A proven path to stable, reliable, scalable modernization

Beginning in 2014, Optum performed takeover and transition activities for the state-based exchange, hosting the legacy infrastructure operations while also building the new infrastructure. Medicaid rules were migrated from the legacy system to the new exchange system and a backlog of paper applications were processed.

During the original Open Enrollment failure, call center wait times exceeded 2 hours due to inadequate staffing by the existing vendor. To address this, Optum assigned 300 paper application agents to support the call center. These agents processed more than 855,000 paper applications and eligibility verification documents to eliminate the backlog in just 6 weeks.

Given the heightened scrutiny following the original failed launch, excessive call center wait times could have undermined the perceived success of the new application launch. The prompt support from the Optum call center helped alleviate a critical issue for the State.

With the new application up and running, the focus shifted to stabilizing the system, including facilitating operational readiness for more than 500 customer service representatives. The team:

• Processed applications, verifications and collected supporting documentation
• Implemented a data entry tool, including staff training
• Reduced manual application processing time from 120 minutes per application to 27 minutes

When Optum began the engagement, content was developed quickly and there was a high number of defects in the system. Over time, defect remediation has decreased the defects to a standard that surpasses industry expectations.

The state’s accessibility requirements make IT solutions accessible to people with disabilities. These requirements are based on the Enterprise Information Technology Accessibility Policy (EITAP) and are even more stringent than the federal requirements which are based on the Americans with Disabilities Act (ADA).

When Optum began working with the state, our product had a high number of accessibility-related issues. With two years to resolve them, a dedicated scrum team was formed with subject matter knowledge to address the issues. The team met the deadline, and there are now virtually no accessibility defects — rare in any state environment.

Beyond correcting defects as quickly as possible using a dedicated team, Optum partnered with the state to build accessibility best practices into the requirement phase of its solutions to avoid future issues. In addition, Optum helped mature the state’s Center of Excellence by implementing accessibility best practices. This helped guide the solution design toward compliance.

Achieving a fully stable system also meant cultivating trust within the partnership. Optum established a relationship that went beyond vendor and buyer. By engaging the right team members, those with in-depth knowledge and accountability, using clear and efficient communication drove the delivery of a quality solution. In addition to logging issues and providing demonstrations, Optum facilitated the state's leadership to socialize progress, including positive defect trends, with full confidence.

By carefully building a strong relationship, confidence between the state and Optum has established a lasting trust. When the state had questions, they were reassured, the right people with the right answers - specific to the area of focus - were available.

After the initial implementation, subsequent years  stabilizing the system and addressing defects, it was time for the state to pivot. A more stable system fostered greater trust in the platform and the desire to build on it. This meant upgrading the overall functionality to allow additional programs to use the platform so more populations could obtain their eligibility determination through the system.

In turn, the expanded functionality facilitated a seamless transition to hosting the system in the cloud,  taking advantage of all the cloud offered.

In March 2020, when the COVID-19 Public Health Emergency was declared, the state needed to quickly put controls in place so that none of its members would lose their coverage or receive lesser benefits in a time of such great need.

The state contacted beneficiaries at the time to determine whether they had experienced a pay cut. If so, it assessed their eligibility for a reduced-cost benefits plan and made the adjustment where appropriate. The state also established a special enrollment period to give those who had suddenly lost workplace benefits the chance to enroll through the exchange. These were previously unanticipated needs that the current system could not address, making it critical to implement the updates quickly.

The team worked tirelessly, and within a month, the necessary changes were implemented—reopening coverage to eligible residents and reinstating those whose plans had been downgraded or terminated. Between April and July 2020, 33,000 residents transitioned to more affordable plans or enrolled in the state’s Medicaid program. During the special enrollment period, nearly 23,000 individuals newly enrolled in coverage through the exchange.

In 2022, the state and Optum embarked on a multi-year modernization project to update the architecture and facilitate several initiatives, including decoupling the front end from the back end, externalizing all business rules and upgrading User Interface (UI)/User Experience (UX) based on findings.

The result was a more simplified user experience for HIX eligibility and enrollment (QHP + Medicaid) — while enabling continuous, disruption-free innovation. To meet this need, the system architecture had to be restructured as a modular, interoperable platform.

This transformation introduced APIs and modern UI/UX strategies, shifting from a traditional upgrade to a full user experience redesign. The team developed a centralized, intuitive, and mobile-responsive platform that integrated modularity, interoperability, and extensibility.

Moreover, the previous system relied on Java-based business rules which were difficult for non-developers to interpret. Optum helped convert these into the Decision Model and Notation (DMN) standard — making them easier to read, share and implement. The DMN-based rules also integrated smoothly with common logging and monitoring tools, improving both troubleshooting and data insights.

Ultimately, this effort transitioned the state’s Health Insurance Exchange (HIX) system from a tightly coupled monolith to a modular, modern platform.

The original HIX system was built as a monolith, with the user interface, business logic and rule logic deployed together. This architecture made updates and scaling difficult. The front end relied on JSPs and jQuery within a traditional MVC framework, limiting flexibility and responsiveness.

To modernize, Optum and the state took deliberate steps to decouple and streamline the system:

• Migrated from jQuery to ReactJS
• Replaced MVC architecture with RESTful controllers
• Transitioned from JSP to HTML
• Adopted a Single-Page Application (SPA) model

Additionally, heuristic analysis identified significant usability gaps. We used the modernization effort as an opportunity to transform the UI/UX of the MAHIX application.

These changes resulted in a system that was easier for all stakeholders to use and more compatible with tools that identify, track, and resolve issues.

Through a human-centered, persona-based design approach we created a seamless experience for HIX consumers. Optum collaborated closely with stakeholder business teams, conducted multiple demonstrations, walkthroughs, and performed internal usability testing to identify and resolve issues. The implementation strategy enabled immediate UI/UX enhancements. This played a crucial role in driving a successful Open Enrollment period, especially following earlier challenges.

The result was a system that offers long-term flexibility and modularity allowing technology enhancements and new partners without disrupting the state’s daily operations.

Today, the portal provides a seamless enrollment experience for MAGi Medicaid and QHP plans, integrating eligibility intake and determinations. Optum continues to work with the state to explore new ways to make eligibility and enrollment across other programs more efficient.

Over the past decade, membership has grown by more than 50%, expanding access to coverage for more beneficiaries who qualify.