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


Case study selection

The case selection process was a highly collaborative effort between Urban Institute staff and ASPE. We decided to seek practices that—

  • Reduce the burden that consumers must shoulder to qualify for or retain benefits;
  • Reduce agencies’ administrative costs for determining eligibility, at application and/or renewal;
  • Reduce the proportion of denials and terminations that occur for procedural reasons, such as a consumer’s failure to provide requested information;
  • Reduce (or at least not increase) delays before applicants’ eligibility is determined;
  • Reduce (or at least not increase) the proportion of erroneous eligibility determinations; and
  • Retain or strengthen programs’ targeting of eligibility and enrollment.

We looked for initiatives with a reasonable quality of evidence documenting fulfillment of one or more of these substantive criteria. However, many integration efforts are in their early stages, and others have not been evaluated to assess their impact at the desired level of precision. Particularly given that our research took place as states, localities, and private-sector organizations were developing their approaches to implementing the Affordable Care Act, we recognized that extensive, written evidence of outcomes, including formal evaluations or peer-reviewed publications, would not be available for some of the very interventions that may be especially important candidates for replication in 2014 and beyond. We accordingly decided to look for a blend of promising and emerging practices with a range of evidentiary support.

To find our case studies, we canvassed the published literature, both formal and “gray.” The latter effort included special attention to web sites that serve as the repository for multiple “best practices” at the state, local, and community level, such as websites maintained by the National Academy for State Health Policy (especially NASHP’s “State Refor(u)m” project), the State Coverage Initiatives Program of AcademyHealth, the National Governors Association Center for Best Practices, Enroll America, the National Conference of State Legislatures, the American Public Human Services Association, and the Coalition for Access and Opportunity.

We also consulted with experts who are tracking state, local, and private-sector activities in this area. They included Urban Institute staff monitoring state implementation of the ACA as part of work funded by the Robert Wood Johnson Foundation; staff of both the Urban Institute and the Center on Budget and Policy Priorities assisting in the Work Support Strategies Project funded by the Ford Foundation and other leading philanthropies; the members of the Technical Working Group for this project, who are identified in Appendix B; and other national experts. This led to a list of potential case studies, from which those profiled below were selected.

Case study development

We investigated written literature to learn about policy decisions, implementation details, and key results for case studies involving data-based renewals in Louisiana, Express Lane Eligibility in Louisiana and South Carolina, SNAP/SSI pilot projects, and Utah’s “eREP” initiative. For the remaining case studies—those involving Minnesota and Single Stop USA—the Urban Institute conducted five interviews with key informants. These interviews examined how each practice was developed, its operation, its results, key lessons learned, and additional sources of information relevant to understanding the practice and its effects. Interviews were conducted by telephone, using semi-structured discussion guides that were tailored to the characteristics of each practice and the information known to the study team before the interview.

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