Addressing the State of Ohio's Medicaid Eligibility Error Rates through Blockchain Technology
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The State of Ohio’s (State’s) Medicaid program serves more than 3.1 million Ohioans. Despite more than a billion dollars in technology investments, the State eligibility determination processes continue to incorrectly determine eligibility at a significant rate. The resulting application backlog and improper payments put both beneficiaries at risk of not receiving necessary healthcare services and the State at risk of owing hundreds of millions of dollars in recoupment to the federal government. Internal and external audits have routinely identified a root cause as deficiencies in the State’s technology solution. This proposal presents a blockchain-based Medicaid eligibility solution as a viable technology investment to address current challenges in the eligibility determination process. Built on a blockchain infrastructure, the proposed solution uses hierarchical deterministic (HD) wallets to build beneficiary profiles, a series of smart contracts to streamline the determination process, and a system integration tool to allow for seamless integration into the State’s Health and Human Services (HHS) system. An independent review of global trends in blockchain technology signal that the disruptive technology is gaining mainstream attraction healthcare and government industries. Through assessing the advantages and disadvantages of blockchain technology, this proposal demonstrates that it can be a viable solution to addressing primary challenges with current technology. Further, introducing disruptive technologies aligns with the current administration’s forward-thinking views on technology and its power in integrating citizen services. Based on these analyses, this proposal concludes that this solution be considered for adoption.