A Blueprint for the Future Executive Report · Of the three-quarters of a million children (763,000) who were uninsured at the time of the 2005 California Health Interview Survey

Eclipse Solutions, Inc. 2151 River Plaza Drive, Suite 320, Sacramento, California 95833

Phone: (916) 565-8090 • Email: [email protected] • Fax: (916) 565-5126

MODERNIZING ENROLLMENT INCALIFORNIA’S HEALTHPROGRAMS FOR PREGNANTWOMEN AND CHILDREN

A Blueprint for the Future

Executive Report

Prepared for:

Blue Shield of California Foundation

California HealthCare Foundation

The California Endowment

The David and Lucile Packard Foundation

August 10, 2007

Executive Report

Executive Report August 10, 2007 — Page ii

Table of Contents

Introduction & Purpose ................................................................................................ 1

Background.........................................................................................................................1

Project Scope and Approach ....................................................................................... 3

Findings / Business Problems ..................................................................................... 4

Policy Environment....................................................................................................... 9

Piecemeal and Conflicting Legislation.................................................................................9

Funding Availability .............................................................................................................9

Program Silos .....................................................................................................................9

Multiple Agency Oversight ................................................................................................10

State versus County Eligibility Administration....................................................................10

Specific Legislation ...........................................................................................................10

Lessons Learned from Other States.......................................................................... 11

Other State Summary .......................................................................................................12

Recommendations ...................................................................................................... 14

The Future State...............................................................................................................14

Interim Recommendations ................................................................................................19

Improving Self-Service to Increase Enrollment...........................................................19

Enhancing the CHDP Gateway to Streamline Enrollment ..........................................21

Better Facilitating Continuous Coverage ....................................................................24

Conclusions................................................................................................................. 28

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List of Figures

Figure 1 – Shared Services on the ESB....................................................................................15Figure 2 – High-Level View of the Self-Service Enrollment Process in the Future State............16

List of Tables

Table 1 – Summary of Findings / Business Problems .................................................................5Table 2 – Comparison of Ongoing Efforts to Streamline Enrollment Processes ........................12Table 3 – Estimated ‘Program Look-Up’ / Inquiry Development Costs ......................................18Table 4 – Estimated ‘Enrollment’ Development Costs...............................................................18Table 5 – Interim Recommendations and Estimated Costs .......................................................27

Introduction andPurpose

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Executive Report August 10, 2007 — Page 1

Introduction & PurposeIn August 2006, the Blue Shield of California Foundation, the California HealthCare Foundation,The California Endowment, and the David and Lucile Packard Foundation (collectively, the“Foundations”) contracted with Eclipse Solutions, Inc. (Eclipse) to conduct an independentassessment of California health and social services program requirements and associatedinformation technology (IT) systems to develop a blueprint for achieving the goal of a morestreamlined, integrated and efficient approach to enrollment and retention. Streamlined,integrated and efficient are defined as follows:

Streamlined: Reducing the need for consumers to share information more than once.

Integrated: Sharing information electronically with minimal human intervention.

Efficient: Minimizing redundant activities and supporting ongoing operations with on-line,real-time connections.

It is within this framework that the findings and recommendations are organized and presentedin this Executive Report. A more complete description of this programmatic and technicalassessment, along with its results, is contained within a separate document, ModernizingEnrollment in California’s Health Programs for Children – Report Appendix.

Background

Enrollment processes for California’s health and social service programs are complex anddisconnected. Based on a recent study conducted by the UCLA Center for Health PolicyResearch, more than half of California’s uninsured children were eligible for public programs in2005, but were not enrolled1. While the number of uninsured children decreased in 2003 due toextensive local and statewide efforts and resources invested in outreach and enrollment byMedi-Cal and Healthy Families and locally funded Healthy Kids programs, numbers since thenhave remained static.

As California’s population has grown in size and diversity, so have its programs that servechildren and pregnant women. Indeed, the programs designed to serve that population havebecome more numerous and more complex; in addition, local programs for children are isolatedfrom other programs designed to serve similar populations. Complex eligibility requirementsand siloed enrollment processes supported by stand-alone systems can act as barriers to theuninsured seeking coverage and care. Finding it difficult to maneuver through the public healthinsurance maze, prospective beneficiaries can be discouraged from applying for services.Many programs that have been designed to address their needs require the same or similarsets of information to determine eligibility. Redundancies and inefficiencies are sometimes thenorm rather than the exception.

In an effort to make it easier to apply to California’s programs that serve children and pregnantwomen and streamline the enrollment process, the California Legislature passed Senate Bill 24(SB 24) in October 2003. This bill required the California Department of Health Care Services(DHCS) to establish two new electronic gateways – the Newborn Hospital Gateway, which

1UCLA Center for Health Policy Research, October 2006. Of the three-quarters of a million children (763,000) who

were uninsured at the time of the 2005 California Health Interview Survey (CHIS 2005), nearly one-half millionchildren (447,000) were eligible for either Medi-Cal or Healthy Families under current rules for enrollment—but theywere not enrolled.

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would enable hospitals to electronically submit enrollment data for infants automatically eligiblefor Medi-Cal from birth through age one year because their mothers had Medi-Cal coverage forthe delivery, and the Prenatal Gateway, which would enable pregnant women to apply for Medi-Cal with a new, simplified application form from a provider’s office, start coverage the same day,and keep coverage until a final eligibility determination is completed by the Medi-Cal program.Women over-income for Medi-Cal (over 200% of poverty) are to be referred under SB 24 to theAccess for Infants and Mothers (AIM) program (300% of poverty). Finally, SB 24 stipulated thatnone of the above would occur until funding and staffing were available to DHCS; once the newenrollment mechanisms are in place, the state is responsible for health care costs and allprogram administration.

In response to the passage of SB 24, DHCS began researching an approach to implementingthe bill and continues to assess its options for accommodating the requirements of this andother related bills. DHCS also requested the Foundations to support its efforts to implement thebill. The Foundations, in turn, have chosen to offer not only proposed solutions to the mandatesof SB 24 but also a comprehensive blueprint for streamlining enrollment and retention of eligibleindividuals in California’s health and social services programs serving children and pregnantwomen.

Project Scope andApproach

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Project Scope and ApproachThe California health and social services programs that were assessed in this study included:

Access for Infants and Mothers (AIM); Child Health and Disability Prevention Program (CHDP); Healthy Families (HF); Medi-Cal for Children (MCC); and the Women, Infants and Children (WIC) Supplemental Nutrition Program.

Eclipse also reviewed the Express Lane Eligibility (ELE) process that allows children who qualifyfor the National School Lunch Program (NSLP) to apply for Medi-Cal and HF, and the SinglePoint of Entry (SPE) unit that screens and processes joint HF and MCC applications andforwards the applications to the counties or the HF enrollment contractor for eligibilitydeterminations on behalf of the DHCS2.

