States receive $241M to develop model health insurance exchanges

The US Department of Health & Human Services have moved forward with its “Early Innovator” grant program to develop model state health insurance exchanges. Six states and a group of New England states will receive $241 million to help them design and implement the IT infrastructure for insurance exchanges, HHS officials said Wednesday.

Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a multi-state consortium led by the University of Massachusetts Medical School will use their grants to develop technology that is reusable and transferable. The Early Innovator grant was created to establish the building blogs for exchange IT systems that could then be quickly implemented in other states to meet the 2014 deadline set by the Affordable Care Act.

Don Berwick, Administrator of the Centers for Medicare & Medicaid Services, said the Early Innovator program was designed to spotlight a wide range of IT models, governance structures and information architectures so that every state could benefit from the various approaches.

“This grant program means that states don’t have to waste money reinventing the wheel, and consumers get the best of the best,” he said in a statement Wednesday.

This effort joins other pilot-project / demonstration projects being set up by HHS to encourage the use of open source technology and multistate collaboration. In addition to health insurance exchanges, HHS recently launched a challenge program for the development of model health information exchanges (HIEs). And a separate pilot launched earlier this month in several states called the Direct Project, which hopes to demonstrate simplified HIEs in Minnesota, Rhode Island, New York, Texas, Tennessee, California and Connecticut.

Proposals from the grantees for Early Innovation funds include:

  • Kansas Insurance Department – $31.5 million – the state will extend its new Kansas Medicaid/CHIP eligibility system (K-MED) and integrating it with the Kansas Health Insurance Exchange. They hope to explore the possibility of creating a “cloud” solution for other states to have their own instance of one or more of these healthcare applications.
  • Maryland Dept of Health and Mental Hygiene – $6.2 million – Maryland proposes to build off a prototype it has already developed that models the point of access for the Exchange, integration with Maryland legacy systems and the federal portal systems, and Maryland’s consumption of planned federal web services (e.g. verification and rules).
  • University of Massachusetts Medical School – $35.6 million – the proposal includes individuals and small businesses in Connecticut, Maine, Massachusetts, Rhode Island, and Vermont. The proposed project approach will be to create and build a flexible Exchange information technology framework in Massachusetts and share those products with other New England states.
  • New York Department of Health – $27.4 million – New York proposes to build off its eMedNY Medicaid Management Information System (MMIS) system to build products for the Exchange.
  • Oklahoma Health Care Authority – $54.6 million – Oklahoma proposes to extend its current technical architecture of Medicaid Management Information System (MMIS) and several other systems to implement the Oklahoma Health Infrastructure and Exchange initiative. Oklahoma will issue an RFP under this grant to conduct a gap analysis to determine the necessary steps for its systems to become operational for the Exchange factoring in portability and reuse.
  • Oregon Health Authority – $48 million – Oregon is using commercially available, off-the-shelf software to create the Exchange and the grant will help the state create a modular, reusable IT solution that will provide customers access to information, financial assistance and easy health insurance enrollment.
  • Wisconsin Department of Health Services – $37.7 million – Wisconsin’s proposal envisions a single, intuitive portal through which residents can access subsidized and non-subsidized health care and other state-based programs (e.g. Medicaid, CHIP, child care).
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