Policy & Practice | Fall 2024

technology speaks

By Mina Nemirow

Modernizing Integrated Eligibility: Pathways to Success

B enefit programs provide essential financial, medical, nutritional, and other supports to families across the United States. Because they rely on federal funding, state-adminis tered benefit programs must comply with complex federal rules. These rules often vary from program to program—creating significant risk for states and friction for families and eli gibility workers. Integrated eligibility systems were the intended solution for streamlining and simplifying the administration of multiple programs. States have invested billions in these systems and continue to spend an estimated $6.5 billion annually. 1 Yet they’ve largely fallen short of their promise. Application processes have grown more complicated for families, while day-to-day tasks have become more difficult for eligibility workers. Meanwhile, fraud, waste, and abuse persist. In its 2023 reporting cycle, the Centers for Medicare and Medicaid Services (CMS) estimated $50.3 billion in improper payments. 2 As of February 2024, the U.S. Department of Agriculture issued warning letters to all but three states. 3 Beyond compliance challenges, states are increasingly strained by the “double whammy” of growing demand for public benefits and difficulty training and retaining experienced eligibility workers. Given these reali ties, states need actionable strategies for meeting heightened demand, improving compliance, and delivering more human-centered services.

Improving Integrated Eligibility

Accelerate Progress inTargeted Areas By implementing targeted robotic process automations (RPAs), states can fast-track improvements that bring rapid relief to overburdened eligibility workers. For example, focusing small scale automations on discrete processes like program recertifications, new application processing, beneficiary renewals, and changes in beneficiary information can drive new efficiencies. Similarly, consider exploring use cases for artificial intelligence (AI). For

The untenable status quo is fueling demand for change and, more spe cifically, improvements to integrated eligibility processes and systems. Each state will forge its own path—whether it’s full system replacement, in-place modernization, or some combination of the two. Regardless of the path states choose, prioritizing three pillars and tying them to state policy objectives (e.g., population health outcomes) will set the foundation for success (see Figure 1).

Illustration by Chris Campbell

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