The supporting technologies included in this review were the CHDP Gateway (GW), whichprovides an automated pre-enrollment process for uninsured children seeking a healthassessment at their CHDP provider’s office to receive ongoing health care coverage throughMedi-Cal or HF; Health-e-App, an Internet application that electronically transmits applications,signatures and supporting documents from local enrollment sites to SPE for processing andeligibility determination for HF, screening of applications for Medi-Cal, and referral of Medi-Calapplications to the counties for eligibility determinations; and One-e-App, a web-basedapplication that enables users to access publicly-funded health and social service programsincluding Medi-Cal, HF, county indigent programs, and Healthy Kids (county-sponsoredcoverage expansion programs) . In addition, Eclipse obtained an understanding of the systemsof records that support the programs in this review. This includes the administrative vendor’s(MAXIMUS) proprietary system (MAXe2), which supports AIM and HF, the Integrated StatewideInformation System (ISIS), utilized by the WIC program, and the respective system interfaces toCalifornia’s Medi-Cal Eligibility Data System (MEDS).

To conduct this assessment, Eclipse reviewed written materials and interviewed subject-matterexperts. We also spoke with local program representatives and other states to gathercomparative data. In addition, we met with a representative of the State Chief InformationOfficer (CIO) to ensure that our recommendations are consistent with the State’s informationtechnology vision and future direction. We also reviewed recently passed legislation that relatesto the scope of this project. During this assessment, we validated the data we gathered withrepresentatives of DHCS, the Managed Risk Medical Insurance Board (MRMIB), and TheCenter to Promote HealthCare Access to ensure that our understanding of the programs and ITsolutions included in the assessment was accurate.

Based on this assessment, Eclipse has developed both interim and ‘future state’recommendations that, taken together, offer a blueprint for streamlining the enrollment processfor health and social services programs that serve children and pregnant women in California.

2HF and AIM is administered by the Managed Risk Medical insurance board (MRMIB). MRMIB is responsible for

overseeing various aspects of the program, including eligibility, enrollment, and oversight of MAXIMUS, theadministrative vendor.

Findings / BusinessProblems

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Findings / Business ProblemsThis assessment identified several issues and observations about how individuals apply for, andenroll in, programs that serve children and pregnant women in the State of California3. Programeligibility is defined differently in each program. Processes and systems that support thesefunctions have evolved over time and are neither streamlined, nor well integrated in mostinstances. Without a holistic approach, opportunities to coordinate functions across programsand to realize efficiencies are minimal. Currently, applicants are generally unable to learnabout, or electronically apply for, more than one program at a time4 unless local agenciesprovide them with extensive assistance and do much of the application process on behalf of anapplicant.

The issues and observations identified in this assessment are captured into five overarchingfindings / business problems. These include:

1. Lack of a Unified Agency-Wide Approach. The Health and Human Services Agency(HHSA) has not taken an enterprise-wide approach to develop, implement, andstreamline enrollment processes for California’s health and social services programs inorder to eliminate IT strategies that focus on the implementation of a single program andpose barriers or limit the exchange of information with other programs that providecomplementary services to recipients.

2. Minimal Data Sharing Between Programs. The extent to which California’s health andsocial service programs share data is minimal. Applicants wishing to apply for multipleprograms provide the same information more than once, which leads to errors that makeit difficult to establish the full range of services an applicant may be eligible to receive.

3. Enrollment Processes are not Always Consumer Friendly. Current enrollmentprocesses are not always consumer-friendly (e.g., confusing application forms), whichdiscourages eligible persons from applying for services they could rightfully receive.

4. Outdated and Disparate Technology. Some of DHCS’ major IT systems use datedand disparate technology, making it difficult to enhance them to support the currentbusiness need to exchange and use common data.

5. Reliance on Manual Processes. Many activities that support enrollment processes forCalifornia’s health and social services programs are manually performed which isexpensive, time consuming and error prone.

Each finding, with summary observations and examples from the current environment thatillustrate the business problem, is presented in the table below.

3See Program and IT Solutions Overviews, Executive Report Appendix for additional information.

4Applicants can apply for two programs using the join Medi-Cal/Healthy Families mail-in application form. They can

also apply for CalWORKS, Food Stamps, and Medi-Cal using the SAWS 2 application form.

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Table 1 – Summary of Findings / Business Problems

# Finding/BusinessProblem

Summary Observations Examples

1 Lack of a UnifiedAgency-WideApproach

No coordinatedHHSA-wideapproach.

Discrete fundingstreams.

Multiple programsilos.

Stand-aloneenrollmentprocesses.

There are no federal / statemandates that require coordinationacross all the programs included inthis assessment.

Funding streams are oftendesignated for a specific program,limiting their use for cross-programcoordination.

Programs are housed in differentdivisions serving the samepopulation.

There is no comprehensiveapproach to simultaneouslycapturing data and determiningeligibility across multiple programs.

Separate systems are used todetermine program eligibility (e.g.,Medi-Cal and HF).

Program eligibility varies due tocomplex set of policy rules.

While ISIS, the CHDP GW andMAXe2 interface with MEDS, they donot interface with each other.

Health-e-App does not directlyinterface with MEDS.

Each program has its ownapplication form (except the JointApplication and ELE/NSLP).

Systems do not support electronicclient referrals to other programs.

Single sign-on functionality (i.e., theability to sign on once to accessmore than one gateway) does notexist for providers who access theDHCS gateways (i.e., the CHDPGW, the Breast and Cervical CancerTreatment Program [BCCTP GW].

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2 Minimal DataSharing betweenPrograms

No common front-endfor data capture andscreening.

No common back-end for eligibilitydetermination androuting.

Limited real-timeaccess to MEDS.

Minimal interfaces toregulatory agencies.

Absence of standarddata elements andlayouts.

The Joint Application and Health-e-App collect information for HF andMCC but do not gather sufficientdata to enable counties to determineeligibility for adult Medi-Calprograms.

Eligibility re-determinations for HFand MCC are not automaticallysupported by technology, which limitopportunities for sharing previouslyprovided data. 50% of theapplications received at SPE are forre-determinations.

DHCS/HHSA has not developedenterprise-wide technologystandards across its differentapplications and systemimplementations (ISAM, Assembler,Flash, COBOL, DB2, etc.).

Less than 10% of the HFapplications received in SPE aresubmitted through Health-e-App,limiting the opportunity to share datathat is provided online.

While a DHCS system interface withthe Employment DevelopmentDepartment (EDD) exists, the payrollinformation from EDD is dated;efforts to reliably verify income aremanually performed (e.g.,request/view pay stubs).

Data-sharing delays are experiencedwhen data is transferred from One-e-

App to Health-e-App when userpassword updates fail to occur at thesame time.

In most instances, the process ofproviding supporting documentationis manual; matching supportingdocumentation to applicationspresents opportunities for error.

