Integrated eligibility: From concept to reality

What does integrated eligibility mean to health and human services (HHS) organizations, system integrators (SI), and Centers for Medicare and Medicaid Services (CMS)?

It is safe to assume that the response will have some commonality but will also have many variations based on who is responding.

Let us consider the key aspects of integrated eligibility - vision, funding, timeline, operations, collaboration, and systems integration. Each state is at a different level of maturity when it comes to its integrated eligibility implementation. Some states have defined their vision and have gone a long way towards achieving their goals. Some have had limited success. And there are some who have had no success and are re-thinking their strategy.

An ideal end-to-end integrated eligibility system comprises of several components of varying magnitude and complexity, starting from federal expectations to local platform. States that are still in the process of formulating their integrated eligibility strategy do not need to re-invent the wheel. Careful orchestration of the elements including regulatory requirements, implementation approach, use of tools and the lessons learned from implementations by other states, whether successful or otherwise, can help them build a powerful integrated eligibility system and turn the concept into reality.