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Pa. submits plan for Medicaid eligibility system upgrade

By , - Last modified: January 31, 2013 at 9:24 AM

Pennsylvania has submitted an implementation advance planning document detailing its proposals to upgrade its Medicaid eligibility system, according to the Pennsylvania Department of Public Welfare.

DPW spokeswoman Anne Bale said the document was submitted Jan. 8 to the Centers for Medicare & Medicaid Services, outlining eligibility and system changes that would put Pennsylvania in compliance with ACA regulations and allow it to communicate with the federal hub." It is on an accelerated 30-day review.

A January Kaiser Family Foundation report showed Pennsylvania as one of only three states that had not submitted an advance planning document or had it approved, but Bale said the report was inaccurate on that point.

At stake is a time-limited 90 percent federal match for development of Medicaid systems and 100 percent federal funding for exchange IT development.

"Independent of their decisions to build a state-based exchange or expand Medicaid, states will need to prepare their systems for new eligibility, verification, and renewal requirements," the Kaiser report said. "In 2014, the systems must not only have the capability to determine eligibility based on modified adjusted gross income, they must also implement new data-driven verification processes intended to deliver real-time eligibility determinations and coordinate with exchanges."

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