused on making the most of their budget dollars,” said Will Saunders, group president, Xerox Government Healthcare Solutions. “We implement service offerings that allow states to provide the highest level of service to their citizens without cutting programs.”

Shumlin has made health care a key part of his economic development strategy. He is working to decouple health care from employment in his state by encouraging residents to use federal subsidies provided under federal health care reform legislation to purchase their own insurance when the bill goes into effect in 2014.

Shumlin is pushing for this in order to drive his state toward single payer health care, which requires a single pool of potential policyholders. The US Supreme Court heard a challenge to the federal bill brought by 26 states earlier this year and is expected to issue a final ruling in the coming months. State officials admit it will be harder to implement single payer in Vermont without subsidies provided through federal health reform as it stands now.

The state wants to be on a full single payer system by 2017, three years after federal health care reform insurance rules come into effect. The move to single payer would be heavily reliant on federal rules such as rate affordability/premium allocation requirements and the prohibition on excluding individuals with pre-existing conditions under current rules. Federal rules also include an individual mandate requiring individuals to purchase health insurance or pay a fine.

The individual mandate is a key part of the Supreme Court challenge brought by states who say the federal government is reaching too far into areas that states typically manage. If the Court sides with the states, Vermont will face an uphill battle in creating the single pool required for single payer. Governor Shumlin has not yet offered an alternative plan if the ruling goes with the states.

In a press event in Utah yesterday, Governor Gary R. Herbert detailed the state’s response to the breach including a full-scale independent audit of technology security systems and the appointment of a new technology director. Local law enforcement is also conducting a separate investigation.

The security audit will be conducted by Deloitte.

“The State of Utah must restore the trust placed in it,” the Governor said. “Cyber-security is the modern battlefront and we are all enlisted—you, me, our state agencies, the Legislature—all of us have a critical role to play,” he added.

The Governor made a public apology to citizens effected by the breach including 500,000 individuals who had less sensitive information stored on the compromised server.

“The compromise of even one person’s private information is a completely unacceptable breach of trust,” said the Governor. “The people of Utah rightly believe that their government will protect them, their families and their personal data. As a state government, we failed to honor that commitment. For that, as your Governor and as a Utahn, I am deeply sorry.”

According to law enforcement authorities, cyber attacks on public information systems have increased 600% this year, resulting in nearly a million attempts daily by cyber terrorists or hackers to infiltrate the State IT network.

The Governor is appointing Sheila Walsh-McDonald as the new Health Data Security Ombudsman. She will oversee individual case management, credit counseling and public outreach.

The Governor also announced the resignation of Stephen Fletcher, executive director of the Dept. of Technology Services (DTS), and the subsequent appointment of 28-year IT veteran Mark Van Orden as acting director of DTS.

Under the terms of the agreement, CSC will develop and implement a new enterprise MMIS solution for healthcare administration. CSC has partnered with CNSI, to develop this solution, which will be aligned with CMS’ Medicaid Information Technology Architecture (MITA) framework.

The upgrade will bring the state in line with federal health care reform requirements and serve as the basis for a broader IT platform for state health care services.

“We commend the Department of Health and Mental Hygiene on its decision to work with CSC as it continues to make strides in updating technology that not only helps the department meet federal healthcare reform requirements, but also makes it easier for physicians to receive payment for the services they provide Medicaid recipients,” said Gene Ransom, CEO of the Maryland State Medical Society, MedChi.

Under the terms of a newly proposed bill, individuals would have access to personal health premium accounts where they could amass funds from a variety of sources to buy health care coverage. The plan comes as the state is coming up on a deadline for certification from the federal government for its health care exchange plan.

Federal health care reform requires that states either create their own health insurance exchange for state residents or have a generic exchange administered for them at the federal level. Republican legislators are calling this a financial instrument for consumers to use so that they can afford health insurance.

The new proposal makes no mention of a health insurance exchange, and Republicans have said openly that it is not an exchange. Minnesota has been working toward creating its own state run health insurance exchange for several months and is attempting to get federal funding for the project.

Supporters of health insurance accounts say that it would solve the same problem of insurance affordability that health insurance exchanges are supposed to solve for consumers. They are also pushing the Governor to ask for an exemption from the exchange model in order to offer personal accounts instead.

Other states are looking at more “free-market” alternatives to health insurance exchanges. Governor Scott Walker of Wisconsin who currently faces a recall challenge created an Office of Free Market Health Care to find alternatives to federal health care reform requirements. In Pennsylvania, Governor Tom Corbett is proposing a multi-exchange concept that would allow privately run exchanges to compete for business with the state exchange.

