Manage eligibility and entitlement services for medical assistance programs more effectively
Cúram Income Support for Medical Assistance enables social program organizations to improve the efficiency and effectiveness of managing eligibility and entitlement services for medical assistance. Cúram Income Support for Medical Assistance equips organizations with a powerful, proven set of business tools and processes designed specifically for the effective management of both traditional medical assistance programs as well as Affordable Care Act and MAGI (Modified Adjusted Gross Income) based Medicaid programs.
Curam Income Support for Medical Assistance supports:
- Multiple models of medical assistance including government subsidized insurance models requiring citizen payment of premiums.
- Integrated service delivery shares evidence and business processes, determining eligibility across multiple medical assistance programs.
- Automated eligibility and entitlement determination uses pre-populated rule sets that can be easily appended and modified.
Multiple models of medical assistance
- Provides individuals and families the ability to apply for assistance with their health care through the range of Insurance Affordability programs including traditional and MAGI-based Medicaid, CHIP, Insurance Assistance or the State option to provide a Basic Health Program
- Supports complex program processing including spend-down, retroactive eligibility and long term care.
- Achieves accurate results and complete coverage across medical assistance programs.
- Ensures the correct application of complex eligibility policies through evidence entities, rules, and business processes for mandatory US Medicaid coverage groups, as well as optional programs including long term care, refugee and emergency medical assistance.
- Enables compliance for US Health Care Reform, Patient Protection and Affordable Care Act (PPACA) and requirements for enhanced eligibility and enrollment for Medicaid programs.
Integrated service delivery
- Improves team-based decision making for better citizen outcomes.
- Enables organizations to share evidence and business processes.
- Provides a platform for enterprise-wide modernization.
Automated eligibility and entitlement determinations
- Complex eligibility rules and processes, managed by the system, enhance caseworker decision-making and effectiveness.
- Evidence entities, rules, and processes support the specific mandates of the Affordable Care Act, including expanded Medicaid eligibility.
- Cascading eligibility enables administrators to set program hierarchy, prioritizes programs, and allows for multiple program eligibility results that deliver the necessary benefits to citizens based on their unique circumstances.
- Change-in-circumstance processing supports retroactive changes in data and automatically reassesses citizen benefits.
- Evidence entities, rules, and processes support the specific mandates of the Affordable Care Act, including expanded Medicaid eligibility and determining eligibility for insurance assistance or the state option to provide Basic Health Program.
- Eligibility summaries and budget sheets guide new caseworkers through decision analysis, displaying details on how eligibility is determined for medical assistance coverage groups.
The Cúram extensive administrative and development tools allow agencies to easily configure and extend the solution, speeding deployment and simplifying maintenance. Provides proven and cost-effective capabilities to help states meet 2014 healthcare reform mandates while taking incremental steps toward enterprise modernization
Cúram Social Program Management PlatformCúram Verification Engine
Cúram Income Support for Medical Assistance Resources
IBM Software Subscription and Support is included in the product price for the first year.
Not available for purchase online.