Examples of Promising Practices for Integrating and Coordinating Eligibility, Enrollment and Retention: Human Services and Health Programs Under the Affordable Care Act. Challenges and lesson learned


The state’s rapid success involved trade-offs. Because officials decided to enroll as many people as possible, as quickly as possible, state and county staff did a tremendous amount of work manually over a short period of time. This imposed administrative costs. Although staff expressed great enthusiasm for undertaking the work, some exhaustion and “burn-out” resulted.

Officials understood that they could have avoided these costs by delaying the start of enrollment until IT systems were ready. That would have impeded access to care for consumers and adequate reimbursement for hospitals for at least an additional six months. Or they could have asked consumers, rather than state staff, to complete the necessary paperwork to transition from GAMC or MinnesotaCare to Medicaid. The foreseeable result would have been that many would have failed to make the transition. Instead, DHS and counties chose to shoulder the burden themselves. Consumers and hospitals benefited greatly, but it came at a cost.

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