Transforming Medicaid Eligibility and Enrollment

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 is using 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.

Low-Risk High Performance

The new solution will streamline eligibility determination, reduce manually intensive work, and advance 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.

Through our partnership with RedMane, the Commonwealth will take advantage of technological improvements that ensure staff have the needed information at their fingertips when working with those in need.

Through our partnership with RedMane, the Commonwealth will take advantage of technological improvements that ensure staff have the needed information at their fingertips when working with those in need.

carl ayers

Family Services Division Director, Virginia Department of Social Services