Social Services Synchronicity

States face decision on integrating health and human services eligibility: Rip and replace, or work with what they have.

by / March 28, 2005
It's been painful, but states keep struggling to simplify business operations in the back office and at the front counter. Administrators examined the work behind accounting, procurement, HR, payroll, licensing and other functions, finding unnecessarily complex and redundant MOs.

States had no choice -- budget shortfalls and dire revenue projections made it clear something had to be done. Legislators and the executive branch privately acknowledged the need to rationalize operations through drastic, politically unpopular steps that elected officials would never have risked 10 years ago, such as cutting jobs and aggressively pursuing automation.

The need to change trumped the status quo, and state and local governments now see outdated and redundant health and human services eligibility systems as the next target. If administrative simplification isn't motivation enough to pursue a new approach to eligibility determination, the potential cost savings should set the wheels in motion.

The California Performance Review (CPR) examined the eligibility determination process for three state programs: Medi-Cal (California's Medicaid program), California Work Opportunity and Responsibility to Kids (CalWORKs), and food stamps. The CPR found California counties spend $308 to $493 per person to determine eligibility for the three programs -- an average of $337 per eligible person.

"The counties use at least 19 different technological platforms for eligibility processing," the CPR said. "While there are implementation plans under way to reduce the platforms to four, the current environment causes the state to maintain different eligibility systems and to develop additional interfaces for the state eligibility data files."

Fixing Eligibility
States have spent considerable time and money revamping the information systems supporting various state-administered health and human services programs, but eligibility determination applications didn't get the same attention. These applications escaped notice partly because states had enough trouble trying to undo the information silos built up in discrete health and human services agencies.

Eligibility information collected from clients by state agencies managing Temporary Assistance for Needy Families (TANF) -- a federal program that provides funding to states for services that help needy families -- wasn't shared with agencies managing other assistance programs, despite the high percentage of clients accessing multiple programs.

Besides building eligibility determination systems for TANF, states built similar systems for other programs, such as food stamps, Medicaid and energy bill assistance. Agencies then dealt with headaches related to maintaining multiple systems; social workers grew frustrated because they had to enter the same client's information into three or four different systems, which only increased the chances of erroneously entered information; and clients had to visit three or four different agencies to apply for services.

State and local governments dutifully built different eligibility determination applications for the individual silos, at least in part, because the funding process demanded it. Health and human services funds that come from different federal agencies are earmarked for narrow purposes, allowing states little leeway in how they spent grant money. Using money from, say, the federal Administration for Children and Families to finance an information system that didn't exclusively support the work of a state's department of children and families was impossible under the funding stipulations.

Dealing with myriad eligibility determination applications that don't share information with each other isn't easy or cheap, and state and local governments have begun building integrated applications to determine eligibility for multiple health and human services.

Given the age of the hardware that processes state health and human services -- 20- or 30-year-old mainframes using batch processing and running old operating systems -- states have a few choices for creating integrated eligibility systems. Some are deploying completely new software platforms. Others are using Web services and service-oriented architectures (SOAs) to forge links between legacy applications, making them act like a single system.

Building eREP
Utah chose to build a new platform.

The state is knee-deep in implementing its electronic Resource and Eligibility Product (eREP) -- an automated eligibility determination system for several state-managed programs, such as TANF, food stamps and Medicaid. eREP will replace Utah's Public Assistance Case Management Information System -- a mainframe eligibility system developed in the 1980s.

When all eREP modules are successfully rolled out, the system will determine eligibility for more than 260,000 needy individuals per month for services offered by three state agencies -- the Department of Workforce Services, the Department of Human Services and the Department of Health, said Mark Schultz, Utah eREP project executive.

The first module, Utah Cares -- a referral Web site to help Utah residents find state and community services -- went live in late 2003, Schultz said. The second component, InfoSource -- an online policy reference manual for TANF, food stamps, child care and Medicaid programs with links from the eREP system rules -- launched in April 2004.

Utah began piloting an eligibility-screening module at the end of 2004, he said, explaining that it captures information to determine if a client or family is potentially eligible for state programs, and produces an application form that will become an electronic application submission.

"We're not going live with the actual eligibility component until the end of 2006," Schultz said.

Social Enterprise Management
Utah is working with C
Shane Peterson Associate Editor