Opportunities under the Affordable Care Act for Human Services Programs to Modernize Eligibility Systems and Expedite Eligibility Determination. Modernizing eligibility systems

07/01/2014

For information technology (IT) improvements that are in place by no later than December 31, 2015, and that are required for Medicaid eligibility purposes, the federal Medicaid program will pay 90 percent of investment costs. Even if human services programs also benefit, a time-limited exception to normal cost-allocation rules eliminates the need for them to share in those investment expenditures, so long as the investment involves either—

  • the development or procurement of a business service that serves both Medicaid and human services programs; or
  • the construction of an interface between Medicaid and a human services program that helps the Medicaid program (1) verify eligibility or (2) “fast track” Medicaid enrollment of uninsured individuals, based on information in their human services case files. This step can also include development of functionality needed for the interface to obtain necessary information from human services records, functionality that can help the human services program in other ways as well.

This opportunity is available in all states. Whether or not a state expands Medicaid eligibility, the ACA requires it to use data matches with reliable sources, whenever possible, to determine eligibility. That shift to data-driven eligibility has required, in turn, a significant investment of federal IT funds needed to modernize Medicaid’s previously outdated eligibility systems. Human services programs can participate in such modernization efforts, but they may increase their likelihood of successfully tapping into these resources by taking an approach that minimizes time demands on Medicaid staff, given the competing demands of ACA implementation. As one possible strategy, the human services agency could volunteer to carry out most of the work needed to develop or procure a new service or interface that promises to serve both health and human services programs.

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