The Minnesota bill is sponsored by two key Republican lawmakers who are chairmen of legislative health care committees — Rep. Steve Gottwalt, R-St. Cloud, and Sen. David Hann, R-Eden Prairie. The Minnesota Chamber of Commerce has also announced its support for the plan.

The American College of Emergency Physicians issued a press release this morning saying that proposed cuts to Medicaid in the state will significantly endanger patients in need of emergency care. According to the physicians, more than 18,000 emergency patients sick enough to need hospitalization would have been denied coverage of emergency care had they been Medicaid patients living in Washington State.

The Washington State plan also is in violation of the federal “prudent layperson standard,” because it refuses to pay for diagnoses that it considers non-urgent. The physicians note that the list of non-urgent diagnoses were created without input from doctors.

“Perhaps one of the most concerning things about the plan is that it seeks to control spending — and deal with the lack of available alternative care settings — at the expense of the patient,” said Renee Hsia, MD, MSc, of the University of California (San Francisco), who has conducted numerous studies on evaluating emergency department use in several states and nationwide. “The emergency department is the first resort for patients, and also the last resort. If there are no alternatives for people to get medical care, how can you deny them coverage for a urinary tract infection or for a complication from Alzheimer’s?”

Health care providers are asking state lawmakers to barrow against future tobacco settlement funds to provide the $220 million needed to continue offering some level of service to low-income residents who do not qualify for Medicaid until the state gets help from federal health care reform in 2014. However, Governor Gregoire has indicated that she does not want to see a securitized budget.

Borrowing through this scheme would provide a one-time influx of capital, something the state has done before but this would be the first time that something like this would be done for operational purposes. The state legislature is supposed to break on March 8 and no deal has yet been completed. Lawmakers in both houses and in both parties have indicated there is little support for the borrowing plan.

Federal health care reform legislation created new and significant requirements for states to comply with leading many states to launch court challenges claiming overreach and unconstitutionality. They have had enough success that the Supreme Court is expected to issue a final ruling later this year.

However, in the interim the deadlines remain and states – even those that aren’t opposed to the measure are running out of time. Vermont and New Jersey are the two latest states to take up debate on whether to institute state run health insurance exchanges.

Health officials in New Jersey are applying for funds even as debate continues in the legislature in order to make sure they meet a fast approaching set of deadlines. The federal government is offering states funding assistance to set up their own exchanges. However, the application deadline for those funds this year. States then only have until 2013 to use those funds and build the exchange. Funds that aren’t used by the 2013 deadline will be revoked and exchanges that aren’t online by the 2014 deadline will be federally administered.

This timeline doesn’t provide states with the luxury of time that politicization requires. States waiting for the late year court ruling may find themselves boxed out of funding support ushering in a new level of federal control.

In Vermont the legislature will take up debate over their exchange today with the goal of implementing a statewide single payer health care system which local republicans actively oppose. They are expected to offer amendments making participation in the exchange voluntary rather than mandatory as required by federal law.

The federal government just approved hundreds of millions of loan funds to states for the creation of non-profit cooperatives another key component of health care reform legislation. Proposals were approved in Nebraska, New York, New Jersey, Oregon, New Mexico, Montana and the city of Milwaukee. With still more in the pipeline.

These cooperatives are designed as a cost control by allowing them to provide lower cost alternative coverage on the exchanges. However, private insurers like WellPoint are making an end run around that by setting up private exchanges designed to compete with state and federal exchanges. Some Governors are supporting this like Tom Corbett of Pennsylvania who is attempting to advance a multi-exchange model in his state legislature.

Overall the mixed messages coming from statehouses are setting up risks if the courts side with the federal government are paving the way for increased consumer burdens. In California, insurers are planning an 8-14% rate hike, an increase which out paces the current costs of medical care. Insurers claim that these increases are necessary to offset health care cost inflation, but also follow a growing tend of premium increases ahead of limits imposed when health care reform comes fully online in 2014.

“Consumers should be outraged that premiums continue to grow faster than underlying costs,” said Gerald Kominski, director of the UCLA Center for Health Policy Research said in the Los Angeles Times. “There’s help on the horizon for millions of Californians from health reform, but things may get worse before they get better.”

A point that seems to be true for the nation.

