Medicaid Eligibility System Transformation

Medicaid Eligibility System Transformation

The Medicaid department provides eligibility services for crucial health insurance programs, such as Medicaid and Child Health Insurance Program (CHIP), to the citizens in its jurisdiction. By leveraging state resources alongside localized support, the department successfully works toward enhancing healthcare access throughout the state.  

A project team at the department was eager to deploy their new version of the Medicaid eligibility system in fall 2013, but had reservations regarding its capabilities and accuracy in calculations using the new Modified Adjusted Gross Income (MAGI) rules. Our CEO, Jamey Harvey, took the initiative to employ a comprehensive quality assurance (QA) methodology consisting of over 300 extensive tests. This meticulous process revealed that the software was largely unsuccessful in its initial cases.

Agilian needed to direct efforts to improve the accuracy of the MAGI eligibility rule calculator to pass federal mandates and go live. This challenge was complicated by inconsistent rules between the Marketplace eligibility, Medicaid, and CHIP, requiring complex and precise documentation during the system development and implementation of MAGI.

Our Project Manager then worked diligently alongside vendors for 45 days to modify and refine the code until it produced accurate results in 95% of the test cases. This is an impressive achievement, considering they reached a nearly 99% success rate through user interaction alone.

Following this successful performance, our team was entrusted with the responsibility of driving an independent quality assurance (QA), operations, and maintenance group to guarantee that high-quality standards were met for the project’s deliverables. We also crafted and maintained a production change control board system and developed automated selenium testing to ensure quality.       

Result: The project has achieved extraordinary success, passing rigorous federal blueprint testing and launching on time. It is now nationally recognized as one of the most successful MAGI eligibility projects in the US – a result of the highly skilled teams and well-honed processes developed by our consultants.