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CLIENT CASE STUDY


State of Ohio: Integrating service delivery and improving outcomes for the citizens

Learn how our integrated service delivery model improved outcomes through an easy online access to eligibility and benefits through a self-service portal.

Overview

Momentum 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.

1Gabriel, 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=2&.&

Opportunity

Ohio 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.

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

  • 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.

  • 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.

Solution

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.

Using the 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.

The integrated eligibility program is rolling out in three primary phases:

Phase I: Completed October 2013
The 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 1.5 and 2: To be completed January 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.

Phase 3: Commencing June 2014
The solution will be expanded to support additional health and human services programs and services that require eligibility determination beyond the CRIS-E and CRIS-E dependent programs.

Results

The 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. State officials project another 600,000 will sign up for coverage in the next year.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.

  • 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.

  • 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).

2Candisky, Catherine; The Columbus Dispatch; “Ohio’s Medicaid-enrollment website works smoothly on first day”; December 10, 2013.

Infographic

A story of integrated service delivery and improved outcomes for the citizens of Ohio