Cut paperwork, not care. Make your state’s investments work together.
Your Medicaid agency, vendors and managed-care plans are investing in new ways to exchange information and handle prior authorization. The next task is making those capabilities work for the same providers and people across the program.
Delaware has funded shared infrastructure that other states can use. You do not have to commission another isolated network to put it to work.
Compliance is the starting point. Adoption is the test.
A payer API can be ready while a small practice still faces separate integration, testing and operating costs. Members can still be left navigating disconnected provider portals, plan systems and Medicaid processes.
Coordinate the work across fee-for-service and managed care, beginning with prior authorization. Keep existing systems and make the connections reusable for the next program requirement.
Three opportunities for Medicaid leaders
1. Make your existing investments work together. Direct the state’s MMIS/MES vendor and managed-care plans to connect their APIs through SHN and coordinate provider onboarding, testing and support. There are no SHN participation fees or transaction fees for the designated Open Access transactions.
2. Give the state better operations and oversight. Follow Delaware’s approach to seeking federal Medicaid systems funding through an Advance Planning Document for optional Network Management and Network Intelligence across fee-for-service and participating plans. Define the additional operating work and authorized program-wide analysis the state needs to reduce duplication, resolve recurring problems and see whether investments are delivering results.
3. Help small and rural providers participate. Use Delaware’s CMS-approved Rural Health Transformation Plan as a template for funding provider adoption, including onboarding, EHR integration, testing and training. Rural practices cannot benefit from connections they cannot afford to implement.
States define their own eligible scope and obtain applicable approvals. Delaware’s approach is a reusable starting point, not a transferable funding approval. Sponsoring a service does not create new rights to participant or member information.
Bring the market together without replacing its systems.
Medicaid, insurance departments, plans, providers, HIEs and technology partners can coordinate implementation while retaining their own authority and responsibilities. The same provider relationships often extend into Medicare and commercial coverage, making shared adoption work more valuable.
We do not need to harmonize state regulation to harmonize implementation.