Medicaid Registrations Way Up in Territory

Luis Sylvester
Luis Sylvester

While the territory’s hospitals were devastated by September’s hurricanes, more residents are eligible for medical assistance and the Virgin Islands government will be paying less for it.

Luis Sylvester, representing Molina Medicaid Solutions in the U.S. Virgin Islands, gave members of the Senate Committee on Health, Hospitals, and Human Services an update on his company’s system Friday.

He said since Medicaid Management Information System (MMIS) was brought into the territory in 2012, the registered residents in Medicaid rose from 8,000 to 25,000.

Residents who earn below a certain income level who qualify for the program, including the elderly, the disabled, pregnant women, children younger than 21 and those in the Temporary Assistance for Needy Families program.

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The Medicaid program is also know as the Medical Assistance Program (MAP) in the Virgin Islands. Residents can call 340-715-6929 or send email to [email protected] to find if they are eligible.

Before the Virgin Islands got into this system, MAP claims were processed manually on paper, payments were delayed and providers were reluctant to get into the system. Now claim adjudication has been reduced to six seconds and clean claims are processed in one week, Sylvester said.

Department of Human Services Commissioner Felecia Blyden told the senators a federal law in February removed the local matching funds of 45 percent for MAP and it is now covered 100 per cent by the federal government.

Streamlining the registration process is just one area where DHS is making efforts.

“The department is working towards placing outstation workers (next month) at all hospitals and Federally Qualified Centers territory wide. The workers will assist new enrollees and existing members with various services,” DHS director of MAP Gary Smith, said.

He said the goal is to have 50,000 residents registered in the program.

The MMIS provides services to recipients and providers, manages computer processing, and provides management reporting for planning and program control.

The system will remain in effect until 2022, since Gov. Kenneth Mapp approved a six-year extension of the contract.

The contract is unusual in that it allows a partnership between the territory and the state of West Virginia. The partnership, the first of a kind between a state and a territory, uses the platform developed by West Virginia, but a firewall exists between the two entities.

Sylvester said claims processed annually have gone from 1,000 to 100,000. He added that Molina’s goal is “A future where everyone receives quality healthcare.”

Senators present at the hearing were Nereida Rivera O’Reilly, Janelle Sarauw, Dwayne DeGraff, Kurt Vialet, Sammuel Sanes, Novelle Francis, and Marvin Blyden. They generally expressed praise for the initiatives.

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