RD71 - Semi-Annual Progress Report on Eligibility Systems Modernization - January 2015


Executive Summary:
In December 2012, the Department of Social Services (DSS) entered into a contract with Deloitte Consulting, LLP to modernize the existing automated eligibility systems for all public assistance programs, beginning with the Medicaid program. DSS partnered with the Department of Medical Assistance Services (DMAS) to accommodate changes in technology to support implementation of new Medicaid requirements and eligibility determination.

The scope of the contract includes implementation of the changes to Medicaid to meet federal Patient Protection and Affordable Care Act requirements, replace the current legacy eligibility system Application Benefit Delivery Automation Project (ADAPT), automate Medicaid categories not currently in ADAPT, implement a statewide document management and imaging system, and convert current Families Access to Medical Insurance Security(FAMIS) and Medicaid cases from ADAPT and the DMAS system, Child Health Administration Management Program System, into the new case management system, Virginia Case Management System (VaCMS). There are three projects for eligibility modernization: MAGI (Modified Adjusted Gross Income); Program Migration; and Conversion.

Work on the eligibility modernization projects continues. The MAGI project was implemented on October 1, 2013. Within the first nine months of implementation, local departments of social services experienced a 62% increase in Medicaid applications. Between October 1, 2013 and October 31, 2014, the Commonwealth received 349,217 MAGI applications. The volume of applications has challenged the ability of local department staff to process them timely.

The Conversion project scope included converting data and case/client extracts from the legacy systems into VaCMS on a monthly basis. As of October 31, 2014, all conversion activities were completed, and the Conversion project is in the closeout phase.

Prior to implementation, state and vendor staff participated in two formal readiness reviews, called Gate Reviews, required by the federal Centers for Medicare and Medicaid Services. Both the MAGI and Conversion projects passed the Gate Reviews prior to implementation. The Gate Review for the Migration project has not yet been scheduled. The experience in the Commonwealth with the new system and the volume of applications in the first year of MAGI implementation challenged the ability of local department of social services staff to process the applications timely. The project teams from DSS and DMAS have identified a number of changes that could be made to the system to enhance service delivery. In addition, CMS is requiring changes to the online portal for Medicaid to make it more Medicaid-centric and dynamic in function. These changes were not included in the original contract or any of the subsequent modifications. In July 2014, DSS executed a contract modification of $15,530,378 to accommodate the service delivery efficiencies and workflow changes. The efficiencies and workflow changes will allow Medicaid-only applications to be processed by DMAS contract workers. These changes are now included in the Migration project. Multi-benefit applications, applications that include Medicaid and at least one other public assistance program (such as SNAP), will still be processed by local department of social services staff. As a result of the most recent contract modification, the implementation of the final Medicaid requirements shifted from June 2015 to August 2015.

The majority of the costs for the latest contract modification are eligible for 90/10 federal funding. Total expenditures through October 2014 include payments to Deloitte Consulting, LLP, salaries for the DSS staff, and procurement of hardware/software tools for the MAGI project. Total expenditures for the three projects are $58,056,109 ($49,124,512 NGF and $8,931,597 GF). Payments of $39,800,445 have been made to Deloitte Consulting, LLP. Approximately $8,600,000 has been spent on hardware and software products, with the balance of expenditures being for costs such as DSS staff, and training and travel for local department of social services employees who participate on the project teams.