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3 EnrollmentProcesses are notAlways ConsumerFriendly

No public access.

Limited ability todetermine eligibilityfor multiple programs.

Confusing applicationforms.

Complex eligibilityrequirements.

Multi-steppedprocess forcontinuous Medi-Calcoverage.

Clients cannot currently accessprograms online (via the Internet) toapply for coverage from their homesor other remote locations. (Note: theGovernor announced in 2006 thatthe State would make Health-e-Appaccessible to the public.)

Presumptive eligibility applicationprocesses (through the CHDP GW,ELE) do not support the process ofattaining continuous coveragewithout the collection of additionalinformation for those who may beeligible.

Due to the lack of a look up tool intoMEDS - ELE spends significant timeattempting to enroll clients who arealready enrolled in Medi-Cal (fortyfour % of applicants through ELE arealready enrolled in Medi-Cal).

Applicants go to multiple locations toapply for the different programs.

System access is usually limited tomutually exclusive user populations,as required by some programs.

4 Outdated andDisparateTechnology

Some systems areusing datedtechnology.

Technology notextensible and maybe difficult to maintain

Minimal systemintegration

Technologyenvironment cannotefficiently supportever-changing policyenvironment andlegislative demands.

Some systems have beenextensively modified and may bedifficult to maintain (e.g., MEDS).

It is difficult to find staff to maintainsystems using dated technology.

Current technology does not supportelectronic self-service.

Degree of system integration isminimal.

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5 Reliance on ManualProcesses

Paper applicationsare completedmanually and re-keyed into systems.

Documents arerouted via USPS andovernight mail.

Cross-programreferrals are manual.

Eligibility re-determinations arenot supported bytechnology.

File clearanceactivities requiremanual intervention.

Programs collect the same or similardata elements multiple times, whichutilizes resources inefficiently andincreases the opportunity for datadiscrepancies.

Routing of Medi-Cal applicationsbetween SPE and the counties ismanual (printed, batched and sentvia overnight mail).

Routing of applications from AIM tothe counties is manual (printed,batched and sent via overnight mail).

Routing of applications from theschools to SPE is manual (printedand mailed).

Applications (some application data)that SPE routes to the counties arere-keyed into the county welfaresystems.

The AIM application process isentirely paper-based.

The concept of ‘bridging’ is manuallyperformed – counties mail Medi-Calre-determination applications to SPEfor HF eligibility when Medi-Calincome limits are exceeded.

In most school districts the ELEprocess is paper-based.

The absence of the BenefitsIdentification Card (BIC) number onjoint application requires manualprocessing and increases workloadlevels in SPE.

PolicyEnvironment

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Policy EnvironmentIn government, policy drives programs. Many of the state’s health programs must comply withfederal rules for the state to receive federal funding. In addition to the federal government, theprimary policy-makers are the Legislature and the Governor, while the role of the state agenciesand departments is to implement the policies mandated by these elected officials. In the healthcare arena, the policy landscape has become more and more complex over time, making itincreasingly difficult to obtain and provide health care services in a seamless and integratedfashion. Indeed, as the population of California has grown, health and social services programshave become more numerous, more complex and some have become more isolated from otherprograms designed to serve similar populations. The following paragraphs summarize thevarious ways in which this complexity can impact health care policy.

Piecemeal and Conflicting Legislation

Legislators introduce bills in response to concerns presented by their constituencies. In somecases, each legislator, or each constituency, has a different perception as to what kind oflegislation will best address the identified concerns. Because each legislator wishes to takeaffirmative steps to address problems, several legislators may introduce legislation to tackle oneor more aspects of the same issue. Further, because each health care program has its ownadvocates, and their interests do not necessarily overlap with the interests of the advocates ofother health care programs, legislators may introduce bills that only affect one program whenthe same problem affects multiple programs. This can result in piecemeal legislation that mayeither have differing and possibly conflicting impacts on the same program, or may makechanges to only one program when those same changes would make sense for other programs.

Funding Availability

Over the years, federal as well as state legislation has often been introduced that containsinadequate funding to implement its provisions, yet the State has generally been expected, andhas been able, to do so anyway. Since FY 1998-99, the number of Medi-Cal eligibles(individuals receiving services paid for by Medi-Cal) has increased dramatically, from anaverage of 5,024,700 to 6,664,700 each month in FY 2006-07, an increase of nearly 33 percent.During that same time period, the total cost of the program has grown at an even faster pace, bynearly 74 percent, from just over $20 billion to nearly $35 billion annually. In the face of theseincreases combined with periodic budget deficits, it has become common for the Legislatureand the Governor to enact legislation that contains no funding at all for implementation of newlegislation.

Program Silos

California’s health care programs have become remarkably complex over time, complicating theability of everyone involved in the health care process to ensure that patients receivecomprehensive, integrated health care services that address the full range of their health careneeds. Instead, programs generally develop on a stand-alone basis, creating a silo effect inwhich programs have little or no interaction with one another. This generally happens becauseit is simply too difficult for either policy-makers or policy implementers to figure out how to createand implement program changes that take other programs into consideration.

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Multiple Agency Oversight

Each health care program administered by the State of California is subject to a variety ofmandates that are often conflicting. The State Legislature and advocacy groups work to createa vision of a health care system that serves patients with needed care in a seamless manner.Federal oversight agencies establish a variety of eligibility and administrative requirements thatensure accountability and protect patients, but may conflict with the State’s overarching policygoals. For example, federal requirements related to verification privacy, citizenshipdocumentation and obtaining approval to expend federal funds may impede the State’s ability toallow the data sharing necessary to create a truly seamless system. Further, federal and stategovernments often view their own requirements as more important than those of the other,making it difficult to obtain consensus on the best approach to implementing needed changes.

State versus County Eligibility Administration

In some states, eligibility determination for Medicaid and other federal programs is handled atthe state level, with local offices staffed by state employees who report directly to the stateagency responsible for overall program administration. In California, many key health andhuman services programs, including Medi-Cal, are administered by county agencies, making itdifficult to implement policy changes uniformly throughout the state, particularly if those changesare viewed as not being in the best interest of the county. In this project, this situation playsitself out in the manner in which the Statewide Automated Welfare System (SAWS) operates inCalifornia. County administration of programs allows flexibility but may also mean that eachcounty operates its programs in its own way. In this environment of distributed responsibility(the Medi-Cal rules are established by the State, not the counties), it is difficult to gainconsensus on a single process or system. The SAWS in California is actually comprised of fourseparate systems, ISAWS, CalWIN, LEADER and C-IV. Los Angeles has its own independentsystem, LEADER. Four counties formed a consortium and agreed to share business processesthrough the C-IV system. Eighteen counties formed a consortium to purchase CalWIN as ashared system that is actually customized for each county. ISAWS is used by the remainingsmaller counties and is slated for elimination, with the affected counties moving to C-IV. Asignificant challenge with these disparate systems is information-sharing in a manner that isconsistent with consumers’ legitimate expectations of privacy and confidentiality.

