Program Integration into an Existing State Medicaid Eligibility Solution

Many states are challenged by the task of adding programs to their existing healthcare eligibility systems. We understand the difficulty because we’ve tackled this opportunity head-on when adding to existing eligibility and enrollment solutions for clients.

We have a proven track record of successful integration. Let’s take a look at how we integrated multiple state and federal program eligibility and enrollment systems into Arizona’s Medicaid eligibility and enrollment platform.

Their Challenges
The state of Arizona chose Alluma to build out their modernized, fully federally compliant Medicaid-integrated system, after having used a version of One-e-App, called “Health-e-Arizona,” for years in all their Community Health Center clinics. Then, because of their commitment to best practices, they partnered with Alluma to integrate eligibility determination for SNAP and TANF programs. After establishing this system, our client needed a way to determine if people who are 65 years or older, or are disabled, are eligible for support in paying for ongoing services at a nursing-facility level of care.

Our Solution
In the first phase of the solution, we created an eligibility and enrollment system for Arizona that incorporated eligibility determination for Medicaid and KIDS CARE (Arizona’s CHIP). We know that by combining applications, more people get connected to the support they need. So, we integrated additional eligibility functions.
  • We worked with the state to partially integrate SNAP and TANF, and connect applicants to the Federal Insurance Marketplace. We achieved full integration of eligibility applications within a two-year period.
  • Later, when Arizona decided to expand their long-term-care program, we integrated additional functions including: a pre-admissions screening tool, a financial assessment tool, a medical assessment tool, and integration with portals used by the department of developmental disabilities.  

HEAplus has resulted in over 25% of Arizona customers’ Medicaid enrollment being processed in real time in 2018. As recognized by CMS and Manatt, Phelps & Phillips Law Firm (CMS Learning Collaborative Vendor):
  • HEAplus is one of the most highly integrated, automated eligibility and enrollment system in the nation.
  • CMS rates HEAplus as one of the top 3% systems in meeting MARS-e security standards, ensuring a high level of critical security for all HEAplus users.
  • The most recent integration, the Arizona Long Term Care Solution, was launched on time after the state completed extensive testing. Our solution met the goal of enabling the agency to make timely decision on 80% of applications within two years.