our-thinking-people-working-laptop-1400x768
Case Study

Cognosante helps state Medicaid programs adopt MAGI eligibility determination processes

Challenge

To build technical and operational programs in order to enable a state Medicaid program to adopt the Modified Adjusted Gross Income (MAGI) calculation to determine beneficiary eligibility as required to ensure compliance and cooperation with the Federally Facilitated Marketplace (FFM) and the No Wrong Door enrollment policy (NWD) under the Affordable Care Act (ACA).

Challenge

To build technical and operational programs in order to enable a state Medicaid program to adopt the Modified Adjusted Gross Income (MAGI) calculation to determine beneficiary eligibility as required to ensure compliance and cooperation with the Federally Facilitated Marketplace (FFM) and the No Wrong Door enrollment policy (NWD) under the Affordable Care Act (ACA).

Solution: Cognosante planned, built, staffed, and operated a Service Center to support individuals looking to obtain and maintain eligibility for Medicaid and the Children’s Health Insurance Program (CHIP). The center served as the entry point for these individuals, and Cognosante agents provided the following services: eligibility and redetermination facilitation, verifications collection, changes in eligibility, eligibility appeals facilitation, and the provision of referrals and other information.

To support the multiple streams of information coming into the Service Center from customers, the Medicaid agency, FFM, and others, Cognosante delivered a robust case management technical solution with integrated telephony and document management.

Result: The Service Center technology solution and team of Service Center professionals processed a monthly average of 44,000 inbound telephone calls, 5,000 incoming pieces of mail, and 11,000 incoming faxes.