Specific Legislation

There are a number of bills, either already enacted or proposed, which seek to streamlineenrollment processes, improve access to services, or expand coverage.5 While several of thebills passed during the most recent legislative session have the potential to make health careprogram enrollment and retention processes for low-income children, and for others, morestreamlined, integrated and efficient, there are several programmatic, fiscal and IT impedimentsto their implementation. DHCS is seeking resources for each of these bills but is unable tomove toward implementation until resources are provided. Further, as the Governor’s newlyproposed health care reforms seek to expand eligibility for public programs that serve low-income children and adults, even greater demands will be placed on existing enrollmentsystems. In the face of these challenges, Eclipse proposes recommendations in this documentthat may assist DHCS in meeting some of the requirements included in these bills.

5An analysis of the legislation that was reviewed in this project can be found in the Executive Report Appendix.

Lessons Learnedfrom Other States

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Lessons Learned from Other StatesEclipse researched five other states that have implemented systems to streamline theirenrollment process in order to identify approaches that might prove effective in the Californiaenvironment. As a part of our research, we interviewed staff from each state. Our interviewsfocused on the types of systems other states have implemented to integrate and streamlineservices as well as the organizational and procedural changes required to support thosechanges. The states interviewed were:

Pennsylvania,

Texas,

Massachusetts,

Louisiana, and

Arizona.

General observations of lessons that California can learn from other states include the following:

Many other states are facing the same challenges California is confronting in attempting tocreate a more streamlined, integrated and efficient approach to enrollment and retention.Solutions that have been developed by other states often involve a combination of systemsworking together to support their enrollment processes.

Executive-level sponsorship is critical to support the development of an IT infrastructure thatfacilitates the exchange of information across programs and to streamline enrollmentprocesses. This level of support assures for a top-down view of the programs and theirinter-relationships, assigns a high level of priority and visibility to the project, provides for thenecessary resources, and maintains the momentum to support and implement the futurestate.

A strong, empowered governance structure must be created to serve as the framework formaking informed IT decisions and to ensure that IT resources are allocated appropriately tomeet business needs. This governance structure must also serve as the forum forinvolvement from multiple stakeholders and cross-departmental/divisional cooperation andteamwork.

Most of the five states we studied have already, or are currently moving toward web-basedapplications that offer online application and enrollment functionality, and shared services tomultiple programs. Federal matching funds are available to states that are developing newinformation systems to streamline their application and enrollment processes.

Some states have streamlined processes for programs that extend beyond those included inthis review, and are enhancing their existing statewide eligibility systems that arecomparable to MEDS as part of their effort to streamline eligibility and enrollment.

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Other State Summary

A comparison of efforts to streamline enrollment processes in other states is summarized in thefollowing table.

Table 2 – Comparison of Ongoing Efforts to Streamline Enrollment Processes

State Department(s) System ProgramsSupported

FunctionsSupported

Year ofInception

Pennsylvania PublicWelfare

COMPASS Medicaid,FS, LTC,SCHIP,NSLP,Community-basedServices,Low-IncomeHomeEnergyAssistanceProgram

Webapplicationthat allowsindividualsand CBOs toscreen, applyfor, view andrenew abroad rangeof socialservices.

Fundingsecured in1999.

Texas Health andHumanServices

TIERS,YourTexas

Benefits.com

FS, TANF,Medicaid,SCHIP(planned)

Service-orientedarchitecturesupportsonlineeligibilitydeterminationandenrollmentavailable tothe public.

TIERSimplementedin 2003;YourTexas

Benefits.comimplementedin 2006.Vendorcontractcancelled in2007.

Massachusetts MassHealth,DHHS

The VirtualGateway

WIC, HealthInsuranceand HealthAssistancePrograms,SubstanceAbuse, FS,Child CareSubsidy,VeteransServices,CommunityServicesand Long-term

Webapplicationthat providesonlinescreening,referral andintakeservices formultipleprograms atthe sametime.Information issharedamongexisting

Implementedin 2004.

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State Department(s) System ProgramsSupported

FunctionsSupported

Year ofInception

Support legacyeligibilitysystems.

Louisiana Health andHospitals,SocialServices

ACESS Medicaid,other healthand humanservicesprograms;plans tosupport itsstatewideautomatedchildwelfareinformationsystems(SACWIS)andentitlementprograms

RecentlypurchasedCúramSoftware’scommercial-off-the-shelf(COTS)SocialEnterpriseManagement(SEM)system toprovide thepublic withweb-basedbenefitsscreeningacrossmultipleprograms.

PurchasedCúramapplicationin 2006.

Arizona AZ HealthCare CostContainmentSystem

Health-e-Arizona

Medicaidprograms,SCHIP,Long-termcare, SSI,FoodStamps,TANF

Web-basedenrollmentapplicationthat screensfor eligibilityand submitselectronicapplications.

Implementedin 2003.

Recommendations

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RecommendationsThe purpose of this project was to develop a blueprint for achieving the goal of a morestreamlined, integrated and efficient approach to enrollment and retention for California’s healthand social services programs that serve children and pregnant women. Creating moreopportunities for applicants to learn about, and apply for multiple programs at one time willsignificantly impact their ability to access services they could rightfully receive. Sharinginformation across programs will not only make the application process easier for applicants, butimprove data accuracy and reliability. Reducing manual activities that are redundant will savetime and resources.

To that end, the recommendations for addressing these challenges in the long-term (FutureState) and near future (Interim Recommendations) are presented below.

The Future State

The ideal future state has been designed to streamline enrollment, increase efficiency andintegrate systems so that information can be shared electronically6 with minimal humanintervention. The future state encompasses the following set of improvements:

A governance structure to provide a framework for ensuring that IT organizationalresources are targeted to deliver maximum business value. This will be:

A framework that drives decisions related to IT direction, policies and investments.

A multi-stakeholder organization that includes CHHSA, DHCS, CDSS, MRMIB,Department of Public Health (DPH), Counties, State CIO representatives and consumerrepresentatives to direct cross-program activities.

A comprehensive technology solution that is consistent with state and federal IT directionand that streamlines and integrates the enrollment process through the combination of:

A common front-end, that allows consumers to input basic information into an onlinescreening tool and apply for services via the Internet. This web-based self-service willallow consumers to screen for many programs from many locations and submit onlineapplications directly to programs, in which they are interested.

A common messaging infrastructure, that will serve as the platform on which to buildcommon back-end services, control access and authorization, and route information toexisting systems. Built utilizing modern enterprise architecture, this model incorporatesthe creation of an Enterprise Service Bus (ESB) that will make available the commonservices and serve as a central repository of shared business rules and processes. Thisenables authorized to perform a multi-program applicant search, verify program eligibilitystatus, enroll and re-enroll in multiple programs online, and provides the basis foradditional shared services.

