Driving Medicaid Efficiency: Leveraging Technology for Better Provider and Beneficiary Outcomes

In the U.S., approximately one out of every five dollars spent on healthcare is spent on Medicaid (Kaiser Family Foundation [KFF], 2025). According to the most recent data provided by the National Health Expenditure, Medicaid spending grew by 7.9% to $871.7 billion in 2023 (CMS.gov, 2024). This spending growth puts additional pressure on state budgets, especially as some members of Congress are considering plans to cut nearly a third of projected federal Medicaid spending.

A significant driver of administrative costs and data redundancies in legacy Medicaid systems occurs during the Integrated Eligibility process, which determines eligibility for citizens to access benefit programs. The Centers for Medicare and Medicaid Services (CMS) found that 36 states are operating outside of regulatory compliance with at least one federal requirement related to the renewal process (CMS.gov, 2024). Factors like long call times and delayed application processing increase the risk of miscommunication and errors, which, in turn, translates to using additional funding to amend these errors. Additionally, regular operating costs such as labor expenses, call center support, and technical debt incurred from housing data on siloed legacy systems, can quickly add up and increase pressure on already strained state budgets.

According to a recent study, total spending on administrative services was about $33.8 billion annually for Medicaid or approximately 5–6% of total expenditures (Health Management Associates, 2024). Moreover, these inefficiencies can lead to substantial delays and frustration for enrollees. A survey conducted by the Center on Budget and Policy Priorities found that 40% of Medicaid enrollees in numerous states experienced significant delays in processing applications due to administrative backlogs (Cbpp.org, 2025).

A modern Medicaid enterprise platform offers a centralized, secure approach that can effectively manage administrative costs, which gives state health workers the freedom to allocate Medicaid funding in more meaningful ways. Being proactive about enrollee data also empowers state workers to shift from a reactive to a proactive stance in all aspects of their work.

Applying human-centered design principles and addressing non-medical drivers of health through connected, modular platforms enables state Medicaid programs to provide more comprehensive and preventive care. This not only improves individual health outcomes but also contributes to significant cost savings for a state’s Medicaid system. 

Applying HCD principles to a new Medicaid portal puts the users at the center — focusing on the needs of members, providers, and partners. Designing with this in mind could provide a one-stop shop for members, providers, and partners to see their (or their patient’s) Medicaid healthcare data, find recent news and events, receive notifications, reach out for help, and much more.

Non-medical interventions can also make a significant impact, taking pressure off Medicaid funding and budgets and providing better outcomes for citizens. More state Medicaid programs are starting to offer wellness benefits such as stipends for GED test prep, vouchers for a dependent’s summer camp, or a catalog of home health aides.

North Carolina’s Healthy Opportunities Program found that non-medical interventions such as access to food and reliable transportation actually saved $1,000 on expenditures per enrollee per year (North Carolina’s Department of Health and Human Services, 2025). A major contributor to this decrease in spending was the reduction in emergency room utilization as a means for enrollees to avoid food insecurity and housing instability.

Connecting enrollees to custom programs through user data collected on enterprise platforms not only saves on costs, but it also empowers enrollees to make healthier, preventive choices for their long-term health and wellness.

Maryland’s MD THINK initiative further demonstrates the impact of human-centered design and integrated platforms. By consolidating data across health and human service programs, Maryland reduces repetitive requests for information and delivers services faster, effectively addressing non-medical needs and improving overall health outcomes (statescoop.com, 2024).

Enterprise-based solutions offer real-time information, enabling state Medicaid programs to proactively address challenges such as budget constraints or global health crises. A revitalized platform also alleviates stress for both state workers and enrollees by providing real-time access to their data, restoring trust and bolstering cooperation in state processes.Additionally, eliminating data silos protects states from fraudulent activity or nefarious actors attempting to steal sensitive medical data. In the future, an enterprise platform could do even more — using advanced analytics to predict state- wide health trends, assisting state case workers in designing personalized care plans, and facilitating real-time collaboration across agencies. While the full potential has yet to be realized, the benefits are already clear: enterprise Medicaid portals offer a promising path forward for state agencies.