Modernized Benefit Systems: California Leads the Way

Feb 28, 2012

By Elizabeth Kenefick

As CLASP has previously highlighted, the health care reform bill, formally known as the Affordable Care Act (ACA) presents a major opportunity to simplify how both health and human services programs determine program eligibility. States can use health care reform to streamline the application process for public benefits. In other words, if someone applies for one program, the state captures that data and the applicant could also apply for other programs with the same application.

California has taken a major step toward making this vision a reality with the introduction of SB 970 Streamlining Enrollment into Health and Human Service Programs by Sen. Kevin De León. This bill would ensure that any modernization of health insurance information technology systems also would apply to all of California's human service programs, including CalWorks (TANF) and CalFresh (SNAP).

California was the first state to pass legislation establishing a state health insurance exchange under ACA. To meet the expected increase in enrollment applications, California also created the California Health and Eligibility Enrollment & Retention System, or Cal-HEERS. While crucial to the success of the health insurance coverage expansion, as it stands the new system would split the current unified public benefits enrollment and case management system, leaving other human services programs behind.

SB 970 would provide for greater horizontal integration, requiring that by the end of 2015 an applicant for or recipient of a public health coverage program could also apply for other human services programs using the same application. In other words, it encourages California to ensure that any short-term improvements to its IT systems could integrate with other human services programs down the line.

Currently, the ACA allows states to scale up and streamline enrollment in health insurance programs using enhanced federal funding to pay 90 percent of the costs for a limited time. Guidance from the U.S. Departments of Health and Human Services and Agriculture clarified that human services programs can benefit from improvements made with this funding through Dec. 31, 2015, without the cost allocation that would otherwise be required. SB 970 sets California up to take advantage of this time-limited opportunity and consequently is a model for other states that wish to bring their benefit programs into the 21st century with coordinated and streamlined eligibility systems.

For more information on this bill and leveraging opportunities in health reform, visit CLASP's Benefit Access and Health Care Reform Resources page which includes the following resources:

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