Looking Ahead: Eligibility-Dedicated Data Feed to Support MaineCare Renewals and Enrollment

Two weeks ago, we announced communications support for MaineCare partners and providers regarding changes the federal government is making to MaineCare (Maine’s Medicaid program) eligibility. This message provides an early look at planned data-sharing that will help the Maine Department of Health and Human Services (DHHS) verify information needed for MaineCare eligibility. Our goal is to help eligible Mainers keep their coverage and access to services with as little disruption as possible.

No action is needed now. We are sharing this information early to make providers aware of what is being planned. We will share more information as plans and timelines are finalized.

DHHS will continue to use administrative data sources it has access to as much as possible to support automatic (“passive”) renewals for MaineCare members. Federal changes to eligibility mean we need additional information to help more eligible members maintain their MaineCare coverage. This data will help Mainers continue to benefit from MaineCare, which in turn will help providers minimize the impact of these federal Medicaid cuts on their revenue and on their charity and uncompensated care.

Clinical Data Will Help People Stay Enrolled in MaineCare

Electronic health record (EHR) systems contain clinical data that Maine and numerous other states are planning to use to help exempt Medicaid applicants and members with work-limiting health conditions from Work Requirements. In Maine, this data will support MaineCare eligibility determination activities administered by the Office for Family Independence (OFI). DHHS intends to partner with providers to collect this information through HealthInfoNet, the State’s contractor for this work. HealthInfoNet will identify indicators of exemptions from work requirements by collecting and processing this clinical data from providers. Using clinical data alongside claims and other administrative data to generate more timely and comprehensive information will help keep Mainers enrolled in MaineCare. We will refer to the data sent to HealthInfoNet for this purpose as the eligibility-dedicated clinical data feed.

Until the eligibility-dedicated clinical data feed is established we will be basing automatic exceptions for work-limiting health conditions on claims data alone in order to meet implementation deadlines.

This Data Sharing Will Be Separate from the Health Information Exchange

The eligibility-dedicated clinical data feed will be separate from the health information exchange (HIE) data that many providers already share with HealthInfoNet.

The eligibility-dedicated data feed will include only the information needed to support MaineCare eligibility activities. This information will be stored separately from HIE data. It will not be available through HealthInfoNet’s clinical portal or through analytics tools used by some provider organizations. The eligibility-dedicated clinical data feed will be used only in support of OMS and OFI activities associated with eligibility.

Key details to note:

  • The steps needed for a provider to establish this new data feed will vary by provider organization. For example, some provider organizations already have a data feed with HealthInfoNet that can be used as a starting point. Capabilities of the organization’s EHR vendor or technology support may also affect the work needed to establish the data feed. Providers eligible for relevant Rural Health Transformation Program (RHTP) funding may consider using this funding for these costs, as determined by the allowable uses of specific RHTP opportunities.
  • We expect it will take the majority of provider organizations two to four months to build their eligibility-dedicated clinical data feed with HealthInfoNet. This time range will be dependent on provider organization’s or vendor’s availability to engage with HealthInfoNet. We expect it will take less time than building a typical HIE data sharing connection with HealthInfoNet.
  • Clinical care teams are not expected to need to take additional steps to send this information as part of their day-to-day work. Once the data feed is established, the identified data categories will be shared automatically with HealthInfoNet.
  • Broad categories of exemptions in statute for work-limiting health conditions include those who are blind or disabled, have a substance use disorder, disabling mental disorder, or complex medical condition. DHHS continues to work with the federal government to clarify data related to these categories that may assist states to automatically exempt individuals, including information related to a person’s ability to work. Kinds of data may include demographic information, diagnosis indicators, encounter or event indicators, and billing codes, among others.

More Information Will Be Coming – No Action Needed Now The Department and HealthInfoNet will distribute instructions for provider organizations to opt into this initiative and implement the eligibility-dedicated data feed. Future communications will include information such as:

  • Which provider types will be prioritized for establishing these connections
  • How providers can participate
  • The types of information that will be needed
  • Technical requirements and specifications
  • Onboarding and implementation steps
  • Timelines
  • Testing procedures
  • Contacts for technical and operational questions
  • Technical assistance and training, including materials, trainings, and office hours, to help providers prepare for the data-sharing process

No action is needed now. Please watch for future communications from us. We will let you know when providers need to take action, including when it is time to begin the process of establishing an eligibility-dedicated data feed with HealthInfoNet.

For more information, please visit mainecare.gov/work. OMS and HealthInfoNet will release an FAQ in the near future and will provide points of contact prior to initiating work with providers to establish the eligibility data feeds. In the meantime, we ask that you subscribe to our MaineCare Provider E-Messages to stay up to date as we share additional information.