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Bill seeks to speed up Guam Medicaid processing by piggybacking on other states' IT contracts


By Pacific Island News Staff

Vice Speaker Tina Muna Barnes is proposing to authorize the Guam Department of Public Health and Social Services to reuse other U.S. jurisdictions' contracts for Medicaid Enterprise Systems.

“When tens of thousands of families need this coverage, when private clinics plus our government hospital need this revenue, we must do everything in our power to make Medicaid as efficient as possible,” Muna Barnes said.

The Medicaid Enterprise System is an automated system of managing Medicaid claims processing and information retrieval. These systems are required to meet certain standards set by the Centers for Medicare & Medicaid Services (CMS) to receive federal funds.

Tina Muna Barnes

As one of the conditions for enhanced funding, states are required to "promote sharing, leverage and reuse of Medicaid technologies and systems within and among states," according to CMS.

Bill 267-37 would authorize DPHSS to join existing contracts, hence reducing "acquisition lead time and administrative burden and costs.”

If the bill is enacted into law, the patients would benefit from faster processing of claims and applications, and a more convenient online portal. Healthcare providers can also see improvements in the approval rate and timeframe of receiving payments for treating Medicaid patients.

More than 45,000 local residents rely on Medicaid for their health needs, according to DPHSS.

“Now that our federal partners are recommending this strategy, and our local experts have concurred this bill is needed in order for Guam to take advantage of these partnerships - it makes sense for the legislature to respond accordingly," the vice speaker said.

In November 2023, Edward Dolly, the director of State Systems for CMS, wrote to DPHSS, encouraging Guam to “leverage cooperative purchasing through multistate or territory collaborations "for the local Medicaid program."

“In addition, CMS believes that reuse enables the federal government, states, and territories to effectively share (Medicaid Enterprise Systems)  information technology assets to reduce risk, lower implementation, and operational costs, accelerate development and service delivery timelines, increase consistency across Medicaid programs, and improve the overall quality and maturity of all MES,” Dolly wrote.

Carlos Pangelinan, chief human services administrator at the Division of Public Welfare, endorsed the bill.

“Acquiring a state-of-the-art mechanized claims processing and information retrieval system would substantially improve the ability to process and pay claims, improve program integrity, and allow greater efforts toward processing prior authorization requests and add value to Medicaid patients and providers by improving service,” Pangelinan said in a letter to Muna Barnes.

“In addition, many of the currently labor-intensive federal reporting requirements would be able to be completed by or with the assistance of system-generated reports," he added.

Pangelinan added the change in legislation would also:

  • Allow for personnel to be reallocated from manual processing tasks to customer service and case management, rather than hire more employees.

  • Reduce the errors, delays and other administrative burdens that come with paper-based applications.

  • Reduce processing times for new applications, through the use of an online portal.

  • Automate workflows, ensuring predefined timelines for processing and automatic alerts when deadlines approach. This would help reduce penalties related to noncompliance with established time frames.

  • Offer robust audit capabilities, in addition to allowing DPHSS personnel to track application statuses, monitor processing times, and generate comprehensive reports for internal review and external audits.


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