Modernizing Medicaid: Lessons from Functional Eligibility and interRAI Integration

As Medicaid programs evolve, states are turning to standardized, clinically rich assessment tools like interRAI to determine level of care (LOC) eligibility and support comprehensive care planning. Unlike homegrown tools, interRAI’s international clinical validation and cross-setting design make it ideal for aligning eligibility, case management, and outcomes.

🧠 Key Lessons for Modernization:

• Clinical Depth Enhances Equity
  Tools like interRAI-HC collect standardized data on cognition, mood, physical function, behavior, and caregiver support, ensuring assessments reflect the full scope of individual needs, not just check boxes.

• Standardization Enables Portability
  interRAI’s consistent structure supports data continuity across programs and settings, critical for beneficiaries transitioning between HCBS, nursing facilities, and hospitals.

• Technology Infrastructure is Non-Negotiable
  States adopting interRAI must invest in interoperable IT systems that support digital assessments, real-time scoring (e.g., case mix groups), and seamless integration with Medicaid eligibility systems.

• Training is Central to Success
  interRAI’s clinical rigor demands that assessors are not just trained on form mechanics, but on underlying care domains, coding rules, and implications for care planning.

🔧 Recommendations:

1. Choose interRAI as the core statewide tool across HCBS, NF, and managed LTSS programs.

2. Build digital platforms that support assessment, scoring, and system-level reporting.

3. Tie interRAI indicators to quality measurement, rate setting, and equity monitoring.

4. Create clinician-led implementation and training teams to guide successful rollouts.