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Integrating Eligibility and Enrollment for Health and Human Services

By Domenic Fichera

Nava partnered with the State of Vermont to help integrate the enrollment and eligibility processes for all of its health care and financial benefit programs, such as Medicaid for the Aged, Blind, and Disabled and Supplemental Nutrition Assistance Program (SNAP).

Our shared long-term goal is for Vermonters to understand, access, and maintain their benefits more easily, in one place. In the near-term, we identified and addressed the biggest barrier to success: the time-consuming process of submitting and processing paper documentation.

Approach

Nava deployed a team to Vermont to map out current service processes and identify the most common barriers for Vermonters applying for or renewing benefits. We addressed them with modular, reusable, and flexible software and design that could be quickly integrated to serve people now—and later be easily adapted to handle policy changes and evolving user needs.

The first version launched as a pilot, serving 50 Vermonters per month, and rapidly scaled up to serve thousands per month. While rolling out the new features, we also created a process to ensure that State staff could easily integrate them into their programs’ operations, according to their timelines and priorities.

Outcomes

Within four weeks of beginning development, Nava deployed a simple, secure web application with an uploader tool. It allowed Vermonters to submit their eligibility documents more quickly and easily—electronically, using the devices they have—instead of by mail or traveling in person. As a result:

  • 55 percent of users were able to submit documents within one day of the State requesting them, compared to just 11 percent before, and

  • 42 percent had their documents processed the same day they uploaded them.

Vermont Document Uploader Tool-b87ce7.gif

The Uploader provides a dynamic experience to users, prompting them to provide different information and upload different types of documents depending on which benefits programs they’re applying for.

Our focus working with Nava has been to build up our own user-centered design capacity, our [agile] process, and successful adoption of these technologies. That’s radically different from the way we were thinking about this one to two years ago. — Cassandra Madison, former Deputy Commissioner Department of Vermont Health Access

Over the next eleven months, we modified and integrated the web application and uploader tool to support 37 health care and financial benefit programs, across five different departments.

Process

Building seamless access to benefits for all in need

Vermont’s Agency of Human Services (AHS) currently administers up to 37 health care and financial benefit programs—that provide things like free or low-cost health care—for tens of thousands of Vermonters. People living on low incomes, as well as the elderly, people with disabilities, and people who are pregnant and/or caring for young children are eligible for benefits.

The State is committed to providing top-notch customer service and improving the Vermonter experience wherever possible. In order to do that, AHS employs a dedicated staff of 250—all experts in health care and benefits policy—to help Vermonters navigate enrolling in and maintaining enrollment in benefit programs.

While Vermont’s system is extensive, the State was aware of opportunities to better support Vermonters. For example, there’s no single place for people to find, apply for, access, and maintain the benefits they’re eligible for. Health care and financial benefit programs require submitting the same information in multiple places. When the State did research, one Vermont resident said that managing their benefits was “extremely time-consuming and frustrating.”

Solving big problems with small, flexible tools

Our approach to addressing large-scale problems like these is to build and release small, modular software components that are loosely coupled by well-defined APIs. This enables us to quickly and consistently deliver services that help people now, while also building a foundation that supports long-term technical sustainability and flexibility.

In the near future, Vermont will be able to replace inflexible and inefficient legacy systems—safely and with minimal impact to services—moving the State closer to the long-term vision of integrating the eligibility and enrollment processes for all health care and financial benefit programs.

Much further down the road, when the time inevitably comes to modernize the software we build today, Vermont can update one simple component at a time, instead of engaging in the time-consuming and costly rip-and-replace of an entire enterprise system.

For now, the uploader is a reliable and robust official channel for Vermonters to provide supporting documentation when applying to any of the 37 programs. Thousands of Vermonters have used it. And, 98 percent said they would use the uploader again. One reported that it’s the “easiest and clearest website I’ve used in some time.” Another said, “The document uploader is a nice step forward and saves me a lot of time and money.” The immediate improvements are clear. But they’re also just the tip of the iceberg.

Repeating success with reusable components

We built the uploader to solve a common problem across many benefits programs: time wasted while submitting documents by mail or in person. To build it, we used components or patterns that can be reused for other applications: front-end design and components that can be adapted for a range of business needs; back-end code for securely formatting and storing submitted documents; and an automated uploader that reliably makes documents accessible to State staff.

So, while the uploader was quickly adopted to meet Vermonters’ current needs, the State can continue to reuse and expand upon it to cover more benefits programs and quickly adapt as policies change.

Alongside the design and development of the tool, we also created a process that helped State staff integrate the uploader into their programs’ operations. This ensured that the uploader not only improved the Vermonter experience, but also helped staff work more efficiently.

After the success of the uploader, we used the same strategy to start building Vermont’s first integrated online benefits application. This project serves a specific program, Medicaid for the Aged, Blind, or Disabled. But, like the uploader, it comprises components that can be reused and expanded upon to address a common problem: because benefits applications are long, complex forms that require conditional logic and different collection patterns they’re often confusing and require entering the same information in multiple places. This initial version of the online application will eventually expand to serve all health care and financial benefit programs, ensuring a consistent and easy experience for all benefits applicants. And we’re again working closely with State staffers on training processes and materials that enable adoption of the new service without interrupting current service delivery.

Our strategy with these projects has helped Vermont more quickly respond to Vermonters’ needs in the near term and will continue to do so efficiently and cost-effectively—even as policies and needs change—in the future. We’re looking forward to seeing this work continuously make it easier for people to get support and assistance from the government, quickly and efficiently. We’re grateful to our partners for helping us bridge best-in-class design, technical, product, and policy expertise to better serve Vermonters in times of need.

Work with us

The uploader tool can be adapted and reused—not only for other programs across the State of Vermont—but for any benefit program. Special thanks to the State of Vermont for supporting broader use.

If an uploader tool could help your team integrate eligibility and enrollment for your programs, we’d love to work with you to rapidly deploy it. We can also help address your integration holistically.

Get in touch.

Integrated Benefits Initiative: Creating a More Human-Centered Safety Net

This case study is part of an ongoing series presenting lessons from the Integrated Benefits Initiative, which uses human-centered design and modern technology to improve access to SNAP, Medicaid, and other safety net programs. Through small-scale pilots around the country, Code for America, Nava Public Benefit Corporation, and the Center on Budget and Policy Priorities are partnering to bring best-in-class design, technical, product, and policy expertise to show how states can build human-centered services fit for the digital age.