Social Interest Solutions

The Affordable Care Act (ACA) is a game changer both in terms of the culture of enrollment in public and subsidized health insurance and in terms of the technical infrastructure that supports the enrollment process.

Information Technology (IT) readiness plays a critically important role in establishing health insurance exchanges that provide a single point of entry to both public and subsidized private coverage. New York State’s IT systems must support Health Insurance Exchanges that connect all consumers to the appropriate coverage opportunities, but the existing systems are antiquated and unintegrated. To ensure that New York State is prepared to launch an Exchange and meet related ACA requirements by 2014, two national organizations, Social Interest Solutions and The Lewin Group, conducted an eligibility and enrollment systems inventory, examining the State’s existing IT assets and deficiencies.

The assessment addressed key questions, such as:

• What are the functional requirements needed to meet Federal eligibility and enrollment mandates?
• What are the key Federal reform priorities that should guide the systems decisions and what are the tradeoffs in selecting certain directions over others?
• What is the best and most realistic design for a seamless, integrated eligibility and enrollment system?
• What are the strengths, weaknesses, and disconnects among the systems currently in use or under development in New York State?
• How could systems used by public insurance programs and systems used by private insurers be integrated into a common Exchange?
• To what extent can New York’s existing eligibility and enrollment systems be adapted to meet the functional requirements of Federal reform and become integrated?
• How are other States responding to the eligibility and enrollment challenges presented by Federal reform?
• What types of capacity, levels of effort, and costs would be required to adapt existing systems?
• What functional requirements cannot effectively be met by current systems?
• What are the alternatives for meeting those requirements and associated strengths and weaknesses?
• What resources and costs would be required to design and build new systems

Read the report associated with this grant, “Preparing New York’s Information Technology Infrastructure for Health Reform: A Gap Analysis”.