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State Innovations in Horizontal Integration: Leveraging Technology for Health and Human Services

Executive Summary

Because most low-income individuals and families qualify for multiple public benefit programs, most states have a long history of using the same technology and staff to process eligibility for the means-tested programs that they administer, such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF).  Such integrated eligibility systems and processes are cost-effective for states because they avoid duplication of effort.  They also promote low-income individuals’ access to the full package of benefits for which they qualify, helping them meet their needs for nutritious food, medical care, affordable child care, and other basic living expenses.

The Affordable Care Act (ACA) required states to make large-scale changes to their eligibility systems for Medicaid in order to create streamlined processing with the health plan coverage and subsidies that are available through health insurance marketplaces (also known as exchanges).  To support these changes, the U.S. Department of Health and Human Services (HHS) made enhanced federal Medicaid matching funds available for states to update or build their systems.  In recognition of the efficiencies of integrating these systems with non-health programs, states have also been given the opportunity of a cost allocation waiver that allows them to temporarily use this enhanced funding to support technology and services improvements to eligibility systems shared by Medicaid and other health and human services programs.  

This issue brief highlights examples of technology and services innovations that states are implementing in support of integration among health and human services programs and discusses common themes across efforts. These examples, which are not exhaustive, are culled from interviews with federal experts and state officials from Alabama, California, Colorado, Idaho, Illinois, Kentucky, New Mexico, Oklahoma, Pennsylvania, Vermont, and Virginia. 

States have taken a wide range of approaches in leveraging their ACA implementation efforts to support a broader range of human services programs.  Though the degree of integration varies widely across states, most states featured in this brief have implemented or are planning innovations in one or more of the following areas:

  • Client portals:  States are making information and services available to consumers through client web portals.
    • Eligibility screening tools can promote cross-program enrollment by helping consumers learn they may qualify for programs that they may not otherwise have been aware of;
    • Multi-benefit online applications guide applicants through dynamic questions to receive eligibility determinations for multiple programs; and
    • Self-service case management features enable consumers to obtain information about and manage their benefits (such as updating case information) through a single point of contact.
  • Eligibility systems and business rules engines (BREs): States are enhancing integrated eligibility systems by programming rules for multiple health and human services programs into BREs.  These efforts can automate calculations and tasks to achieve significant efficiencies for states throughout the eligibility and enrollment process.  They can also dramatically shorten the eligibility determination process for consumers across a range of programs, in some cases allowing for real-time determinations.
  • Call center technology: Advanced call center technologies are allowing states to appropriately route calls to the staff with the skills and expertise needed to address callers’ needs.  These technologies give states the flexibility to make optimal use of both generalists who can address questions about all programs and specialists in particular programs or types of issues.  They also give states the flexibility to route calls wherever workers are located, allowing for “virtual” call centers with more efficient allocation of staff resources.
  • Electronic data matching: Using electronic data matching to verify eligibility factors can save consumers who apply for multiple programs from having to provide the same paper documents multiple times.  Some states are implementing new state hubs that consolidate data from multiple sources, making it easier for workers to access and process the information across programs as needed.
  • Document imaging and management: States are using document imaging and management systems to support streamlined processing of paper documents across multiple programs.  These systems make it easier for multiple workers to be involved in a single case as needed over time and across programs, facilitating handoffs among different programs or units of workers, such as call center representatives and workers in local eligibility offices.
  • Data management and analytics: States are examining ways to make better use of health and human services data to improve program operations and outcomes for clients. Data management and analytic tools allow states to merge data from multiple sources (e.g., case records and claims databases) and analyze it at the case, program, or population level to support better decision-making.
  • Mobile tools: States are in the early stages of exploring how mobile tools can help consumers understand, access, use, and maintain their benefits. Some states are starting with optimizing their client portals for tablets. A small number have developed or are exploring mobile “apps.”  Other states are looking for ways to incorporate mobile tools into their workflow.

Although the states included in this study are taking a variety of technology approaches toward horizontal integration, some common themes have emerged.  States have emphasized the importance of executive-level leadership and collaboration across health and human services agencies to provide governance.  They also have stressed the critical role of business process reengineering as a driver for technology projects.  Though states are using a blend of funding streams, they are carefully considering how best to capitalize on the enhanced federal funding opportunity and cost allocation waiver, particularly in light of a recent extension of the waiver for building or upgrading systems through 2018.  They also expect that data and analytics emerging from their technology efforts will help them adjust their horizontal integration approaches for better results and plan for future policy, operational, and technology changes.  The features profiled in this brief can serve as examples to help states improve their operating efficiencies while allowing them to better meet their constituents’ needs.

The full report is available in PDF format