Examples of Promising Practices for Integrating and Coordinating Eligibility, Enrollment and Retention: Human Services and Health Programs Under the Affordable Care Act. First case study area: Streamlining eligibility determination for one program based on data linkages with another program


This first section focuses on practices that have shown progress in streamlining eligibility determination for one program based on data linkages with another program. This can take place across both health and non-health programs. Such strategies can involve, for example, “deeming” eligibility for one program based on decisions made by another program or using data matches from another program to facilitate enrollment or renewal. Creating a new eligibility category or process that overcomes methodological differences between programs can greatly reduce the amount of work required to determine eligibility. Programs can also lighten consumers’ loads, simplifying and shortening application or redetermination procedures while reducing state administrative burdens by taking into account information already received by other agencies. This has been a particularly appealing strategy in recent years, when caseloads in need-based programs rose as social services staffing levels remained flat or fell. This general approach has the further advantage of being able to take advantage of enhanced federal funding. So long as they are fully implemented by December 31, 2015, investments in eligibility systems that help Medicaid determine eligibility can qualify for 90 percent federal funding; even if those systems also help human services programs, the latter can be relieved of the obligation to share development costs, under a time-limited waiver of standard cost allocation rules.1

The practices highlighted in this category include Louisiana’s use of data matches for Medicaid and CHIP renewals, Louisiana and South Carolina’s “Express Lane Eligibility,” and the U.S. Department of Agriculture’s Food and Nutrition Service’s (FNS’s) SNAP/SSI combined application projects (CAPs). Most examples in this category involve adjustments to program eligibility rules. Those adjustments relieve government agencies of the need to request and process information from consumers about issues nearly identical to those already resolved by a different government agency.

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