P&P August 2016

technology speaks By Kristen Duus

Uncovering Oregon’s Path to Integrated Eligibility

T here was no fanfare. There were no reporters. There were no cameras or media. It was almost as though the day had come and gone and no one noticed. For Oregon, Dec. 15, 2015 marked the first step to uncovering the state’s path to integrated eligibility. On this rainy, grey December day, the state’s Medicaid agency, the Oregon Health Authority (OHA), launched its new eligibility system known as Oregon Eligibility, or “ONE.” Only two years before, Oregon was in the national spotlight for the failed launch of Cover Oregon, the state- based health insurance exchange. While still embroiled in legal battles over the failure, in November 2014 Oregon shifted to Healthcare.gov—the federally facilitated marketplace, and almost simultaneously launched the 16-month Modified Adjusted Gross Income (MAGI) Medicaid system transfer project to implement ONE. ONE would bring to Oregon a web- based, state-of-the-art worker portal for workers to determine real-time eligibility for adults who qualify for Medicaid due to income level—a new population eligible as a result of the Affordable Care Act. A self-service applicant portal launched in February 2016, enabling community partners to help Oregonians submit applications and report changes. Challenged by Oregon’s tainted repu- tation for delivering IT projects, ONE would face political hurdles during implementation, and was affected by the change in several key Oregon leadership positions. These changes in leadership included the governor, state Medicaid director, director at the state’s Data Center, and the OHA director.

process before technology, when feasible. This principle drove adoption of best-practice business processes already inherent in kynect. 5. We established project governance. An executive steering committee was formed to oversee project imple- mentation. Voting members included the agency director, chief financial officer, chief information officer, state Medicaid director, and external advisors from the Office of the State Chief Information Officer (CIO), Legislative Fiscal Office, and other state agencies. 6. We embraced the State “Stage Gate” process. The project was overseen jointly by the Office of the State CIO and the Legislative Fiscal Office. The Stage Gate process helped the project to reduce risk and ensure readiness. 7. We focused on communication. Communication specialists deliv- ered regular messages to staff and

How did Oregon successfully launch ONE despite these challenges? Here are 10 factors contributing to our success: 1. We transferred an existing system. Oregon transferred and imple- mented “kynect,” Kentucky’s system. We chose this system because of the similar Medicaid rules, policies, and system interfaces, and the system closely matched Oregon’s needs. 2. We hired a systems integrator. Oregon procured Deloitte Consulting for systems integration services. Deloitte successfully implemented integrated eligibility systems in 23 other states, including the original Kentucky system. 3. We followed project management practices. The business and stake- holder community, technology staff, and consultants strongly supported the use of sound project manage- ment techniques and processes. 4. We managed scope tightly. Oregon chose to change policy or business

See Oregon on page 46

Photo illustration by Chris Campbell

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