Hawaii’s Medicaid platform powers broader transformation

A modular system built with off-the-shelf software gives the Department of Human Services a platform it can expand to serve other agencies.

Like many states, Hawaii had to revamp its Medicaid eligibility system to handle the influx of applicants from the Affordable Care Act.  To get the most out of its investment, Hawaii plans to expand the Kauhale On-Line Eligibility Application (KOLEA) platform to agencies and departments statewide.

Hawaii’s Department of Human Services began working with IT integrator KPMG in January 2013. When the project started, there were roughly 275,000 people receiving Medicaid assistance in Hawaii. DHS knew its existing system, a more-than-20-year-old legacy mainframe, would not be able to handle the reprogramming and staff support needed for the new enrollments, Craig Grivette, principal at KPMG and KOLEA project lead, told GCN.

Rather than writing proprietary software, KPMG built a modular system entirely based on commercial products and enterprise-grade software from Oracle and IBM. According to Grivette, this gave DHS a system it could expand and manage on its own.

Automation tools cut processing time from 45 to three days. The system eased data entry, document viewing and change requests for staff, and citizens were able to apply and access documents and review their coverage status and health plans options through an online portal. 

Grivette compared the new enterprise system to a private cloud-like architecture, as it includes the state’s data hub and allows DHS to add capabilities. For example, since the system’s launch, KPMG has made more than 70 production deployments, modifications and enhancements, including integrating the platform with the federal healthcare marketplace.

The Medicaid solution, however, was just the first installment on Hawaii DHS’ overall goal.

“It will allow us to in a very streamlined fashion provide not only the services to the community, but also provide very streamlined and efficient tools to staff,” Hawaii DHS Director Pankaj Bhanot told GCN.

Eventually, this level of interoperability will allow Hawaii to have multiple department programs, benefit levels and services available to the public and give departments the tools to build their own applications.

KOLEA is not there yet, however.  The platform still needs better integration with other programs, automated data matching and fewer errors.

In December 2015, the state auditor found that KOLEA did not integrate with DHS’ other human services programs, such as the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families, or interface with the Internal Revenue Service for other income data. That integration will take place in Phase Two, which will open the system to other state programs within the DHS’ Benefit, Employment and Support Services Division.  

The audit also found that KOLEA did not perform electronic data matching to verify applicants’ wage incomes.  While DHS is working with the working with the Department of Labor and Industrial Relations to develop a real-time automated process for checking income data, staff conducts manual income verification for some applicants.  A memo between the two departments was signed in August 2016 to further establish how the data is transmitted and stored.

The audit’s reports of KOLEA being error-prone was in part attributed to the fact that the system is new, and users weren’t quite accustomed to it yet, according to KOLEA Project Manager Aileen Hiramatsu.  Verification and eligibility decisions, which used to be manual, are now automated. “We’ve always gone back and made sure that the system was making a determination consistent with policy. And for the most part we haven’t found any significant errors,”  she said.

KOLEA was never a “one and done” system, Givette said. It  is capable of keeping pace with policy and operational changes, including processing complex coverage types and long-term care, which has just been automated. “All of those things are now done electronically in the content repository,” he said.

“We believe that we complied with all of the ACA’s requirements,” Bhanot said, and DHS is working to deliver on all of the act’s visions by the end of 2018.

Phase two work will include building a consent management program so DHS can move from data matching to obtaining consent around data sharing, especially for the data it receives from federal agencies. 

In phase three, Hawaii DHS wants to move Child Welfare and Adult Protective Services to the enterprise system and, afterwards, open the platform up to agencies and departments across the state. It hopes to finalize a system by Dec. 31, 2018, that will include application integration, interdepartmental data sharing and portals and tools for clients, providers and employees.

The overall goal is to be able to communicate between families, the provider community and other stakeholders to plan, develop, implement and evaluate programs. “We believe having a robust enterprise system and very strong applications on it is going to give us that opportunity,” Bhanot said.

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