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A look ahead in health and human services

The Outlook for Eligibility Modernization in Health and Human Services


The Center for Digital Government conducted a survey of government health and human service IT leaders to better understand how states and localities are approaching eligibility modernization projects. In total, 169 responses were collected from the members of the GovTech Exchange, in an online survey during April to June 2014.

While the results from this survey cannot be projected upon the entire population, the results are reflective of those who subscribe to Government Technology magazine with a maximum sampling error in this survey of +/-7.5 percentage points at 95% confidence.


The Affordable Care Act (ACA) provided an opportunity for states to modernize their Medicaid eligibility systems to promote the more efficient delivery of services. States seized this opportunity but many encountered considerable challenges such as compacted timeframes, limited federal guidance and a shortened time for testing before going live.

States are now taking steps to ensure that their near-term eligibility needs are met but are also eagerly looking across the health and human services organization for additional modernization opportunities. State and local leaders are looking to create a workable future-ready system that can easily expand from Medicaid to other programs quickly and efficiently.

In this period of changing priorities and aging systems, we surveyed a variety of state and local IT executives to assess the challenges and opportunities related to eligibility modernization efforts. One thing is clear from the recent survey results: the more that is built from scratch, the greater the implementation risk. States that appear to be achieving success include those leveraging commercial-off-the-shelf eligibility software solutions rather than taking on the risk of building a custom solution.


These are complicated systems that traditionally come with long timelines, missed deadlines and budgets that are often overrun. Fortunately, these challenges are both manageable and solvable. States need and desire an underlying platform and architecture that is service-oriented and facilitates legacy modernization. Additionally, integrated eligibility software available as either on-premise or hosted solutions can ensure timelines are met and reduce risk. As states start to look beyond Medicaid to other health and human services programs having an enterprise architecture platform in place will allow states to quickly expand integrated eligibility into other programs.


Health and human services organizations are continuing to shift their thinking to be less about the systems and more about the citizen. The next step on this journey is to reduce the headaches commonly encountered during integrated eligibility projects by considering lower risk market-ready software solutions that will speed up implementation times but also deliver greater flexibility when scaling to add new human service programs. Beneficiaries should have options on how they access their information — in-person, phone, online and/or mobile. Going forward they will demand it! Improved citizen service will come not only from wider self-service options, but also from capabilities that boost caseworker productivity, such as no-touch processing and auto-renewals. As states confront integrated eligibility modernization or Medicaid modernization efforts, they should also look for enterprise platforms and integrated solutions that can meet their current but also future needs.