6Assumes the applicant has given informed and voluntary consent to sharing information with other programs for the

purpose of determining eligibility.

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Enhanced system integration, to connect existing and future systems to each other viathe ESB, allowing current applications to interface to the new architecture and services,including the ability to validate an applicant’s status (e.g., income, birth records) online.

The figure below presents a graphic representation of the ESB.

Figure 1 – Shared Services on the ESB

Key business features will include:

Applicants will share information only once, regardless of the number of programs for whichthey are applying;

Applicants will be able to apply for services from ‘any door;’

Information is electronically shared via online, real-time connections;

Consumers can receive assisted application support if desired, and can be directed to theservice location that is closest to them; and

Supporting documentation is verified online, to the extent permitted by program policy.

Figure 2 graphically presents the future state approach, followed by a description of anenrollment scenario from the consumer’s perspective.

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Figure 2 – High-Level View of the Self-Service Enrollment Process in the Future State

Applicationand Routing

EligibilityDeterminationandEnrollment

ScreenLaptop

Applicant accessesfront-end tool

Applicant enters basicinformation into an online

screening application

Resident systems

Applicant is enrolled in multipleprograms and receives services

Front-end tool informs applicantof potential program eligibility

Data is validatedagainst regulatory

agency files

Eligibility is determined

Updates aresent tomultiple

programsvia the ESB

Re-determination

req’d?

Applicant completesand submits application

for desired programs

Laptop

Applicant accessesfront-end tool

Applicant enters basicinformation online

Yes

Servicescontinue

No

Apply toprograms?

Applicationform is pre-populated

Yes

Do not retain data

Send data todesired

programs viaESB

Front-end tool notifiesapplicant that applications have

been submitted

Applicant search function isperformed to determine ifapplicant is already enrolledin any programs

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Self-Service Enrollment

A mother logs onto the Internet in the evening from home to research health and socialservices programs that she heard discussed on the radio. The menu-driven website walks herthrough a series of simple questions regarding household income and family composition.Based on the information she provides, the website checks to see if she is already enrolled inany of the programs and shows her the programs for which each family member may qualify.She is also provided with a link to obtain more information about each program. Based on thatinformation, she can choose to apply online for the programs in which she is interested. If sheneeds assistance to complete the application, the website will help her to find a CertifiedApplication Assistant (CAA) in her area.

In this scenario, the mother is pregnant and applies for Medi-Cal for herself and her one-year-old; HF for her 7 year old child, and WIC for eligible family members. Whether she appliesonline or seeks assistance from a CAA, she will only be required to supply information aboveand beyond what she has already provided.

Since she has started the application process for WIC, the website informs her of the WIC officethat is closest to her home and she is presented with a list of possible appointment times.Based on that information, she selects a time that fits her schedule to complete the WICenrollment process. Her application is then submitted online and is routed to Medi-Cal, HealthyFamilies and WIC at the same time. Once the programs receive her application, they send heran electronic confirmation. When her application is received, the information provided on theapplication is checked against the online files of regulatory agencies (e.g., Vital Statistics,Department of Motor Vehicles, as appropriate) to validate residency citizenship or immigrationstatus, residency, and other eligibility requirements.7 Once the information is validated andsignatures are provided. is, the mother and her children are enrolled in the programs for whichthey are eligible, and begin to receive services.

If there is a change in her circumstances, the mother can access the website to update herinformation online. If she is still receiving services at the time of re-determination, the systemwill automatically notify her that she must update her information to continue to receive services.When this occurs, she can again access the website or go to her CAA to provide any updates tothe required information, which is automatically checked with the consent of the applicantagainst other records/files (e.g., FTB) to determine whether benefits will continue.

7Under the new DRA requirement, some citizens and nationals will need to present a birth record to the countyoffice.

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Future State Costs

This section provides information about the development costs associated with two keycomponents of the future state: “Program Look-Up” and “Enrollment”. In the future state,system users will be able to conduct queries to identify an enrolled applicant. The ‘ProgramLook-Up’, or Inquiry, service determines if a program or programs knows an applicant. Further,users will be able to enroll an applicant in programs. The ‘Enrollment’ service submits theapplicant’s information to a program or programs. We have also included development costs fora web-based application tool for consumers to apply for programs.

The estimated development costs provided below were developed by Eclipse. These estimateddevelopment costs are not the complete costs for the future state. They do not include anycosts associated with contract or procurement activities, purchase of additional software orhardware necessary to host the solution, securing additional bandwidth or network usage,conducting statewide roll-out or training activities, any county customizations, or ongoingmaintenance and operations. Further, the estimated costs for the web-based tool are illustrativeonly. Finally, we note these cost estimates are based on the knowledge available at the time;any changes to the basic system information, program requirements and mandates,organization and governance, software and hardware platforms, etc. will invalidate the costs aspresented.

In addition, our estimates assume the California Chief Information Officer’s (CIO) CaliforniaEnterprise Architecture Program (CEAP) will take the following actions:

The CEAP initiative to procure and implement an ESB will occur and access will be grantedto the programs listed; and

The CEAP Identity Management initiative will provide the basic structures needed forauthorization and authentication needed to secure access to the ESB. 8

.Table 3 – Estimated ‘Program Look-Up’ / Inquiry Development Costs

System / Program DevelopmentCost

Development Timeframe

AIM $ 184,500 Up to 6 monthsSPE software $ 166,500 Up to 5 monthsMEDS $ 184,500 Up to 8 monthsISIS / WIC $ 40,500 Up to 3 monthsSAWS Not estimated Not estimatedTotal Inquiry Development Costs $576,000

Table 4 – Estimated ‘Enrollment’ Development Costs

System / Program Development Cost Development Timeframe

Web-based tool $3,703,500 Up to 21 monthsAIM $ 711,000 Up to 9 monthsSPE software $ 972,000 Up to 9 months

8For more information about the State CIO and CEAP, please see the Executive Report Appendix.

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System / Program Development Cost Development Timeframe

ISIS / WIC $ 693,000 Up to 8 monthsSAWS Not estimated Not estimatedNewborn $ 562,500 Up to 10 monthsPrenatal $ 554,500 Up to 10 monthsTotal Enrollment Development Costs $7,002,000Total Inquiry Development Costs $576,000Total Estimated Development Costs $7,578,000

Interim Recommendations

It will take time to put the pieces in place to implement the future state recommendations. Thepolicy environment is dynamic, however, and the state needs to be able to respond to existingrequirements in the meantime. Accordingly, we recommend the state pursue a number ofshorter-term, interim recommendations, which are discussed below.

The interim recommendations have been designed to meet the study goals in the near-term by:

Improving self-service to increase enrollment; Enhancing the CHDP Gateway to streamline enrollment; and Better facilitating continuous coverage.

