The state Department of Health Care Services is ready to begin the discovery and planning phases for two modules that would help update the California Medicaid Management Information System (CA-MMIS).
"The Medi-Cal fee-for-service claims system is by far the largest module in the CA-MMIS modernization effort, and will potentially account for more than half of the total budget," DHCS spokesman Anthony Cava told Techwire in an email.
"Additionally, the complexity and size of California’s health care ecosystem makes it difficult to find a single off-the-shelf solution or comparable service used by another state."
The system is a base layer to the Medicaid system for around 13.2 million Californians.
Because of the size and complicated nature of the module, the department is going through a discovery and planning phase, which has an estimated budget of $1.5 million in fiscal year 2018-19. Initial funding was included in the FY2017-18 budget.
The second upcoming module is the Third Party Liability solution, called the California Automated Recovery Management System (Cal-ARM), which is still in the middle of the Project Approval Lifecycle (PAL) with the Department of Technology. Once that is done, a request for offer (RFO) will be released.
"As part of the PAL process, DHCS completed a thorough alternatives analysis comparing various buy versus build options," Cava continued. "Through research and a formal Request for Information (RFI), completed in collaboration with CDT, we believe there are sufficient options for commercial solutions that could be implemented or modified to fit the state’s needs."
"Current cost estimates for the implementation of this module (based upon the RFI responses) are roughly $20 million over two fiscal years starting in fiscal year 2019-2020."
The CA-MMIS modernization is being implemented in an agile digital services approach with a user experience focus. CA-MMIS was developed in the 1970s to process payments for Medi-Cal providers.
In 2010, DHCS had awarded a contract to Xerox, which was then turned back over to DHCS in 2016.
