Utah’s Eligibility System Leaps into the 21st Century

By Guest Blogger

This blog post was originally published on State Refor(u)m’s State of Implementation Blog on July 12, 2012. It was written by Nicole Dunifon, Program Assistant at the National Academy for State Health Policy.

Many states are seizing the opportunity to draw down a 90 percent federal matching rate to design and develop new and upgraded Medicaid eligibility systems to support seamless enrollment. To secure the 90 percent match, states must submit an advanced planning document (APD) to the Centers for Medicare and Medicaid Services (CMS) that demonstrates their systems will meet seven standards and conditions. As many states are considering their eligibility system enhancements and writing their APDs, we wanted to share exciting information technology (IT) innovations from Utah that have improved enrollment and retention in Medicaid, CHIP, and other human service programs.

In May, Utah hosted eight Maximizing Enrollment state teams and provided an in-depth look at Utah’s systems enhancements. During this meeting, representatives from Utah’s Departments of Workforce Services (DWS) and Health (DOH) explained how multiple system components work together to streamline processes for eligibility workers and offer a more customer-friendly experience for applicants.

Examples of Utah’s IT innovations include:  

  • eRep – A rules-based eligibility system that is used for multiple human service programs, including the Supplemental Nutrition Assistance Program (SNAP), Medicaid and CHIP. Using the information provided by the applicant, the system can generate an automated determination of an applicant’s eligibility for multiple human service programs.
  • eFind – A web-interfacing data warehouse that collects, compiles and standardizes information from different state and federal data sources (such as quarterly wage, unemployment insurance, Social Security, and many more) into a single screen or portal for the purpose of verifying eligibility criteria for various public assistance programs. This eliminates the need for workers to log into multiple different systems with different passwords and protocols, making the process of verifying electronic eligibility data streamlined and efficient.  
  • MyCase – A customer-facing online account page where Medicaid or other human services program enrollees can access and report changes to basic personal case information, such as an address change or a pregnancy. Enrollees can also complete a coverage recertification and opt to receive electronic notices.
  • eNotices and eAlerts – Paperless notifications through email or text message that prompt an enrollee to log into their MyCase page with pin number protection, to access updated information on their case. Utah is the first state to receive CMS approval to transmit notices electronically rather than via US mail. An enrollee can opt in to receive all of their notices.
  • Online Chat – As an alternative to calling, clients can use the online chat function to reach an eligibility specialist to ask questions about MyCase, online application and renewal, and more. Communication with a specialist happens through an instant messaging-type conversation on the client’s computer. To ensure the online chat staff is able to communicate professionally and concisely, DWS interviewed candidates solely via chat to test their ability to communicate clearly and succinctly.
  • Call Centers – An integrated call center with one phone number that people can call to inquire about all public assistance programs. Call center staff can conduct interviews; process change requests; answer case status questions; and make coverage determinations while the customer is on the phone.

Utah’s in-house IT staff played a major role in the design, development, implementation and maintenance of these system enhancements. The state’s investment in their IT staff allows Utah more control over their systems, and the state requires external vendor assistance only for discrete projects.

Whether using a vendor or internal IT expertise, these kinds of systems enhancements can be expensive. However, Utah reports a savings of over $2 million in the first year of using their eFind system. In addition, the state is saving over $500,000 annually by sending electronic notices instead of paper. Aside from the potential return on investment, the time-limited 90 percent federal matching rate makes it a good time for states to invest in and improve their Medicaid eligibility systems.



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