Recent news has shined a spotlight once again on the state’s poor record with large-scale IT projects, with the Administrative Office of the Court’s endeavor being the latest headline. However, California has at least one significant IT accomplishment, one that points to valuable lessons as the state gets ready to ensure health care coverage for millions of people under the federal Affordable Care Act.
More than 8.6 million Californians currently receive access to Medi-Cal, CalFresh (Food Stamps) and CalWORKs benefits through a large-scale, complex automation system that was thoughtfully designed and executed under a successful partnership between counties and the state. This health and human services enrollment system stands out as an exception to the state’s IT track record, with a statewide scope, and record of success in meeting the needs of local jurisdictions working to ensure Californians receive the assistance they need.
County health and human service agencies and state health care and social services departments worked closely to implement the initial computer system and several more recent modernizations. Recognizing the state’s role in program oversight and the counties’ responsibility for day-to-day management, the state and counties work as partners to set priorities for upgrades to the system and collaborate to ensure the projects came in on-time and on-budget.
This thoughtfully conceived approach was developed on a bipartisan basis by counties, the Wilson Administration and the Legislature. The health and human services enrollment system remains the only successful statewide automation of the three major health and human services programs in the state’s history. In 2010, California’s Chief Information Officer listed the system as a major “automation win” for the state.
In the midst of the great recession of the last several years, with unemployment rates of 10 and even 12 percent, and many people turning to the health and human services system for the first time, counties enrolled more than 1 million new people into Medi-Cal over the last three years. In Sacramento County alone, we’ve enrolled more than 99,000 people in that time.
Significant recent budget cuts faced by counties made this task challenging, but California has been successful in enrolling so many uninsured children and families during this critical time because of the strategic initiatives we’ve undertaken in recent years to ensure the system is modern, client-friendly and cost-effective. These recent projects range from development and expansion of Internet-based application systems to integrated voice response systems to reducing paperwork through document imaging. By taking advantage of modern technology, reducing costs and paperwork, and reducing the number of visits clients must make to an office, clients are receiving the critical assistance and health care they need while having more streamlined interactions with county eligibility workers.
This partnership has set California up to be well-positioned and ahead of the game – and ahead of most other states – to implement the federal Affordable Care Act, including, among other improvements, a new Health Benefit Exchange that will allow Californians to submit one simple application for health care and other programs by January 2014.
California will be closely watched as it becomes one of the first states in the nation to move forward with health care reform and its exchange. A recently released study by the UCLA Center for Health Policy Research estimated nearly 5 million uninsured Californians could gain access to health coverage in 2014.
Fortunately, the successful experience in modernizing health and human services enrollment for Californians in need in all 58 counties – paired with our other business process efforts to enhance customer service – positions the state to build upon this proven system, and do so on a quick timeframe, with minimal risk, and with a comprehensive, integrated customer service focus. This automation model also aligns with the federal government’s vision of people having more control over their own health care and ensuring they have the information needed to make the best decisions, including coordination between health care and human service programs for people who need both.
As we’ve repeatedly and recently seen, automation failures can be hugely costly to the state and California taxpayers. But done right, automation can have winning results for government and taxpayers. Large complex systems are manageable and efficient when state and local jurisdictions work together in their respective roles. California will be well-served to build on the lessons learned as it works to bring the promises of federal health care coverage to people by 2014.