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When South Dakota launched its bid to get a new system in 2007, a main goal was to find something that would help the state analyze Medicaid. The federal state program that provides medical care for the poor is the state's most costly, and officials always are trying to find ways to improve efficiencies and savings.

But South Dakota officials say the feds have complicated the project at times. Earlier this year, the state sent a letter expressing disappointment over a change in CMS' longstanding support for a complete system overhaul to one that falls short of the original goal. Since the contract was awarded in 2008, CMS has changed its Medicaid billing requirements, which in turn has added complexity to the state's project.

There is no time frame to finish the project, let alone restart it. Meanwhile, CNSI is involved in litigation in Louisiana, leading officials here to question the company's ability to finish the project. CNSI was also a subcontractor in developing the Affordable Care Act website, whose launch last fall was marred by delays and malfunctions.

that letting 50 flowers bloom is not a good idea anymore," he said.

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The contracts are lucrative, and Salo said state government officials who write project proposals often are overmatched by the resources brought to bear by tech companies. Thus, contracts often are written to the advantage of the companies, complete with loopholes and provisions in their favor.

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Old system lacks ability for analysis

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Such analysis, for example, can identify which providers are getting the most money and whether they also are getting the best results, which can help policymakers fine tune the program.

"The state's tried to fire the vendor," he said. "CMS wouldn't let us. not forced to stick with vendor

Rep. Mark Mickelson, a Sioux Falls Republican, has questioned the program since being elected in 2012. He Converse Fashion Style

System weighted toward tech giants

calls it a "classic three way standoff."

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The state has spent most of the $62 million budgeted for the new computer system, and South Dakota is at odds with contractor Client Network Services regarding how to resolve differences on the project.

The system in use then and now can pay claims, but it can't provide analysis in the way modern computing power can.

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liability to the state," Fierberg said.

The state with assistance from the federal government would replace the aging, 1970s era computer system that helped administer South Dakota's Medicaid program. Through a bidding process, a Maryland based computer company with ties to the federal government was chosen to build the new system.

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"We went into it with great optimism that this was going to be something to help us analyze the program and not just pay claims," said Sen. Phyllis Heineman, a Sioux Falls Republican who was a member of the House when the program started.

Complicating the issue, say state officials, is the Centers for Medicare and Medicaid Services (CMS), the behemoth that oversees the federal health programs. The agency has provided 90 percent of the funding for states to modernize their Medicaid computer systems, including in South Dakota, so it has a stake in overseeing that process.

has battled six years to make digital upgrade

Dropping CNSI, Fierberg added, would have resulted in a lengthy delay to get the project rebid and restarted, and it would have resulted in CMS recouping the $50 million that it paid to South Dakota to complete the original contract.

And when the state sought to divorce itself from CNSI and dissolve its contract in 2010, the federal government pushed the state to mediate its problems with the company. Had the state walked away, say officials, CMS threatened to force South Dakota to pay the 90 percent project cost.

"We did strongly suggest that it was the best alternative after each side had filed suit against the other," Fierberg said in an email. "This was because the (system) work was, by the state's own assessment, at least 60 to 65 percent complete at the time."

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Because states are at a disadvantage, Salo said the area could benefit from more uniformity among the state systems, but a national standard also would mean that states would give up some of their policies.

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Mike Fierberg, a spokesman for the federal agency in Denver, disputes the characterization it "forced" the state to mediate with CNSI.

Today, the state is no closer to completing that project than it was four years ago, and what appeared to be a simple concept on paper has instead turned into a quagmire.

On paper, it was a simple plan.

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Medicaid Management Information Systems also vary by state, Salo said, in the way they pay Medicaid providers, organize providers and in what they report. Lawmakers in each state have developed specific policies, and the technology has been adapted in each state to reflect those Converse Shoes Ladies White policies.

"They're just awful," Salo said. "We kind of joke that the number of times an MMIS contract, or an IT contract, has come in on time and on budget and on spec, happens never."

States across the country have embarked on similar upgrades to what's known as their Medicaid Management Information Systems. Like South Dakota's, many of those systems are based on obsolete mainframe technology. Matt Salo, executive director of the National Association of Medicaid Directors, said many of those states have had experiences similar to that of South Dakota.

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