Increase the Likelihood of Implementing a Medicaid Management Information System

By Jason Duhon and Tamyra Porter

Medicaid Management Information System (MMIS) developments are like the Tolstoy quote, “Happy families are all alike; every unhappy family is unhappy in its own way.” MMIS successes are all similar, but MMIS failures are failures in their own unique ways — or there are as many ways that MMIS developments fail as there are failures. However, states can be proactive to increase the likelihood for success.

What is an MMIS?

An MMIS is a “mechanized claims processing and information retrieval system” — essentially a claims adjudication system that states use to process their Medicaid claims. While many state leaders may not understand every detail of what an MMIS is, most are aware that the contracts to develop, implement, and run these systems are massive. In some states, a new MMIS represents the single largest information technology (IT) contract in the state’s history. Like other components of Medicaid Enterprise Systems (MES), the Centers for Medicare & Medicaid Services (CMS) pays 90% of the cost to build a new system, plus 75% of the maintenance and operations. This means that while the contract will be a significant financial commitment for the state, the federal government will make the vast majority of the payments.

It typically takes years to complete a new MMIS implementation. Despite the considerable expense and the accompanying public, state, and federal scrutiny, perhaps the most interesting thing about MMIS implementations is the frequency of failure over the years. It is more important than ever for states to avoid MMIS failure because some canceled MMIS implementations have resulted in CMS withholding payments for new MMIS implementations.

Canceled and Troubled MMIS Implementaions

Below is a list of some MMIS implementations resulting in cancellation, cessation, or implementation without certification:

  • Canceled before delivery
    • New York (2017)
    • California (2016)
    • Montana (2016)
    • Maryland (2015)
    • Nebraska (2008)
  • Ceased system development; no restart
    • South Dakota (2008)
  • Implemented but not certified; paid over $500 million in temporary payments
    • Maine (2005)

In addition to these system failures, numerous implementations move forward only to result in negative press and admonishment by state leaders.

Why do MMIS implementations fail? All MMIS implementations face challenges, but some start to fail from the earliest stage of the project. Download the white paper to learn more.

Download the White Paper

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