Integrated Eligibility

Enhanced funding rules create
an opportunity to expand
coordinated eligibility
across programs.”

Dawn Boland, Principal, Healthcare and Human Services Practice
Dawn Boland

Integrated Eligibility

Developing eligibility solutions that cross organizational boundaries and technology infrastructures is challenging. CSG helps you craft effective strategies and coordinated plans for your integrated eligibility initiatives. We also provide comprehensive project assurance services to so that your plans are successfully implemented.

CSG'S Expertise in Action

 
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Protecting Health Information for Coloradoans

 
Denver
Denver

The Colorado Department of Healthcare Policy and Financing is dedicated to improving healthcare access and outcomes for Coloradoans. In order to protect the privacy of the people it serves, the State engaged CSG to perform an independent security and privacy controls assessment and evaluation of its Health Insurance Marketplace and Integrated Eligibility System’s shared connection to the Federal Data Services Hub.

MARS-E v2.0 Security Assessment by CSG

CSG applied CMS’ Minimum Acceptable Risk Standards for Exchanges v2.0 (MARS-E 2.0) and tested each of the more than 350 security and privacy controls. CSG produced a Security Assessment Report with findings and recommendations, which was incorporated into the State’s Plan of Action and Milestone document. CSG also provided an Annual Security and Privacy Attestation for ACA Systems for submission to CMS.

Colorado is committed to protecting the privacy of its residents. CSG’s privacy and security assessment assures Colorado is protecting the confidentiality, integrity and availability of Personally Identifiable Information (PII), Protected Health Information, (PHI) and Federal Tax Information (FTI).

Modernizing Missouri's Eligibility System

 
Jefferson City
Jefferson City

The Missouri Department of Social Services (DSS) has launched an initiative to modernize its Integrated Eligibility System. When fully implemented, the new customer-centric system, will process applications in real-time and provide the flexibility and core functionality the State needs to leverage the system across all of its eligibility programs and services.

PMO by CSG SM

DSS selected CSG to provide a full-service Project Management Office (PMO) to oversee the system modernization. CSG develops in-depth project management plans which document the processes and procedures of each business area to help the State establish a comprehensive vision and ensure its objectives are met. We provide critical oversight and management of the solutions vendor and project team, identify and track project risks and issues, develop risk mitigation strategies, and facilitate organizational change, including training on the Agile methodology. CSG is also supporting the State in maintaining effective communication and project transparency with CMS throughout the engagement including submission of Advance Planning Document Updates to maintain compliance with CMS and obtain enhanced federal funding.

DSS is committed to improving its healthcare and social services programs to provide more efficient services for Missouri citizens. CSG is here to assure the State meets its goals.

Ensuring Quality Projects:
Rhode Island Relies on CSG

 
Providence
Providence

Rhode Island’s Unified Health Infrastructure Project (UHIP) is a multi-phased effort, developing an integrated technology platform across healthcare and human services programs. UHIP is a collaboration of five Rhode Island government agencies with a vision for a single technology solution that simplifies enrollment for individuals and families eligible for Medicaid/CHIP, SNAP, TANF, and commercial-based healthcare plans. The integrated eligibility system, including a Modified Adjusted Gross Income (MAGI) rules engine, supports eligibility and enrollment functions for all insurance affordability and public assistance programs.

IV&V by CSG SM

Rhode Island selected CSG to provide comprehensive Independent Verification and Validation (IV&V) services for the design, implementation, and operation of the UHIP technology platform. The CSG team conducts proactive project health and risk assessments encompassing the full system development life cycle. Our assessments identify project risks and opportunities to implement best practices. We develop risk mitigation strategies, alternative approaches, and recommendations for improving project performance.

CSG is also leading the State’s user acceptance testing to validate that the system complies with federally-mandated requirements. In addition, we provide independent security assessments and system audits.

Rhode Island is pursuing a vision to improve access to healthcare and human services programs. CSG is there to help the State achieve that goal.

Managing Integrated Eligibility Projects:
Illinois Relies on CSG

 
Springfield
Springfield

As the Illinois Department of Healthcare and Family Services (HFS) mobilized to meet ACA requirements, it launched a major initiative to implement a new Integrated Eligibility System (IES). The IES links to the State’s health insurance marketplace and supports eligibility and enrollment for multiple HHS programs including SNAP and TANF.

CSG and HFS: An Integrated Team

HFS selected CSG to establish a Project Management Office (PMO) and provide other essential services including early technical assessment and strategy for the IES, JAD session facilitation, development of the DDI and Independent Verification and Validation (IV&V) RFPs, and additional procurement support.

Our oversight and management of the implementation contractors and project team assures that all aspects of the project – including requirements management, adherence to the schedule and budget, project governance, technical architectures, testing, and organizational changes – are effectively achieved.

Illinois is pursuing a vision of integrated service delivery that improves the lives of its people. CSG is here to help.

The Iowa Eligibility System

 
Des Moines
Des Moines

The Iowa Department of Human Services provides public assistance benefits to more than 450,000 Iowans. The current eligibility system has been in place since 1984, making upgrades and enhancements costly and time-consuming. Like other states, Iowa must address new ACA mandates, evolving eligibility determination rules, health insurance marketplace, and interfacing with a new MMIS. In order to support these interconnected challenges, the Department has chosen to procure a new eligibility system and deploy it using an agile development approach.

Organizational Change by CSG

The new integrated eligibility system affects the work processes of hundreds of employees. The Department recognizes the importance of preparing the staff for the coming changes, and selected CSG to help them complete a change assessment, develop a customized change management plan, and move forward with the plan’s implementation. More than 300 key staff have been trained in the principles of organizational change and empowered to become change sponsors as the new system is deployed.

DHS is committed to providing improved access to healthcare and human services programs for Iowans. CSG is there to help achieve this goal.