Further, the interim recommendations address the requirements of SB 24 and recently passedlegislation that was included in this assessment. The criteria that were used to select theinterim recommendations are listed below:

The interim step addresses a problem associated with the enrollment process that is relatedto the goal of being streamlined, integrated or efficient;

The interim step can be pursued with existing IT resources / staff;

The interim step does not ‘step on’ the DHCS’ planned / ongoing Feasibility Study Reports(FSRs), which will result in a level of analysis that is more in-depth than what this projectallows; and

The interim step does not exceed the HHSA’s delegated spending authority.

Each interim recommendation is described below and summarized in Table 5 with theirassociated development costs. Similar to the caveats presented above regarding the futurestate costs, the estimates provided for the interim recommendations are also limited and do notreflect the total costs of implementation. We have identified the limitations of our estimates inthe discussion below. We also note that these estimates have not be reviewed or approved bythe State.

Improving Self-Service to Increase Enrollment

1. Develop an Informational Website

The statewide portal (http://www.ca.gov) has recently been updated to reflect a new ‘look-and-feel’ and structure. As part of this effort, HHSA will lead the development of the health servicecenter to provide health-related information on such issues as public health programs and

http://www.ca.gov/

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managed care. In addition to that, we recommend that HHSA provide further outreachassistance and develop an informational section that:

Provides a single access point through which an applicant can learn about multipleprograms, available in the State’s threshold languages, for which they might be eligible.Based on providing anonymous information, visitors can identify assistance programs thatmay meet their needs; and

Links those visitors to the specific program websites, enrollment applications, or servicelocations based on their initial search.

The estimated development costs for this type of informational website are approximately$210,000 with a development schedule of up to 6 months. These are strictly development costsand do not take into account any associated costs for contracts or procurement, scopedefinition, compliance with HIPAA privacy and security requirements, additional hardware andsoftware needed for hosting the solution, additional bandwidth requirements or network usage,or ongoing maintenance and operations costs.

2. Evaluate One-e-App’s Re-Use Potential in the Future State

As each program has its own online screening and application tool, but none of them have amultiple program screening tool, we recommend that the State investigate and evaluate One-e-App. The One-e-App application could serve as the basis of an online screening/application toolfor the future state. The future state process would have applicants’ information entered onceand provided to multiple programs for their individual application processes.

As the rules for each program vary, the ability to isolate and update those rules independentlywhile minimizing any changes to software programs that utilize those rules would be very useful.The One-e-App application has created a business rules engine that provides this type offunctionality. As the State contemplates the future state, it should evaluate the One-e-App rulesengine as a possible asset to be leveraged. While Eclipse believes the One-e-App rules engineshould be considered as a reusable asset, the State should be mindful of feedback receivedfrom consumer advocates regarding One-e-App, surrounding limitations in error correctionfunctionality, the lack of uniformity on important core eligibility and procedural issues amongparticipating counties, and a cumbersome consumer interface.

As shown in our analysis, other states are facing enrollment and retention challenges that aresimilar to California’s. Approaches and solutions to these challenges vary. Eclipse alsobelieves that it would be prudent for the State to conduct an alternatives analysis of other similartools in the marketplace that automate and streamline the enrollment process for the purpose ofcomparing functionality and identifying the ‘best fit’ for the State’s needs.

3. Create a Public Enrollment Application for AIM

The application process for AIM is entirely manual. If the program is continued9, we supportMRMIB’s current efforts to develop an electronic application for AIM by adding AIM to the newpublic version of Health-e-App. We also note that under the SB 24 Prenatal Gateway, women

9This recommendation is predicated on the continuation of the AIM program which is recommended to

sunset in the Governors Health Care plan released in January 2007.

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screened ineligible for Medi-Cal but potentially eligible for AIM must be referred to MRMIB forthat program; inclusion of AIM in Health-e-App would provide for a more efficient way of makingsuch referrals from the Prenatal Gateway. The estimated development costs for creating apublic enrollment application for the AIM program by including it into Health-e-App areapproximately $266,000 with a development schedule of up to 9 months. As mentioned above,these are strictly development costs and do not take into account any associated costs forcontracts or procurement, scope definition, compliance with HIPAA privacy and securityrequirements, additional hardware and software needed for hosting the solution, additionalbandwidth requirements or network usage, or ongoing maintenance and operations costs.

Enhancing the CHDP Gateway to Streamline Enrollment

4. Improve Beneficiary Data Integrity

During our interviews, data integrity was one of the most frequently mentioned shortcomings ofthe CHDP Gateway. The current matching algorithm “determines” a match based on the datainput. This process, known as ‘file clearance’, needs to be more accurate and robust.

Further, even when the provider knows that the match is incorrect, the provider is not permittedto modify the result. This can lead to an incorrect association between a person and a MEDSrecord, or the creation of a MEDS record with incorrect data that may be entered to “trick” thesystem in order to enroll an applicant in CHDP. To address this problem, CHDP Gateway usersneed to be able to edit or update beneficiary information they enter into the system.

Lastly, the recipient’s BIC number should be included on the Joint Application. Including the BICnumber on the Joint Application would allow the user to query beneficiary records in MEDSbased on the BIC number10. This would help to minimize the possibility of either creatingduplicate records in MEDS, or incorrectly merging beneficiary records in MEDS. Using the BICnumber to identify a beneficiary’s record in MEDS will allow the user to update the beneficiary’spresumptive record, rather than erroneously creating an entirely new record.

The estimated development costs for improving the beneficiary data integrity cannot accuratelybe estimated. Analysis of the MEDS/SCI systems was not specifically within the scope of thisengagement. However, previous assessments of the MEDS system provided estimated coststo modernize MEDS. Modernizing the MEDS system or systems would allow for the use ofmore modern technologies for beneficiary searching and matching based on the diverseCalifornia ethnic population.

Creating a long-term solution for beneficiary data integrity improvement will require a morethorough business process review of the procedures and analysis of existing code that supportthe processing of multiple possible matches made during a CHDP transaction. It is apparentthat the current process of resolving multiple records does not meet user expectations andcreates additional workload for both the users and MEDS personnel. In the future state,automated file clearance should be a service available though the ESB for all programs. Thecost for adding the BIC number to the Joint Application form is not provided.

10As of the DHCS’ review of this draft report, Eclipse was informed that a new version of the Joint Application will be

produced in 2007 that will include a field for the BIC number.

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5. Expand CHDP Gateway access and implement system controls to ensure thatconfidential data is protected.

The CHDP Gateway – both the Internet application and the POS device – provide significantcapabilities for access to the DHCS Medi-Cal infrastructure in general, and to MEDS inparticular. Because nearly all programs must have access to MEDS, it would be helpful tofurther expand the access mechanisms available through the CHDP Gateway.

