Social Interest Solutions promotes access for individuals and families by influencing the implementation of health reform, streamlining eligibility and enrollment across health and human services programs, and advancing online tools that help people connect to the services they need.
The Affordable Care Act (ACA) has laid a strong foundation for the movement toward affordable health coverage for all. An estimated 17 million have gained health coverage through the ACA since the first open enrollment period began in late 2013. But challenges persist: millions of people still remain without affordable health coverage, states are in flux with decisions about Medicaid expansion and whether to operate their own health insurance exchanges, and metrics to monitor and measure the success of federal and state efforts are incomplete. Social Interest Solutions is working to inform these issues in order to promote seamless and efficient implementation of the ACA.
The ACA Spotlight is an infographic series highlighting effects of the ACA on individuals and families. Each Spotlight illustrates how ACA policies impact health insurance access and affordability through Medicaid, the Children’s Health Insurance Program, and Qualified Health Plans and subsidies offered through health insurance exchanges. Recent Spotlight topics include the family glitch and HealthCare.gov health plan cost and choice in 2016.
In the realm of health and human services, “horizontal integration” refers to the sharing of data, policies, processes, technology, and/or staff across services or programs to streamline eligibility and enrollment. Because most low-income individuals and families qualify for multiple public benefit programs, most states have a long history of using the same technology and staff to process eligibility for the programs that they administer, such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF). Social Interest Solutions works to promote integrated eligibility systems and processes that make states more efficient and expand individuals’ and families’ access to the programs states administer.
SIS played an important role in promoting the inclusion of horizontal integration principles into the Affordable Care Act. SIS provided technical assistance to staff from the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee to craft language on systems development and enrollment IT standards that eventually became Section 1561 of the Affordable Care Act. This language broadened the scope of ACA systems reform to help people connect to programs beyond health coverage, such as SNAP and Earned Income Tax Credit (EITC). SIS has continued to monitor horizontal integration activities, having recently produced a study in partnership with the Center on Budget and Policy Priorities examining state innovations.
The Affordable Care Act (ACA) called for a modernized approach to consumer access, including electronic data matching, submission of electronic documentation, electronic verification of eligibility information, and the simplification and integration of enrollment and eligibility across a range of health and human services programs. Funding mechanisms under the ACA offer opportunities for states to leverage federal dollars to improve the eligibility and enrollment process for other programs at the same time they build out their Medicaid systems to support these requirements. Social Interest Solutions is dedicated to putting the consumer at the center of the eligibility and enrollment process by leveraging technology and utilizing data-driven design principles to help people connect to the programs and services they need.
PROOF OF CONCEPT
Improving User Experience
SIS has undertaken a research and design project focused on transforming the online user experience of calculating household income, a crucial step in determining eligibility for means-tested programs. Current online tools for collecting household income details can be confusing and cumbersome for consumers, leading to coverage delays, eligibility errors, and miscalculation of benefits. Research findings from this project identified best practices and examined lessons learned from a range of enrollment sites and design approaches. These findings will be used to inform the development of a comprehensive web-based resource that educates stakeholders about the importance of the consumer user experience and provides free resources to guide integration of good user experience principles into health and human services online tools.
Social Interest Solutions achieves its policy objectives through research and evaluation, technical assistance, and thought leadership.
Research & Evaluation
Social Interest Solutions conducts research and produces white papers and reports on policy issues related to health reform, horizontal integration, and modernizing access. We work in partnership with program administrators, community-based organizations, advocates, policymakers and other stakeholders to analyze proposed policies, evaluate program and system implementations, and share best practices and challenges from our work implementing systems at the local and state levels.
Facilitating CalFresh Eligibility and Enrollment for SSI Recipients
California is the only state in the nation where SSI recipients are not eligible for the SNAP nutrition program. A new report from the Coalition of California Welfare Rights Organizations, the County Welfare Directors Association of California, and Social Interest Solutions outlines options to streamline SNAP enrollment for SSI recipients if California decides to change this policy. See the report, Facilitating CalFresh Eligibility and Enrollment for SSI Recipients.
Social Interest Solutions brings to the table significant health and human services policy and program expertise and an in-depth understanding of technology solutions development and implementation. SIS supports our partners through requirements analysis, application and systems design and implementation, business process reengineering, consumer feedback, evaluation, and project management. We work in partnership with other stakeholders to maximize the effectiveness and efficiency of technology solutions to promote access to quality health and human services.
SIS played an important role in conceptualizing the systems development and enrollment IT standards that were part of the Affordable Care Act. SIS worked with staff from the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee to craft language on these standards that eventually became Section 1561 of the Affordable Care Act. SIS directors were subsequently recruited to work with the Office of the National Coordinator for Health IT and the Enrollment HIT Workgroup to support standards development and implementation. SIS supported teams created to address Business Rules, Verification Interfaces, Privacy and Security, and Data. The final enrollment standards were adopted on September 17, 2010, and SIS continues to monitor their implementation.
Social Interest Solutions is a thought leader in the use of technology to streamline and improve the eligibility and enrollment process for public health and human services programs. Informed by our work on the ground implementing eligibility and enrollment systems at the state and local levels, SIS brings unique knowledge about what works and what challenges persist. We partner with innovative and cutting-edge technology and design partners with the ultimate goal of creating a more modern and consumer-centered approach to enrolling low-income individuals and families into needed programs and services.
PROOF OF CONCEPT
Improving User Experience
SIS has undertaken a user experience research and design project focused on transforming the online process for household income calculation. Current tools for programs that collect household income details and conduct complex calculations are incomplete and cumbersome, causing consumer confusion, coverage delays, eligibility errors, and miscalculation of benefits. Research findings from this project identified best practices and examined lessons learned from a range of enrollment sites and design approaches. These findings are being used to inform the development of a prototype for a new approach to collecting income and household data. When ready, design elements from this approach will be shared with stakeholders with the goal of supporting consumer-centric application solutions.