Health Information Exchanges Could Close Data Gaps in Medicaid Work Requirement Medical Frailty Determinations

States implementing new Medicaid work requirements must identify medically frail enrollees exempt from these rules, but traditional claims data in MMIS systems lag behind real-time clinical information—creating coverage continuity risks. This analysis explores how health information exchanges can supplement state data systems with more current diagnostic and utilization information to support timely ex parte exemption determinations. The approach is particularly critical for managed care plans where encounter data reporting delays compound identification challenges.

Managed Care

This is outside commentary from Manatt Health, not part of Medicaid Monitor's independently scored news coverage.

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