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

07/21/2014

Building the eREP system was a large project, involving many different programs and interfaces. Utah officials report that, as with many such projects, it was complex to integrate multiple systems. However, coordination and communication among state program staff and IT staff helped overcome these difficulties.

From a very early stage, Utah officials recognized the central importance of maximizing federal funding for IT development. As explained earlier, this ultimately involved drawing down federal dollars from three different programs, TANF, SNAP, and Medicaid. The proposal development and application process was complicated, especially with staff not completely familiar with all applicable procedures across multiple federal agencies. To address this challenge, the state hired an expert consultant to help prepare the documents needed to obtain federal funding.61

Utah officials cited working with outside vendors as another challenge. While the collaboration with IBM on phase 1 of the project was successful, state staff found that partnering with an outside vendor reduced their ability to nimbly modify the project’s scope of work. After assessing in-house expertise and determining that they had the necessary project-management and IT expertise, officials decided to bring the process in-house for phases 2 and 3, both to save money and to enhance the state’s flexibility. Officials cautioned that in moving the process in-house, they needed very clear goals and requirements to ensure that they did not continue to expand the scope of the project more than was needed.62

State staff also noted that building a rules engine can be difficult when existing policies leave room for interpretation. Officials were surprised to find that many of existing policies were confusing and difficult to follow. They expect to see improvement in this area over time, with a new system in place that enforces the disciple of requiring a precise and objective statement of decision rules.63

From initial planning and development in 2002 to the first benefits issued through eREP in 2009, the full release of the system in 2010, and expansions in 2011, the process for implementing eREP took nearly a decade. While counseling patience and realistic expectations about long time frames, officials also stress a countervailing need for clearly defined plans and goals, with a focus on outcomes, to keep ongoing state efforts on track.64

Other observers note that states are now positioned to pursue initiatives like Utah’s on a much more rapid time frame, for many reasons. States can learn from Utah’s experience; information technology has advanced considerably since 2002; eligibility systems and interagency collaboration are farther advanced than they were a decade ago; and as noted earlier, enhanced federal funding is currently available for IT investments in eligibility systems, allowing more rapid, short-term progress.65

Utah staff noted the importance of adequately testing new systems. The state used small batches of cases to see how information would interact in the new system. Rather than rolling out an entire system at once, the state staggered implementation, using a five- to six-month period to bring innovations live in one part of the state at a time. The state found this to be a useful approach that allowed the early identification and resolution of problems before statewide implementation.

Utah staff noted the importance of adequately testing new systems. Utah’s protocols included user, system, and production testing. The state used small batches of cases to see how information would interact in the new system. Rather than rolling out an entire system at once, the state staggered implementation, using a five- to six-month period to bring innovations live in one part of the state at a time. While this presented some challenges in terms of operating both the new and old system at the same time in different parts of Utah, the state found this to be a useful approach that allowed the early identification and resolution of problems before statewide implementation.66

Finally, documentation of favorable outcomes has focused on state efficiency gains. No evidence of which the authors are aware has shown increased receipt of benefits by eligible households.

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