With nearly 50 percent of the territory’s 1.6 million residents on Medicaid and hurricane recovery efforts still underway, Puerto Rico saw an opportunity to transform its Medicaid eligibility and enrollment operation. RedMane is working with the Commonwealth’s Department of Health on the important initiative.

The cornerstone of the transformation is a new Medicaid system. With an eye toward results, quality, and speed, RedMane used its Smart Transfer approach. This innovative strategy leverages RedMane’s work completed for a wide variety of clients and builds upon the IBM Social Program Management platform, also known as Curam Software.

The new solution went live in less than 30 months, even though much of the project was performed during the COVID-19 pandemic. It includes a caseworker system and citizen-facing portal, each of which is available in English and Spanish.

This new solution has streamlined eligibility determination, reduced manually intensive work, and advanced the Commonwealth’s efforts to provide better care, easier access, and more efficient healthcare delivery.

By maximizing reuse, capitalizing on Commercial-Off-The-Shelf (COTS) software, and tailoring the system to Puerto Rico’s specific needs, the Commonwealth is able to reduce risk and control costs while still achieving high performance.

The next phase of the project is underway. Enhancements to the solution to provide even greater automation and more self-service capabilities will be implemented in the coming months.