Delivering Public Service for the Future

State of Ohio Integrated Eligibility System: Integrating Service Delivery and Improving Outcomes for the Citizens of Ohio

OverviewMomentum toward integrated human service delivery in Ohio accelerated in 2011, with the creation of the Office of Health Transformation. The Office focuses on modernizing Medicaid, streamlining health and human services, and improving overall system performance. This catalyst for transformation came at an important time given that in October 2013, Ohio became the 25th state to expand Medicaid. Federal Medicaid expansion funding will enable coverage for 275,000 Ohioans who had not been eligible for the program.1

The Office is helping to move Ohio’s human services delivery model from one that focuses on the agency to one that centers on people, and provides convenient self-service options similar to those that people have come to expect in their daily lives. A critical component

to the service delivery transformation is improving the eligibility system that supports more than 50 health and human services programs serving Ohioans. The ultimate goal being to deliver these numerous benefits for citizens, all while improving health outcomes.

Business ChallengeOhio was facing a new healthcare landscape where the stakes were higher. State Medicaid Expansion would cover 275,000 more Ohioans. The changing and challenging healthcare environment illuminated an already recognized need to reduce costs, increase efficiency and improve agency business processes.

Ohio needed the right technology system to meet federal deadlines, and also support leadership’s goals for integration and efficiency. The state’s decades-old legacy systems were

cumbersome, siloed and expensive to maintain. Through an integrated eligibility system, the state could:

• Bring together 88 counties with enhanced technology.

• Equip 20,000 state workers with integrated tools and processes to better serve citizens.

• Consolidate state and local data in a centralized warehouse for easier sharing and analysis.

• Simplify eligibility under new guidelines with technology-automated processes.

• Offer self-service options that would help Ohio migrate from an agency-based model to a person-centric model.

• Offer a flexible system/modern technology foundation that could evolve alongside changing policy and program needs.

Copyright © 2014 Accenture All rights reserved.

Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

Copyright © 2015 Accenture All rights reserved.

Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

How we helpedWorking with Accenture, the State of Ohio set out on an ambitious effort to deliver and implement the technology infrastructure that would enable Affordable Care Act eligibility and expanded Medicaid in record time. In fact, it was the most aggressive timeline in the nation.

Ohio selected Accenture to assist with the new integrated eligibility system because of our broad experience with integrated eligibility system implementation, health and human services proficiency, and our track record of on-time/on-budget results in Ohio. Given the aggressive timeframe, Ohio was also interested in the low-risk, expeditious path of using Accenture’s proven Human Services software suite.

Integrated systemThe Accenture Human Services suite allowed Ohio to rapidly implement a new eligibility system capable of handling eligibility across various programs and agencies, and offer citizens easy online access to eligibility and benefits through a self-service portal. With built-in federal hub interfaces enabling real-time data verification and full support for “no-touch processing,” the suite helped Ohio streamline case management and handle a higher caseload through automation and self-service.

Program rolloutThe integrated eligibility program is rolling out in three primary phases:

Phase I: Completed October 2013The first release was delivered on time to support Medicaid expansion under the Affordable Care Act. Phase 1 included the launch of a consumer self-service portal, benefits management software and a rules engine for early enrollment of Modified Gross Income (MAGI) eligibles.

Phase 2: To be completed 2015 The solution implementation will be expanded to non-MAGI Medicaid categories. This expansion will support Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP) and the full range of CRIS-E dependent programs, as well as additional income-driven eligibility programs.

High performance deliveredThe first major portion of the Ohio integrated eligibility project to support Medicaid expansion was delivered on time and on budget, eight months after the contract was awarded. Medicaid coverage in the state now supports 2.4 million poor and disabled Ohioans. Since January 2014, 184,671 Ohioans have enrolled and 28,000 individuals seamlessly transitioned from a limited program to full Medicaid. As of January 2015, more than 1.3 million individuals have applied through Ohio Benefits and 73 percent of all cases have been resolved.

“This is a central location for instantaneous eligibility determination, that’s something Ohio has never had,” said Sam Rossi with the Ohio Department of Medicaid.2

Project results include:Successful go-live. The system has two successful go-lives in the first 10 months. October 1 was the go-live of an online portal for determining Medicaid eligibility. December 9 marked the go-live for Medicaid enrollment. By 10 a.m., the system had successfully accepted 233 Medicaid applications and 1,165 applications had been processed by the end of the day.

No-touch processing. This functionality includes automated processing of intake and case creation and relies on state and federally defined program rules to determine eligibility. Citizens can apply online and receive near real-time eligibility determination without worker intervention. No-touch processing is operational in Ohio for all ACA Medicaid categories. As of December 2014, 49,000 clients have been processed through no-touch. In the first six months of the go live, 65 percent of all applications were walk-in applications.

Increased caseworker capacity. The no-touch processing frees caseworkers from working on processing applications and allows them to spend more time on helping customers in areas that require human interaction. Today, only 50 percent of all current applications are paper (mail, walk ins, etc.). This is an effective 15 percent workload reduction in manual application processing for staff.

Enhanced federal funding. Ohio was able to secure federal funding to cover 90 percent of the cost of the project.

In 2015, Ohioans will also be able to use the system to apply for other social service programs that rely on an income test. These programs include TANF, SNAP, welfare, and Women, Infants, and Children (WIC).

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About AccentureAccenture is a global management consulting, technology services and outsourcing company, with approximately 319,000 people serving clients in more than 120 countries. Combining unparalleled experience, comprehensive capabilities across all industries and business functions, and extensive research on the world’s most successful companies, Accenture collaborates with clients to help them become high-performance businesses and governments. The company generated net revenues of US$30.0 billion for the fiscal year ended Aug. 31, 2014. Its home page is www.accenture.com.

“Technology projects make me nervous because they’re so complicated,” said Greg Moody, director of the Governor’s Office of Health Transformation. “But Accenture and the state teams have really rallied to get more done in a short time than normally happens on a project like this.”3

1. Gabriel, Trip; New York Times; “Medicaid Expansion Is Set for Ohioans”; October 21, 2013; online at http://www.nytimes.com/2013/10/22/us/medicaid-expansion-is-set-for-ohioans.html?_r=1&.

2. Chow, Andy; Ohio Public Radio; “State Unveils New Medicaid Application System”; December 11, 2013.

3. Ghose, Carrie; Columbus Business First; Accenture, state workers praised for ‘fantastic job’ on new Medicaid portal”; September 24, 2013.