When talking about expanded CHDP Gateway access, we are speaking of the Gateway as acommunications gateway. One of the major advantages of the CHDP Gateway is the multiplicityof access methods – over the Internet and via POS devices. Over time, the Payment SystemsDivision of DHCS has received requests from outside entities interested in submitting real-timetransactions to the Medi-Cal website / network.

The current FI contractor researched the possibility of creating a separate communicationschannel to process these transactions. The transactions would flow into CA-MMIS and beprocessed. We believe this to be a concept that should be further explored and implemented.This expanded access would create an application programming interface (API) or web servicetransaction to allow third party applications to communicate securely, in a standardized fashion,with the Medi-Cal system. This access should be tightly controlled via the designation of specificsystem authorization levels and access rights, secure protocols for file transmittal, and to assurefor compliance with HIPAA regulations. This mechanism could provide access to practicemanagement systems, One-e-App / Health-e-App, pharmacy management systems, and otherState and federal programs for referral of likely presumptive eligibility beneficiaries.

Many of the interim steps involve greater access and communication with the DHCS Medi-Calinfrastructure and specifically the CHDP Gateway. While this is just one possible solution to theneed for greater access, it makes sense to minimize the number of moving parts whenproceeding with multiple infrastructure development efforts. As we discuss in the section onimplementation of SB 24, we recommend that the separate communications channel be createdwithin the CHDP Gateway.

As the current FI contractor has already explored the costs involved in providing this expandedaccess to the Gateway, we will not provide any costing data for this interim step.

6. Implement SB 24 in the CHDP Gateway

As part of the original scope of this engagement, a critical question was the location of the twonew Gateways mandated by SB 24. The CHDP Gateway is the recommended location for both.

As part of the POS network, the CHDP Gateway is available to CHDP qualified provider officesand was implemented in 2003 to provide an automated pre-enrollment process for uninsuredchildren; these children must, however, submit a follow-up application to receive ongoing healthcare coverage through Medi-Cal or HF. Currently, only CHDP authorized providers are qualifiedto enroll children through the CHDP Gateway, but the state has discretion to add otherproviders. The CHDP Gateway enrollment process, while not perfect, offers providers a real-time enrollment response.

Forty percent of the current presumptive eligibility transactions are submitted through POSdevices. This suggests that SB 24 enrollments must be available on the POS device in order toreach the target population in the locations where they obtain services.

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Creating a new computer application for SB 24 would require nearly 100 percent duplication ofboth the CHDP application and its communications networks. The entire duplication of theCHDP application network is not feasible due to the qualified provider authentication processwhich is unique to the CHDP program criteria. This is not an acceptable alternative when takenin conjunction with the recommendation to create an interface from MEDS to the SPE softwareto make it easier for applicants to obtain continuous coverage (see recommendation #8below).Further, the inclusion of the SB 24 populations will be better afforded through theexpansion of the CHDP Gateway (see recommendation #5 above).

The estimated development costs for implementing SB 24 in the CHDP Gateway are broken outinto several pieces. The estimated development costs for implementing the newborncomponent of SB 24 in the Internet portion of the CHDP Gateway are approximately $468,750with a development schedule of up to 10 months. The estimated costs for the prenatalcomponent of SB 24 in the Internet portion of the CHDP Gateway are approximately $453,750with a development schedule of up to 10 months.

As before, these are strictly development costs and do not take into account any associatedcosts for contracts or procurement, scope definition, compliance with HIPAA privacy andsecurity requirements, additional hardware and software needed for hosting the solution,additional bandwidth requirements or network usage, statewide rollout and training, or ongoingmaintenance and operations costs.

The costs for implementing both the newborn and prenatal components of SB 24 in the POSdevice portion of the CHDP Gateway are not provided. Since the POS devices areprogrammed by the POS device vendor, cost data was not available for comparison orcalculation. The estimate included above does not consider development costs for thefunctionality for MEDS, file clearance, eligibility tracking, and forwarding application information.

7. Create a simple income screen utility for WIC in the CHDP Gateway

The CHDP Gateway should be enhanced to do a simple WIC income screening. This wouldallow the provider to advise applicants of their potential eligibility for the WIC program.Incorporating this functionality would involve minimal changes to the current CHDP Gatewayfunctionality. Since the current CHDP Gateway already maintains one set of income lookuptables for potential eligibility, adding another table and associated response messages could beaccomplished easily. However, it is unknown how many providers would utilize this new utility.

The ability to facilitate cross-program referrals could greatly serve the applicant. As the CHDPprovider would likely be involved in the WIC biometric screenings, having the ability to adviseapplicants of their potential WIC eligibility during the CHDP enrollment process would enhanceand facilitate the WIC referral process at the CHDP point of service. While this recommendationimproves outreach, we also recognize that it does not entirely close the loop – that is, it does notallow for the electronic transmittal of data from the CHDP Gateway to the WIC system of record,ISIS. Although this measure would go beyond the scope of SB 437, we recognize the value ofthis enhancement and encourage the DHCS to consider this functionality in their upcomingfeasibility study.

The estimated development costs for adding an income screen for WIC in the Internet portion ofthe CHDP Gateway are approximately $166,500 with a development schedule of up to 5months. The costs for implementing the WIC income screening in the POS device portion of the

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CHDP Gateway are not provided. The POS devices are programmed by the POS devicevendor, so no cost data is available for comparison or calculation.

As mentioned above, these are strictly development costs and do not take into account anyassociated costs for contracts or procurement, additional hardware and software needed forhosting the solution, additional bandwidth requirements or network usage, statewide rollout andtraining, or ongoing maintenance and operations costs.

Better Facilitating Continuous Coverage

8. Consider the CHDP Gateway presumptive eligibility transactions as an incompleteapplication for continuous eligibility and send a file from the CHDP GW to the SPEsoftware to initiate follow-up activities in the unit.

This recommendation leverages existing SPE outreach services to follow up on pre-enrollmentforms received via the CHDP Gateway as an effective way to improve enrollment for continuouscoverage in HF and MCC. Using information gathered in the CHDP Gateway presumptiveeligibility transaction is the first step in the enrollment process. Involving the SPE early in theprocess could increase the number of applicants required to submit follow-up applications forHF and MCC after requesting PE who actually complete and submit their applications forcontinuous coverage.

In this scenario, a nightly batch file from the CHDP Gateway back-end infrastructure can beuploaded into the SPE software as an incomplete Joint Application for follow-up. This sameprocess can be implemented for any other enrollment transactions received through the CHDPGateway,, such as those stipulated under SB 24. Once SPE receives the incomplete JointApplication, and upon written consent of the applicant, SPE can then contact the applicant togather the additional household and detailed income information and assist the applicant withapplying for HF, or for MCC through the county welfare department. This solution allowsproviders to continue collecting the minimum data set required for presumptive enrollment whileproviding continuous coverage support to the applicant.

