State Innovations in Horizontal Integration: Leveraging Technology for Health and Human Services


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 means-tested programs that they administer, such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF). Such integrated eligibility systems and processes are cost-effective for states because they avoid duplication of effort. They also promote low-income individuals’ access to the full package of benefits for which they qualify, helping them meet their needs for nutritious food, medical care, affordable child care, and other basic living expenses.

The Affordable Care Act (ACA) required states to make large-scale changes to their eligibility systems for Medicaid in order to create streamlined processing with the health plan coverage and subsidies that are available through health insurance marketplaces (also known as exchanges). To support these changes, the U.S. Department of Health and Human Services (HHS) made enhanced federal Medicaid matching funds available for states to update or build their systems. In recognition of the efficiencies of integrating these systems with non-health programs, states have also been given the opportunity of a cost allocation waiver that allows them to temporarily use this enhanced funding to support technology and services improvements to eligibility systems shared by Medicaid and other health and human services programs.

This issue brief highlights examples of technology and services innovations that states are implementing in support of integration among health and human services programs and discusses common themes across efforts. These examples, which are not exhaustive, are culled from interviews with federal experts and state officials from Alabama, California, Colorado, Idaho, Illinois, Kentucky, New Mexico, Oklahoma, Pennsylvania, Vermont, and Virginia.

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