Short Takes On News & Events

West Virginia, Virgin Islands, Work Together On Medicaid

By Phil Galewitz

December 11th, 2013, 8:41 AM

West Virginia and the U.S. Virgin Islands don’t have much in common. It was 82 degrees and sunny today in St. Thomas, while Charleston, W.Va.,  saw snow and a high of 32.

But when it comes to Medicaid, the state-federal health insurance program for the poor, the Mountain State and Caribbean territory are now joined at the hip.

To help save money, West Virginia and the Virgin Islands this fall began sharing an information technology system to process their Medicaid claims and pay health care providers. The state and territory still have independent programs with their own eligibility rules, but they are the first to operate a shared back-office system.

Using mostly federal dollars, states typically pay private companies tens of millions of dollars a year to handle their Medicaid claims processing, and the federal government has been looking for years to have states share the workload with other states or U.S. territories.

Molina Healthcare, the Long Beach, Calif.-based  company that processes claims in West Virginia, is now processing the Virgin Islands’ claims on the same system.

“We’re excited to be the first to operate this kind of system,” said Ruth Ann Panepinto,  executive account director of Molina and former secretary of West Virginia’s Department of Health & Human Resources. “This is an incredibly efficient way for U.S. territories to manage their Medicaid programs at far less than the cost of establishing their own independent system,” she said

She said the system will help the Virgin Islands save money and more easily modernize claims processing and make other changes required under the Affordable Care Act.

Michael Melendez, associate regional administrator in the Centers for Medicare & Medicaid Services, said the partnership is a first including a territory, though Arizona and Hawaii have had a similar deal which helps save money for state and federal taxpayers.

Michigan and Illinois in August announced they have set up a similar partnership that is expected to save about $85 million after implementation begins next year, the states said. Under the arrangement, Illinois will use Michigan’s Medicaid technology system.

Medicaid information technology systems do more than just process claims.  They also produce data that helps policymakers and program officials improve care of beneficiaries and detect fraud, Melendez said.

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