The estimated development costs for creating the file transfer from the CHDP Gateway processto the SPE software are approximately $117,000 for the CHDP Gateway process with adevelopment schedule of up to 5 months. The estimated development costs are approximately$337,500 for the SPE software portion with a development schedule of up to 6 months.

These are strictly development costs and do not take into account any associated costs forcontracts or procurement, scope definition, compliance with HIPAA privacy and securityrequirements, additional hardware and software needed for hosting the solution, additionalbandwidth requirements or network usage, or ongoing maintenance and operations costs.

9. Build an interface from ISIS to the SPE software to allow the unit to conduct follow-upactivities with WIC applicants who are interested in applying for MCC or HF.

As we have discussed in the section on WIC income screening in the CHDP Gateway, werecommend enhancing the cross-program referral ability in ISIS. By providing a nightly batchfile interface from ISIS to the SPE software for the transmittal of potential Medi-Cal applicants,SPE could provide presumptive eligibility and application assistance to this client population.Again, this recommendation is intended as an interim step. We recognize that while it facilitates

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referrals from WIC to HF or MCC, it does not offer the reverse – that is, cross-program referralsfrom SPE to WIC. Being respectful of the DHCS’ current efforts to pursue an FSR specific tothe requirements of SB 437, we would suggest that this functionality be considered in theirevaluation.

The estimated development costs for creating the file transfer from ISIS to the SPE software areapproximately $138,750 for the ISIS system with a development schedule of up to 4 months.The estimated costs for the SPE software were given above.

These are strictly development costs and do not take into account any associated costs forcontracts or procurement, scope definition, compliance with HIPAA privacy and securityrequirements, additional hardware and software needed for hosting the solution, additionalbandwidth requirements or network usage, or ongoing maintenance and operations costs.

10. Create interface between the SPE software and SAWS to electronically sendapplications for MCC and AIM to the Counties.

Currently, SPE prints and mails applications for MCC and AIM to the counties for eligibilitydeterminations. We recommend the development of an electronic means to exchangeapplications between SPE and the county welfare offices. MRMIB should create a file layout forJoint MCC/HF Applications to be forwarded to the counties and share it with the SAWSconsortia for acceptance. An FTP site should be developed for secure posting and retrieval ofthe applications. Each SAWS consortium would be responsible to map the file layout in order toaccept the applications. Re-determination applications sent from the counties to SPE can alsobe put into this file layout and sent through the same FTP site.

FTP provides an inexpensive, relatively easy way to share secure electronic information. UsingFTP for these transactions is an interim solution to improve the flow of information and reducethe manual workload of re-keying application data. In the long term, the FTP site would bereplaced by the ESB for sharing application information.

The estimated development costs for creating the file transfer from the SPE software to theSAWS systems are approximately $702,000 for the SPE software with a development scheduleof up to 9 months. The costs for the SAWS systems integration are not given. This estimate ispredicated on the creation of only one output file format for use by all 4 SAWS systems.

These are strictly development costs and do not take into account any associated costs forcontracts or procurement, scope definition, compliance with HIPAA privacy and securityrequirements, additional hardware and software needed for hosting the solution, additionalbandwidth requirements or network usage, per county customizations, ongoing maintenanceand operations costs, etc. The business estimates outlined above assume that there are noadditional changes required in MEDS. Changes to MEDS will require additional funds to beincluded in these estimates.

Summary of Interim Recommendations

As shown in the table below, each of the interim recommendations attempt to address a varietyof the findings and business problems identified earlier in this report. For ease of presentation,the findings are denoted as followed:

A. Lack of unified Agency-wide approach;

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B. Minimal data sharing between programs;C. Enrollment processes are not consumer friendly;D. Outdated and disparate technology; andE. Reliance on manual processes.

They provide some immediate benefits in terms of the project’s goals by:

Streamlining enrollment by creating a single entry point for multiple gateways; Improving integration by creating interfaces between existing systems and sending

electronic files; and/or Increasing efficiency by reducing paper handling and manual processes.

They also move HHSA’s toward the future state by:

Leveraging existing systems that will be connected to the ESB; Re-using interfaces; and Allowing for further improvements as legacy systems are enhanced or replaced.

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Table 5 – Interim Recommendations and Estimated Costs

# Interim Recommendation

BusinessFindings /Problems

ProjectGoals

EstimatedCosts

1 Develop an informational website. A

B

C

D

E Streamlined Integrated Efficient

$210,000

2 Evaluate One-e-App’s re-use potential in the future state. A

B

C

D


--

3 Create public enrollment application for AIM. A

B

C

D


$266,000

4 Improve beneficiary data integrity. A

B

C

D


--

5 Expand CHDP Gateway access. A

B

C

D


--

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# Interim Recommendation

BusinessFindings /Problems

ProjectGoals

EstimatedCosts

6 Implement SB 24 in the CHDP Gateway. A

B

C

D


NewbornGateway =$468,750

PrenatalGateway =$453,750

7 Create a simple income screen utility for WIC in theCHDP Gateway.

A

B

C

D


$166,500

8 Send file from the CHDP Gateway to the SPE softwareto allow the unit to conduct follow-up activities.

A

B

C

D


$117,000(CHDP GW)

$337,500(SPE)

9 Build an interface from ISIS to the SPE software to allowthe SPE to conduct follow-up activities.

A

B

C

D


$138,750(ISIS)

$337,500(SPE)

10 Create interface between the SPE software and SAWS. A

B

C

D


$702,000acrossconsortia

Conclusions

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Conclusions

This report has presented a snapshot that portrays a collection of programs that are designed tomeet the needs of eligible children and pregnant women that are not well integrated on manyfronts. Several programs collect the same or similar data, most of the programs useindependent enrollment systems, and linkages across programs are generally manuallysupported.

This report addressed these concerns by presenting a roadmap for moving the DHCS from itscurrent environment, characterized by multiple stand-alone systems that pose barriers forapplicants seeking to enroll in programs that serve children and pregnant women, to anenterprise-wide approach that offers shared services and shared information. It presents amodel and vision of the future state that must have strong sponsorship and an empoweredgovernance structure to oversee the implementation of a comprehensive technology solutionthat streamlines and integrates the enrollment process through a common front-end, messaginginfrastructure and enhanced system integration. In so doing, applicants will be able to apply forservices from ‘any door;’ and will share information only once, regardless of the number ofprograms for which they are applying. Information will be electronically shared via online, real-time connections; and supporting documentation will be verified online.

In addition, this report included ten interim recommendations designed to meet the study goalsin the near-term by offering ways to improve self-service, by leveraging existing technology tostreamline enrollment and connect applicants to the services they need, and by buildinginterfaces between existing systems to better facilitate continuous coverage. In theserecommendations, this report provides a pathway of recommendations that are both tactical, inaddressing the problems of today, and strategic, in reaching toward the future state.