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


A 2001 review of Utah’s previous eligibility system found that it met only 52 percent of business needs, eligibility determinations varied based on the worker’s expertise, and the system provided no online access for customers.47 Other factors drove policymakers to revise the state’s eligibility system, including a prior history of inconsistent modernization efforts and economic downturns that led to both high caseload growth and reduced funding for eligibility staff.48

Beginning what turned out to be a nearly decade-long modernization effort, the state released a request for proposals for the new work in 2002. Utah’s Department of Workforce Services managed the eREP system’s development, in collaboration with the Department of Human Services, the Department of Health Services, and the State Department of Technology Services49.

The project’s initial development budget was $79 million. Several sources provided funding, with TANF reserve funds contributing $34 million to build the core system. Seventy-eight percent of the total funding for system development came from federal dollars, with the state paying the remaining 22 percent. By program, the federal government furnished 100 percent of TANF funds, 50 percent of SNAP dollars, and a combination of 50 percent and 90 percent funding of Medicaid costs, depending on the expenditure involved.50

The state developed and implemented the eREP system in three phases. The state’s contractor, IBM, carried out the first phase, which focused on TANF and the subsidized child care program. Utah state staff, rather than a contracting vendor, carried out phases 2 and 3. In all three phases, the state rolled out its updated eligibility procedures in one geographic area at a time.

In 2003, Utah began updating its eligibility and benefit processes, releasing several website and eligibility system updates. The first release involved the Utah Cares website, which gave the public information about different assistance programs.

Effective in 2004, the state implemented eFIND, a shared web-based system that health and human services programs use to verify information for eligibility determinations. Caseworkers use eFIND to gather information from 21 federal, state, and local databases, eliminating the need for workers to search each database individually. Data available through eFIND include, but are not limited to, SSA data, unemployment data, wage data, and SNAP qualification data. Individual consumers are required to provide documentation only for items that cannot be electronically verified through eFIND.

Over the next several years, the state built several new resources, including an online application and a customer directory. The state further developed the electronic eligibility system in 2007, issuing the first eREP benefits in 2008. The state finally released the full, modernized eligibility system, including the online application, customer directory, electronic policy, and resource and referral capabilities, in 2010.51

The eREP system incorporates a number of different functions and services to determine eligibility and manage benefits. An eligibility rules engine is the core of the system, facilitating eligibility determination across several programs. Eligibility rules for more than 60 programs let caseworkers use the system to efficiently and consistently determine benefit levels and eligibility for programs like Medicaid, CHIP, SNAP, TANF, and child care assistance.

A customer directory with information about more than 2.3 million people provides a single source of information that can be shared and updated across programs. When one program obtains information from or about a client, that information becomes immediately available to other programs. Such sharing of information across programs reduces the resources required to verify eligibility for each program. It also eliminates the need for consumers to provide the same information multiple times to different agencies.

In addition, the system also provides an integrated communication process for families. For example, if a family applies for multiple benefits, the family does not receive separate notices from different programs describing the applications’ outcomes. Instead, the state sends a single notice that identifies the programs for which the family qualified, identifies the programs for which the family was found ineligible, explains the reasons for such ineligibility, and describes the family’s rights to appeal any adverse determinations. Utah’s previously developed phone system, electronic data matching, and electronic case files were all interfaced with the new eREP system to provide a more seamless eligibility process.52

Under eREP, customers can enter information into the online application, which provides an authentication number to the customer, who then calls to speak with a caseworker. Once all information is entered, the system performs a check to determine the programs for which the individual may qualify. Face-to-face interviews are no longer needed to obtain benefits, but customers can meet with a caseworker, upon request.53

The implementation steps for eREP included training for state staff, conversion to the new system, assessment of operational impacts, and ongoing support for staff. Utah officials note that the training and support were important to ensure that staff learned the new system. The conversion step involved “translating” cases from the old system to the new system. Rather than convert all cases immediately, officials moved only those cases that were determined ready for the new system. Officials shifted work between different staff teams so that those being trained could take the time to learn the new system without affecting ongoing work.54

Table 4 outlines how various components of the eREP system were implemented over time.

Table 4. Timeline of eREP Implementation

Date Milestone
October 2003 Utah Cares – resource and referral website for multiple programs
January 2004 eFIND – data matching to external sources of verification
April 2004 InfoSource – online resource for eligibility policies
February 2007 Utah Helps – online application
October 2007 Eligibility Module development – eligibility system, rules engine, benefit calculation, correspondence, case review, and case management Customer Directory – integrated customer data shared across multiple programs
August 2008 Eligibility Pilot
October 2008 First benefits issued through eREP
June 2009 5,000+ cases in eREP system
August 2009 Human services programs fully integrated
October 2009 Health programs fully integrated


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