Policy & Practice | Fall 2024

Figure 1:Three Pillars

Thoughtful assessments are a good starting point to determine “just-right” integration for each stakeholder group. With customers, for example, more integration is usually better, as families shouldn’t be asked to repeatedly supply the same information—or be burdened with managing numerous websites, benefit application processes, and login credentials. For these reasons, portals for customers and community partners should integrate as much as possible. State workers’ needs are different. Their portals should be tailored to meet needs that differ by state and by administering agency. Experience has shown that training workers on multiple programs is time consuming, and if done too quickly, can lead to burnout and increases in fraud, waste, and abuse. Thus, modernized state worker portals need to be flexible enough to handle everything from single-program to multiple-program implementations.

As with integration, states need to be able to share data in a way that supports better cross-program outcomes without sacrificing each program’s ability to address compliance and drive innovation. Some integrated eligibility implementations were intended to simply reuse data reported by customers at different times. But as program rules get intertwined, it becomes difficult for individual programs to maintain compliance. This approach has also restricted programs’ ability to adapt to new requirements or adopt new innovations. Notably, not all programs use data in the same way. Household addresses are a common example. Addresses are used to communicate with recipients of Medicaid and the Supplemental Nutrition Assistance Program (SNAP). However, in SNAP, addresses also support household budgeting and composition. Therefore, business rules on this dataset would need to be enhanced to accommodate the need.

The past decade has brought tremendous technological advancements—from low-code/ no-code software to intelligent automation. States have an opportunity to rethink integrated eligibility technology with an eye toward vendor independence and greater speed and flexibility in getting updates into production. As states evaluate options, look for a unified user experience, as well as modularity and loose coupling to unlock greater agility. New tech solutions should use microservices to drive less reliance on hard coding. They also should offer a shared data repository to inform programs individually and collectively.

example, states may be able to leverage generative AI (GenAI) to identify code fractures and other system defects. GenAI can give supervisors new mech anisms for reviewing and continually improving the quality of case manager decisions. It can also reveal where customers and workers get “stuck” in the process—helping administrators prioritize technical and/or training investments. Finally, explore oppor tunities to use AI as a system “copilot” that supplements policy and acceler ates on-the-job training. It's time to pursue step-change improvements in customer service,

worker experience, and stewardship of taxpayer dollars. Fortunately, states can tap into today’s technology inno vations—including fit-for-purpose, cloud-based platforms, RPA, and GenAI—to unlock new and better new ways of managing eligibility. Reference Notes 1. https://www.mckinsey.com/industries/ public-sector/our-insights/insights-into better-integrated-eligibility-systems 2. https://www.cms.gov/data-research/ monitoring-programs/improper payment-measurement-programs/ payment-error-rate-measurement-perm/ perm-error-rate-findings-and-reports

3. https://www.fns.usda.gov/snap/ governor-letter-performance-operations

Mina Nemirow is a Senior Director, Product Development, for Gainwell Technologies.

To learn more about integrated eligibility modernization, check out Gainwell’s full white paper.

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