Policy & Practice | Summer 2025

We Have a Vision—It’s Not That Complicated

gives you more than a score: it shows where you’re bleeding time, money, and people and what you can do about it. As seen in the following figure, it helps you plot your progression along a maturity curve (see Chart 1). A Practical Way to Get There The real solution isn’t the Maturity Model itself: it’s what we do with it. The model gives us a structured way to look at every part of an agency’s operation, segment by segment, and figure out exactly where things are stuck, what’s causing the backlog, and how to fix it. We use it to find the best entry points for change—and then we get to work. And while the solutions are largely incremental, we don’t do it one piece at a time. We bundle the right changes to tackle the real problems, starting with the areas where agencies can gain the most capacity in the shortest amount of time. We work with you to implement a package of targeted and, most impor tant, modular improvements such as automation, policy guidance tools, virtual agents, and smart routing, all designed to deliver immediate and measurable impacts. Think of it as a fitness tracker for your eligibility operation: it tells you if you’re sprinting, jogging, or still sitting on the couch. The Maturity Model gives us the map. The solution is in the journey. This is how agencies move from paperwork piles to streamlined, no-touch eligibility and from backlogs to breathing room. The beauty of this approach is that it doesn’t require tearing everything down and starting over. Most agencies already have the raw materials they need—they’re just not using them in a way that creates capacity. To get started, you can focus on five moves: 1. Assessing capacity need 2. Picking one bold goal 3. Bundling your innovations and keeping them manageable 4. Keeping results visible 5. Scaling what works You Don’t Need a Revolution, You Need a Rethink

technology budget is expended to keep their core systems running. The costs for portals, infrastructure upgrades, and keeping up with rule changes absorb nearly the entire budget. And the systems don’t do a good job of making the work visible, which is critical for capacity optimization. This is core to our philosophy. Too often, it’s difficult to see true work volumes and where work is stuck. People guess or have no idea. Many compa nies today closely track where orders are and what comes next, and you can even track where the delivery van is on the day of delivery. However, in Eligibility Operations we often talk to states that have very little data driven insight on how long each worker is taking to do a similar task or who is excelling or who needs coaching. We can’t fix this by continuing to patch and prop up systems built for a different time and a different set of goals. To get us out of here, a map is needed: the Eligibility Operations Maturity Model. Where You Want to Be Let’s say you want to achieve the goal of a 30-minute average determination. Since there is no single solution to that challenge, you need a plan. At C!A, we believe that getting somewhere better requires three things: a clear picture of where you are now, a compelling vision of where you want to be, and a prac tical way to get there. That’s where our Eligibility Operations Maturity Model comes in. By breaking operations into three key domains—people, process, and tech nology—and looking across the process systems of your organization, we can help agencies score themselves across levels of capability, including process standardization, automation and AI readiness, workforce enablement, customer engagement, and data and insight utilization. The Maturity Model

In an article C!A wrote last year, we laid out a bold vision: imagine a world where 80 percent of applicants are approved accurately in less than 30 minutes, whether they apply online, on the phone, or in person. No lines. No paperwork purgatory. No endless call queues. As a company solely focused on improving the capacity of agencies to serve more clients effectively, our goal was clear. It resonated with our clients, who shared, discussed, and started their journeys. But many struggled when it came to creating a comprehensive plan and quickly implementing it. Where Are We Stuck? Currently, realizing the vision seems difficult. The systems many agencies are using were never designed to solve the problem we’re facing. Across the country, eligibility timelines remain stuck at 30 days for SNAP and 45 or longer for Medicaid while caseworkers are overloaded with tasks that shouldn’t even require their attention. At the same time, agencies are pouring more time, money, and efforts into fragile eligibility systems that were coded—at great expense—to handle edge cases and focus on compliance over capacity. Many of our clients are struggling to modernize their core systems, and nearly their entire information

Imagine a world where 80% of applicants

are approved accurately in less than 30 minutes.

Sean Toole is the Senior Vice

President at Change & Innovation Agency (C!A), a Vimo Company.

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