Cutting Through the Complexity

Lessons from Idaho’s Medicaid Readiness Project

Reaching an eligibility decision on the same day a customer applies for services—not 20 to 30 days later—is more than wishful thinking. It’s a reality in Idaho, where just over 70 percent of SNAP applicants and half of Medicaid applicants get same-day eligibility decisions.

This is the story of how Idaho is creating a new model of service delivery. Extending its heritage of family-centered service, the Idaho Department of Health and Welfare is taking a cautious and prepared approach to the Affordable Care Act (ACA) through its Medicaid Readiness Project. The Department sees the law as a springboard to change—streamlined eligibility determination with integrity that delivers lasting human and business value.

This article was originally published in the October 2012 issue of Policy & Practice. It was co-authored by Lori Wolf and Greg Kunz, Deputy Administrators of the Idaho Division of Welfare—Department of Health & Welfare and Debora Morris, Public Assistance Lead for Accenture’s Human Services Group for North America.

The health and human services community has faced significant challenges in recent years. The economic downturn has driven huge increases in caseloads for SNAP, cash assistance and Medicaid programs. Budget cuts and federal oversight only intensify mounting administrative pressures. Idaho has not been immune. In fact, the state saw a 123 percent increase in food stamp caseloads between 2007 and 2010—the second highest growth rate in the nation.¹

When the ACA was signed into law in 2010, it was introduced into this complex environment. Already overwhelmed, many health and human services practitioners viewed the responsibility of implementing such sweeping change as daunting, if not impossible. While states are taking their own approaches to implementation, confusion is common. What do the new rules mean? How must enabling technologies change? What must be done to accommodate growing Medicaid rolls? For many, questions outnumber answers.

¹http://www.urban.org/uploadedpdf/412365-supplemental-nutrition.pdf

The Idaho Department of Health and Welfare found a pragmatic answer. Working thoughtfully and strategically amid uncertainty over the law’s future, the Department sees the ACA as an opportunity to reinvent eligibility processes and modernize service delivery structures—welcomed outcomes no matter what happens with the ACA.

Grappling with the ACA challenges shared by other states, Idaho had an “aha” moment. The Department realized that within the complexity of the law is a fundamental focus on streamlining and modernizing Medicaid eligibility determinations.

Focusing on the processes without getting weighed down by the policies, it became clear that these process improvements aligned with the Department’s own modernization agenda. More specifically, there was a common thread with the Department’s commitment to work as a customer-focused, process-driven organization that provides same day service, minimizes churn, maximizes retention, reduces administrative burdens and costs, relieves staff workload and improves timely service to Idaho’s families. A forward-thinking approach was born from this commonality.

Once developed, this business model informed decisions around planned ACA technology and system changes, positioning Idaho to leverage available 90-10 federal funding while realizing immediate and incremental wins throughout the life of the project.

After reviewing pending rule changes, Idaho designed a three-phase, 23-month project centered on ACA requirements that began in February 2012. This Medicaid Readiness Project is allowing the state to move forward on aspects of the legislation that will provide immediate value while taking a wait-and-see approach to unresolved issues. It is also an example for other states to gain ideas for process changes, technology pursuits and rule interpretation while taking advantage of time-limited federal funding opportunities. The initiative includes the following phases:

1. Modernization
2. Medicaid Expansion
3. Connection