The document discusses Medicaid IT architecture and interoperability. It provides background on Medicaid spending and beneficiaries. It then describes the Medicaid IT Architecture (MITA) framework, which aims to make Medicaid systems more patient-centric, interoperable, and based on industry standards. The framework is a roadmap to guide states in building their own customized IT solutions over 5-10 years. Finally, the document discusses three scenarios for funding collaborative environments and electronic health initiatives like e-prescribing through the existing Medicaid Management Information System (MMIS) funding structure.

1. HIMSS – National Capitol Area Rosslyn, VA October 16, 2008 Medicaid IT Architecture and Interoperability Rick Friedman, Dir. Division of State Systems CMSO, CMS richard.friedman@cms.hhs.gov

2. Medicaid Background Information

3. Growth in Medicaid Beneficiaries Millions of Medicaid Beneficiaries 0 10 20 30 40 50 60 1965 1975 1985 1995 2008

5. MEDICAID: People and Money *About 7 million duals have been subtracted from the total to avoid double-counting Source: Kaiser Commission, 2007 $623 billion 90 million* Medicaid and Medicare $ 297 billion 42 million Medicare $326 billion (1 of every 5 health care $s ) 55 million (1 out of every 6 Americans) Medicaid $1.54 trillion 325 million U.S. Totals Money People

8. Medicaid Information Technology Architecture (MITA)

14. How Would CMS Handle Funding in a Collaborative Environment that Focuses on Interoperability? Three Scenarios and e-Rx Data Flow

19. E-Prescribing Data Flows Physician’s Office Electronic Switch Pharmacy State Medicaid Agency MMIS Claims Engine Rx Claims 1. Eligibility Inquiry and Drug History 2. Rx sent to Pharmacy $ $ Office Visit Claim Pharmacy Claim 3. Drug/drug interaction