During the mid-2000s, the federal government made numerous legislative changes that impacted and shaped the direction of the Medicaid program including (but not limited to): the American Recovery and Reinvestment Act (ARRA), the Children’s Health Insurance Program Reauthorization Act (CHIPRA), the Health Information Technology for Economic and Clinical Health Act (HITECH), the Patient Protection and Affordable Care Act (PPACA), the Health Insurance Portability and Accountability Act (HIPAA), and the International Classification of Diseases (ICD-10). State Medicaid Agencies were swamped with new requirements they needed to make to their technology, policy and processes. In 2011, CMS released version 3.0 of the Medicaid Information Technology Architecture (MITA 3.0). Many of the people working in Medicaid believed that this was just another regulation imposed on them by CMS at a time when states were struggling to implement and adopt the initiatives and laws mentioned above.
When I first reviewed the MITA 3.0 document, it was very overwhelming. The document consisted of more than 1,000 pages and there were concepts and terminology that were foreign to me. I attended a Medicaid conference around the time MITA 3.0 was released and many of the attendees were very dismissive of the new version. The general consensus was that MITA 3.0 was similar to the earlier versions and it would be optional for states to complete a MITA State Self-Assessment (SS-A). But then CMS released the Seven Conditions and Standards (7C&S) for Enhanced Funding Requirements and everything changed.
The 7C&S provided guidelines for State Medicaid Agencies to use when designing, developing and operating technology and systems in support of the Medicaid Enterprise. Essentially, the 7C&S provided State Medicaid Agencies an incentive (i.e. enhanced federal funding) to use MITA 3.0. MITA 3.0 could be used by states to demonstrate not only how the technology enhancements would be used internally, but also how it would help improve access to services for Medicaid recipients. I know this does not sound like a revolutionary concept, but in the world of Medicaid, it was at that time.
I have worked in different states on Medicaid Management Information System (MMIS) implementation projects, and they all cost more than the initial projected budget and they never met their targeted completion date. There were multiple reasons to explain why this occurred and these reasons varied from state to state, but the one thing that all the states that I worked in had in common was that their MMIS projects lacked a vision or a purpose. Maybe during the initial planning for the MMIS project the vision was to improve access to services for Medicaid recipients. But as each project progressed, the purpose of the project changed to designing a system that would minimize the impact to the people working in the Medicaid Agency as much as possible. At some point during these projects, the state would lose sight of why we work in this field-to improve the lives of the people that we serve.