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What you need to know about Medicaid HIEs


ACA wants to build health information exchanges to connect Medicaid providers. Learn what you need to know about them.

When the U.S. Supreme Court ruled on the constitutionality of the Affordable Care Act (ACA), it also ruled that the federal government could not coerce states into expanding their Medicaid programs. Consequently, many states likely will opt out of Medicaid expansion.


In addition to being a practicing emergency physician as well as a professor at Harvard Medical School, Halamka is chairman of the New England Healthcare Exchange Network and co-chairman of the Health Information Technology Standards Committee.

Massachusetts realized Medicaid's desire to increase the quantity and quality of outcomes for its beneficiaries aligned with CMS' mandate to expand HIE nationwide, he says.

The state presented CMS with a three-phase model and was awarded $16.9 million to help implement phase 1 of its plan. Massachusetts estimates the total cost of the plan at approximately $50 million, to be partially funded by Medicaid, partially by the state, and partially from private industry stakeholders.


If Massachusetts can do this, then every other state also might be able to implement statewide HIE by engaging in a similar Medicaid expansion program. Cash-strapped states that opt out of Medicaid expansion, however, might find it difficult to implement such a plan.

Halamka acknowledges that other states also can use this plan to expand HIE, but payers, providers, and government must work together. It's a compelling argument, and one every state should consider, because use of the resulting HIE infrastructure won't be restricted to only Medicaid-related activities.

"If you build a backbone that connects hospitals and healthcare providers in the state in order to support the care coordination Medicaid wants," he says, "you can reuse that backbone for all kinds of purposes. By using state funds with Medicaid matching funds and private contributions, we created a sustainable business model."

The Massachusetts HIE will connect every healthcare provider in the commonwealth through a common set of federal standards, which, not so coincidentally, are the same standards found in the meaningful use stage 2 proposed rule (see more information on the final stage 2 meaningful use rule at Using similar plans, every state in America could effectively build a statewide HIE. States would have to consider expanding Medicaid in their state.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health