Transforming Eligibility
One of the first OHT initiatives would be Ohio's new eligibility system. This integrated system would ensure that a case did not "exist" in any one place. "It’s a case," Plouck said, "It doesn’t matter who you are, where you live and where you started it." The system would be an expensive venture, but virtually everyone, including the Governor, believed it would result in far superior service for end-users.
A key feature of the new system would be a self-service portal. The older system had gradually turned case managers into paper pushers, Plouck said. The self-service portal would expedite simpler cases and free up valuable time, allowing frontline workers to focus their efforts on cases that were more complicated.
As mentioned previously, an elite group of county workers participated in writing the RFP and evaluating proposals from private vendors. As soon as the selected proposal was finalized, system design commenced, and the project team put in 24-hour days developing code, testing it, identifying bugs, and so on.
Seven months after the design process started, the eligibility system launched. Plouck noted that he had spent many years working in the private-sector, managing various, large-scale initiatives, including many IT projects. "I've see some of the best there is," he told Summit participants, "but I don't think I've ever seen anything like this."
For its initial launch, the system focused on a few core services, such as Medicaid, SNAP and TANF, allowing OHT to incorporate additional services piece by piece. One of the first was Medicaid expansion. Despite strong political resistance to expansion, Plouck said, Governor Kasich had managed to garner support from his own party. Two months after gaining legislative authority, Ohio finished incorporating Medicaid expansion into the eligibility system. The state now processes 1.5 million applications, 60% of which are initiated by citizens using the self-service portal. Plouck said their next objectives for the system include the addition of WIC and child care, and planning is underway.
To implement this system at the county level, Ohio began applying the shared-services model they had successfully piloted. The state now possessed an invaluable infrastructure they could offer to counties, a toolkit that includes document management, telecommunication capabilities, and of course the new eligibility system. Counties that wished to implement this infrastructure would be responsible for strategically organizing themselves into clusters that could operate effectively as a single agency. "We're not going to tell you how to do it," Plouck said, "because Ohio has three major cities, some metropolitan areas, a bunch of rural areas, and obviously what works in one area won't work in another."
Plouck said they now have a group of 23 counties that are planning to operate as one using the new system. The group will begin by launching a pilot implementation that includes 9 counties, eventually building out to the full 23. There are also 7 counties in Appalachia who wish to adopt the system.
Outcomes for Ohio
The integrated eligibility system and expansion of county shared services represent only a small portion of Ohio's transformation plan. But the combination of these two initiatives alone has already produced several favorable outcomes. As mentioned previously, Ohio now processes 1.5 million Medicaid applications, and 60% of those come through the self-service portal. Additionally, the state has integrated Medicaid and Medicare benefits, and lowered the growth curve of Medicaid without drastic service reduction. Ohio also qualifies for enhanced federal funding, the result of moving enough clients from institutional to community care to achieve a 50/50 spending ratio, a target they achieved one year before the federal deadline.
The ultimate goal, however, remains moving families toward self-sufficiency. Over the next few years, as the OHT transformation plan continues unfolding, Ohio will build the capacity to track economic and health outcomes.
The early signs are certainly encouraging. Plouck described one particularly uplifting success involving veteran services. "We were trying to get veterans out of nursing homes and into VA care," he said. "Better care, better services, and cheaper for the state." So OHT began incorporating veteran services into the eligibility system, including the addition of five simple questions to the self-service portal for citizens who identified as veterans.
Once the system launched, it soon became clear that many eligible veterans didn’t even know they qualified for care. "So we turned this system on," Plouck said. "Within 20 minutes we found our first veteran. And within 10 hours, he had services that he didn’t have before. Pretty amazing, right?" Thanks largely to the Operating Protocol, the entire incorporation process, from concept to launch, took less than two months.
The new eligibility system now identifies 500 veterans a month, 74% of whom are eligible for services they were not previously receiving. By getting so many veterans out of nursing homes and into VA institutions, Plouck said, Ohio generated millions of dollars in savings annualized for Medicaid. But most importantly: "We can get nearly 4,000 veterans free healthcare."