More than 70 million Americans – 1 in 5 – receive healthcare coverage through Medicaid. The Medicaid Enterprise System's range of services include claims processing, provider and member service, care management, financial management, data analytics and more. The majority of states use commercial products and services to operate the MES and many of these systems have been operating for decades without a major technology refresh or modernization.

The Centers for Medicare and Medicaid Services (CMS), which provides federal administration of the Medicaid program, has encouraged states to modernize their MES to leverage the advancements and innovations that are available in the market. One approach that has recently captured the attention of many states is to procure a Takeover of the MES, providing continuity of operations, while embarking on a Modernization roadmap that makes targeted investments to address the state’s most pressing challenges.

GDIT has significant federal and state experience with Takeover and Modernization projects, including for the New York and North Carolina Medicaid programs. From these experiences, we share five best practices for states considering the Takeover and Modernization option:

Focus more on enterprise change rather than simply updating old systems or programming languages.

Many Medicaid systems are written in outdated languages, such as COBOL, which limits technical modernization. However, true modernization is about looking at the business of Medicaid and introducing efficiencies for better performance and cost-effectiveness, which ultimately benefits the health care delivery ecosystem. Engage business users early to ensure value-creation from your modernization.

Data quality is key.

Medicaid programs collect, use and store massive amounts of data. In fact, data is one of a Medicaid program’s most important assets. The state and its partners must ensure quality data via sound data governance and management. Without this, modernization plans will encounter delays, unnecessary complexity and even failure. Assess the quality of your data and have a sound data management strategy from the start of your modernization.

Consider cloud options for cost and performance.

Cloud services and storage are great--where they make sense. However, states often see the cloud as the latest and greatest improvement without considering the long-term costs associated with cloud hosting. Evaluate cloud options strategically to manage costs so they do not escalate and inhibit funding for other priorities.

Get project governance in order.

States must be willing to actively govern, evaluate and manage projects. Absent a sound governance structure that is consistently followed, timelines will slip, milestones will be missed, and costs will escalate. Establish and socialize a project governance structure before you begin Takeover and Modernization planning.

Be intentional about change management.

Takeover and Modernization projects create a great deal of change across the Medicaid enterprise. Choosing and using an effective, well-understood change management process is essential to involve the right people across the enterprise in the project. Engage stakeholders early and ensure they get the knowledge and resources they need to be successful.

GDIT has the right combination of systems integration and technical acumen, corporate assets and mission focus to assist states as they consider the Takeover and Modernization roadmap.