August 31, 2007 By Patrick Michels
Texas had big plans for its new health and human services application and eligibility program. After investing heavily to get the new system off the ground, officials looked forward to processing Medicaid, food stamps and other public aid claims more efficiently. Data would be stored more reliably. It would be a technological leap.
When it came time to roll out the program in the 1970s, however, employees were up in arms. They were accustomed to the old system; they knew all the tricks. Adjusting to this new program was just another burden atop their already heavy caseloads. Why bother with all this hassle?
With that unceremonious debut, the System for Application, Verification, Eligibility, Referral and Reporting (SAVERR) was implemented.
"Of course, we've all forgotten that," said Stephanie Goodman, spokeswoman of Texas' Health and Human Services Commission (HHSC). "That was 30 years ago."
Now the HHSC is in the middle of another rocky rollout, this time replacing SAVERR and various other eligibility programs with a new program called the Texas Integrated Eligibility Redesign System (TIERS), designed to integrate the application and eligibility process for at least 50 public assistance programs.
TIERS will link nearly 25 government agencies - as opposed to the old systems, which required case workers to enter information for each program separately.
Official reports issued this year, however, as well as state legislative hearings and widespread media coverage, contend that the switch to TIERS wasted hundreds of millions of dollars. Worse, the death of a 14-year-old boy, whose health insurance was mistakenly withheld, according to newspapers around the state, has been connected in the public memory to the agency and its beleaguered program.
For TIERS, evolving demands, an inflexible regulatory and contract framework, and aggressive implementation timelines combined to snarl its rollout. The story of the system's implementation holds lessons for agencies across the nation that are working to integrate complicated systems.
There's just no easy way to introduce a new eligibility program, Goodman said, and tackling the number of records her agency handles doesn't make it any easier. Even as auditors and legislators continue to probe the agency, the HHSC stands by its new program.
An Aging System
Texas' Legislature asked for a replacement 10 years ago for SAVERR, which was implemented in the late 1970s. The program is still used in all but a few counties, Goodman said.
Written in COBOL, a programming language that dates to 1959, SAVERR was built to run on old machines with black-and-green screens and noisy keyboards. Intended for use during face-to-face consultations with aid recipients in government offices, SAVERR requires employees to enter data a few fields at a time before moving on to the next screen. Data is batched overnight and printed periodically for hard-copy records. When people change their address, or enroll or drop out of any program, the old entry is overwritten, and no historical record is left in the program. To access historical data, employees must search through electronic and paper archives. The Austin American-Statesman reported the monthly cost of running SAVERR on HHSC computers at $1 million.
In 1999, the agency was ready with a blueprint for a new system. Where SAVERR processed records for each benefit program individually, the new system, called TIERS, was designed to handle Medicaid, food stamps and Temporary Assistance for Needy Families benefits in an integrated database. By 2003, TIERS was ready to roll out in two Texas counties: Travis and Hays.
At the same time, however, policy changes were brewing that would significantly complicate deployment of the new system. First, the Texas Legislature reorganized the state Department of Human Services - which was responsible for developing TIERS - under a much larger umbrella agency that became the HHSC, which accounts
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