CA DHCS modernizes Medi-Cal provider portal and claims operations with cloud migration
The California Department of Health Care Services (DHCS) operates CA-MMIS, a complex Medi-Cal system that processes about 200 million claims annually for almost 15 million beneficiaries and also manages provider information and other administrative functions. To modernize the legacy platform, DHCS worked with IBM Consulting on a cloud-based Provider Portal proof of concept, using IBM Garage methods, Design Thinking, and Agile practices. The initiative replaced paper-based processes with fully electronic workflows, decommissioned low-value steps, and set a roadmap for a more secure, scalable multi-tenant environment on Red Hat OpenShift and AWS.
- Organization
- California Department of Health Care Services
- Industry
- Public Sector
- Location
- United States
- Published
- February 2025
Reported outcomes
96.7%
user volume migrated to cloudOther quantified impact
Strategic outcomes
Primary read
Use case focus
Showing 2 of 2
- 1Cloud migration
- 2Workflow automation
- Legacy CA-MMIS systems no longer supported business needs and were increasingly cost prohibitive.
- DHCS needed to improve provider satisfaction, streamline administrative processes, strengthen security and privacy, and support efficient access to care.
- IBM Consulting co-created a cloud-based Provider Portal proof of concept with DHCS using IBM Garage, Design Thinking, and Agile practices.
- The team transitioned paper-based processes to fully electronic processes and removed low-value business processes.
- The modernization roadmap included a more secure multi-tenant IBM Z and Red Hat OpenShift on AWS architecture and migration of more than 30 functions to the AWS Cloud platform.
- The initiative onboarded over 30,000 providers.
- PIN resets moved from 30 days to real time.
- Delivery cost was reduced by 30%.
- 96.7% of Medi-Cal user volume, 60% of daily business transaction volume, and 76% of EOS/EOL applications were migrated to the cloud.
- More than 2 features per week were deployed on average.
- Over 3,100 providers adopted paperless processes.
Architecture
A cloud-based Provider Portal proof of concept was built with IBM Garage, Design Thinking, and Agile practices. The roadmap included a secure multi-tenant IBM Z and Red Hat OpenShift on AWS architecture, with more than 30 functions migrated to the AWS Cloud platform.
Implementation partners2
Sources & evidence1
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