Beyond the allegations mad by Mr. Feinwachs, federal investigators are also interested in a move made last year by the state’s managed care providers to donate excess profits back to the state. State officials viewed the funds as a donation, but now there are questions as to whether or not part of the money should’ve gone back to the federal government.

An attempt at a whistleblower lawsuit by Mr. Feinwachs was dismissed in court.

Minnesota spends just over $3 billion a year on Medicaid, a figure the Governor has been working to keep under control as budgets remain persistently low. However, critics have noted that not enough transparency surrounds the process, criticism that has only increased in light of the federal investigation. The lack of transparency seems to be part of the scope of the investigation according to the Minneapolis Star Tribune.

Last year, Governor Dayton instituted the state’s first ever competitive bidding process for health care contracts with the aim of controlling costs and some plans have lost business as a result, although these recent efforts may not have been enough.

State officials are not allowed to comment on which federal agency is leading the investigation or the scope of the inquiry.

Some state lawmakers are hoping for an opportunity when it comes to localized health care reforms. House leaders have passed a measure that says if federal health care reform is deemed unconstitutional by the Supreme Court when it rules on a constitutionality challenge led by states opposed to the law later this year they will start over with health care regulations rewriting them completely.

Current state law says that as long as local regulations comply with federal laws the state will handle the details. This goes a step further and brings the process under state control wholesale. Republican state lawmakers want a clean slate for state regulations keeping them far away from federal control.

The measure will go to the full House floor for a vote later this week and is expected to face some opposition as some lawmakers have raised concerns over whether new regulations will cover those who have difficulty finding or affording coverage.

Federal health care reform has been controversial since it was first introduced. Upon its passage, several states mounted legal opposition claiming that the bill was too costly to implement at best and unconstitutional at worst. Some of those challenges have had limited success, the Supreme Court is expected to take up the issue and make a final ruling later this year.

Some states however, moved forward with implementing requirements as passed. Now, in a few of those states implementation is facing new hurdles as both advocates of the law and its critics raise questions about how the law is managed in practice.

Pennsylvania is moving forward on plans to create a health insurance exchange, one of the key state level requirements of health care reform. Even before health care reform required the creation of an exchange the state was aggressive in monitoring and challenging insurance rates and coverage in the state. Observers felt that the health insurance exchange would further codify this process and put more power in the hands of consumers.

However, once the plan was released insurance exchange supporters have lambasted state government saying that the plan is a giveaway to insurance companies. According to a piece in The Morning Call, leaders of the Pennsylvania Health Access Network, a coalition of health reform supports are saying that the plan as written favors insurers and will not provide any more affordable options for consumers.

Pennsylvania Governor Tom Corbett has asked the federal government for $33 million to implement a state run exchange, but his plan shows multiple privately run exchanges. These exchanges would be managed more by the insurers themselves than as an overarching state run exchange. As CivSource noted last year, some insurers already have a running start on this, WellPoint is creating its own privately run exchange to compete with federal and state managed exchanges. Governor Corbett filed for a challenge to the law when he was attorney general, and critics of the plan cite the multiple exchange concept as a way of letting corporate insurers retain control of the marketplace while still filling the exchange requirement.

In Ohio, consumers and lawmakers are facing similar top-down mixed messages on how to implement health care reform. Governor Kasich has been on record opposing health care reform since the law was passed. However, his state also moved forward on plans for an exchange and other requirements in order to guard against ‘federal takeover.’ Now, the state’s two key health care appointees are locked in a battle on implementation as one supports health care reform and the other does not.

The Mansfield News Journal is reporting that the state is taking a two track approach to health care reform requirements: moving forward on some while simultaneously stalling out on others until the Supreme Court ruling.

Greg Moody, leader of the Office of Health Transformation is using guidance from health care reform to focus in on creating preventative care initiatives and finding ways to lower the cost of health care statewide while improving service delivery. On the other side, Lt. Gov. Mary Taylor, who heads Ohio’s insurance department, has called health care reform a “catastrophic law,” and is doing everything she can to halt its implementation by boycotting the law through the Department of Insurance.

Ohio is part of the group of states challenging health care reform at the Supreme Court. For her part, Taylor has already returned a $1.3 million grant won in Governor Ted Strickland’s administration in order to provide consumer’s with information about their rights to insurance and how to file complaints. She has also indicated that her department will not be applying for or accepting any new funding to implement health care reform requirements – including a health insurance exchange currently being debated in the state legislature.