Transforming CMS’ Medicaid and CHIP program system

Over 89 million people rely on CMS’ Medicaid and the Children’s Health Insurance Program (CHIP) for their health coverage. Through these programs, qualifying families, children, pregnant women, seniors, people with disabilities, and people with low incomes can access health insurance for free or at a low cost.

Fearless is proud to announce we’ll be supporting these programs on a new contract with the Centers for Medicare and Medicaid Services (CMS). Using human-centered design, product thinking, and DevOps principles, we’ll transform the Medicaid and CHIP Program (MACPRO) system for its users.

This four-year, $67 million contract will be one of Fearless’ biggest digital transformation efforts to date. Fearless’ Health & Sciences Portfolio Director, Nichole Weems, is excited about the impact this work will have.

“Medicaid and CHIP serve many vulnerable groups, but they’re especially critical for women and children’s health,” she said. “The federal funding states access through these programs allow many women and children to get the care they need to be healthy and safe. This is more important than ever right now, during a global pandemic.”

The project ensures low-income adults and children have access to quality healthcare across the US.

We’re streamlining systems, products, and processes, allowing Medicaid and CHIP to be more responsive to beneficiaries’ needs. This kind of agility is more important than ever in the public health space, and we’re proud to support it through the MACPRO contract.

How MACPRO supports Medicaid and CHIP

Medicaid and CHIP operate at the state level, with the federal government and individual states jointly funding the programs. Each state has a Medicaid and CHIP state plan, which outlines how the programs are administered in alignment with federal rules. This helps keep states accountable, ensuring programs are administered efficiently and effectively.

But states need to be able to pivot to meet new needs, so these plans can’t be completely set in stone. If they want to change the policies or approaches outlined in their plans, states have to submit state plan amendments (SPAs) to CMS for review and approval.

This is where MACPRO comes in.

Through its suite of products, MACPRO allows users to submit, process, and adjudicate SPAs, as well as other documents and reports. In this way, MACPRO supports Medicaid and CHIP initiatives across the US.

Our goals for CMS’ MACPRO

Fearless is working to improve and enhance the MACPRO product suite so that CMS can collaborate with states more efficiently and effectively.

We’re consolidating legacy systems as we build and deploy a one-stop portal for states and CMS users. We’re also working to make the adjudication process more consistent, transparent, and less burdensome, while enabling agency staff to more easily answer critical questions about Medicaid and CHIP implementation. Our work will improve the experience of MACPRO, while also allowing for more data-driven decision making.

“We want to take this from a compliance-focused process to a data-driven one,” Weems said. “From a state perspective, we’re looking to improve transparency and response time. And on the federal side, we want to provide CMS with the data needed to make better, faster funding decisions. After we’ve made these processes more automated and efficient, we’ll also explore using predictive analytics to better inform decisions around care.”

Our collaborative, one-team approach

The MACPRO effort will be a huge undertaking, and the contract will support 66 direct jobs. But Fearless won’t be doing this alone. We’ll be working alongside Groundswell (formerly CollabraLink), IBM, A1M Solutions, and eSimplicity. Hutch companies Theta and Lucky Rabbit are also support this work.

Thanks to our unique blend of experience and specialties, we’ll be able to holistically improve MACPRO for its users.

“MACPRO is going to be a real collective effort,” Weems said. “Collaboration is key to Fearless’ working style, and it will be more important than ever as we move forward with this contract. Our team has already started to demonstrate a one-team approach, and all our partners are rallying around the work. Together, we’ll work to achieve our goals of improved services, reduced costs, and, ultimately, better care for beneficiaries.”

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