Federal Investments Extended for Improvements in Medicaid and Human Services Eligibility Systems

By Helly Lee

This week, the Centers for Medicare and Medicaid Services (CMS) at the U.S Department of Health and Human Services (HHS) announced that they will continue to invest a higher level of federal funds for modernizing Medicaid eligibility and enrollment systems and allow states to use these improved systems to support other benefit programs such as the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) through the A-87 waiver beyond the current December 2015 expiration date. This critical announcement gives states the assurance they need to continue to move forward in building modernized systems, which will expand the reach of health and human services programs.

The Affordable Care Act (ACA) required significant changes to methods states used in establishing eligibility for public health insurance programs and set forth a vision for streamlined and simplified processes by which people are determined eligible for Medicaid.  To assist states in developing the information technology to meet these expectations and the needs of the growing customer base, CMS authorized an enhanced match rate in 2011, with the federal government paying 90 percent of system development costs. In this week’s announcement, CMS indicated it will issue regulations making this higher match rate permanent for states that meet qualifying criteria regarding system planning and development best practices.

Furthermore, in 2011, CMS, the Administration for Children and Families (ACF), and the U.S. Department of Agriculture’s Food and Nutrition Services (FNS) also announced a temporary exception to the usual requirement under OMB Circular A-87 that when one computer system is used for multiple programs, the development and maintenance costs must be covered with funds from each program. This A-87 Cost Allocation Exception allows human service programs to share a wide range of eligibility and enrollment information technology (IT) components needed by Medicaid, without having to contribute to the costs of developing them. This policy permitted states to capitalize on the investment needed for ACA requirements and create a seamless system to access multiple programs. In this week’s announcement, CMS said it will provide a three-year extension of the A-87 waiver authority to allow states to continue efforts to integrate their eligibility and enrollment systems.

In 2013, a report from the Georgetown Center for Children and Families and the Henry J. Kaiser Family Foundation revealed that nearly all states (47) were already taking advantage of the 90/10 funding and moving forward with updates to their information technology infrastructure. States have been ambitious about their plans, working toward integrated technology improvements not only in health programs but also a range of human services and child welfare programs that will impact program access for millions of families. For example, some states have implemented full-scale redesigns of their computer systems by building integrated eligibility system for health and human services programs. These states have been on the cutting edge of large-scale technology reform and have achieved major accomplishments, along with hard-earned lessons.

Federal government support of the upfront costs of integrated eligibility systems will reap long-term efficiencies for states, the federal government and low-income participants who benefit from these programs. Most individuals who qualify for Medicaid and the Children’s Health Insurance Program (CHIP) will also qualify for one or more state-administered human services programs, such as SNAP and TANF, as well as child care, energy assistance, refugee assistance, and other programs. Eliminating the technology barrier between programs can mean greater access for families and more efficient processes for state agencies because client data is shared across programs in one system instead of having applicants submit duplicate information into multiple systems. Moreover, ensuring low-income people have access to and receive the full package of benefits for which they qualify can address food insecurity and healthcare or housing needs in the short-term and raise their chances for long-term success.

Until these changes were announced, both the A-87 waiver and the 90/10 match funds were originally only available to states for expenses incurred before December 31, 2015. Replacing antiquated technology and building integrated eligibility systems for health and human service are complex, long-term initiatives. An extension of the A-87 waiver and the establishment of the 90/10 funding as a permanent federal investment is a critical step to ensuring the success of integrated systems. These changes will allow states to continue to improve and update their infrastructure to meet the needs of participants and fully build out their systems.

State advocates who focus on poverty and public benefits can seize the opportunity of this important development to learn how their states will be taking advantage of these resources to integrate systems and ensure that families get the full package of benefits for which they are eligible. For state officials and advocates, this is an important opportunity to partner together and invest in long-term technology and systems through any planned or new public engagement processes. Examples of how states are using these resources to implement their ambitious integration plans can be seen at a recent CLASP forum that highlighted the work of six states participating in the foundation-supported Work Support Strategies Initiative.  We also welcome your ideas and accomplishments