In any given year, about 950,000 documents related to state benefits pour into a processing center in Waterbury.
But state officials say that paper pile soon will get smaller because they’re finally making progress on a new, streamlined program that will allow one-stop shopping for benefits like food assistance and health insurance.
The state is rolling out pieces of that plan this year, including a new way to upload documents via cellphone. And by summer of 2020, officials hope to have a website where Vermonters can apply for and manage all of their benefits – a portal that will replace the current version of Vermont Health Connect.
While that schedule is not set in stone, officials acknowledge that Vermont has to move forward due to pressure from federal regulators who aren’t happy about the state’s cumbersome public-benefit systems.
“It can’t be about promises anymore,” said Cassandra Madison, a deputy commissioner at the Department of Vermont Health Access. “It has to be about actual progress.”
The state has been working for years to revamp its benefit programs, which rely in large part on an outdated system called ACCESS that a report last year labeled “obsolete, unsustainable, difficult (if not impossible) to configure to meet federal requirements.”
In a presentation to legislative committees during the first full week of the 2019 session, Madison detailed a host of problems with applying for and maintaining programs including Reach Up, 3SquaresVT, fuel assistance, Medicaid and qualified health plans.
Over 200,000 Vermonters apply for those programs every year, but “they often have to give us the some information multiple times,” she said. “They have to call different call centers, and there’s little to no coordination across those programs.”
Residents face lengthy approval processes, Madison said. And when they need to provide documents, “oftentimes, Vermonters don’t really understand what they’re supposed to submit to us and when, and they can’t do it in an easy or straightforward way.”
The process isn’t much easier on the administrative side. “Our processes are very manual-labor intensive,” Madison said. “Staff have to spend a lot of time memorizing complex system rules and memorizing program rules, which means that the soft skills around customer service have to take a back seat sometimes.”
Because federal funding plays a big role in state benefit programs, federal officials have taken note of Vermont’s deficiencies and have demanded changes. For example, the state is negotiating an improvement plan for Medicaid’s “aged, blind and disabled” benefit.
“There is a risk, if we don’t deliver on that negotiated timeline, that we could face financial penalties,” Madison said.
She told lawmakers that she is “concerned” about those federal-funding pressures. But Madison also laid out reasons for optimism for what’s been labeled the state’s “integrated eligibility” project.
The plan, she said, is not for a single piece of technology that’s going to solve the state’s benefit issues. Rather, Madison said it’s about “a unified customer experience.”
“We want to make sure that Vermonters have a simple and easy way to apply for, access and maintain their health coverage and financial benefits,” Madison said. “We also want to make sure that the state of Vermont can deliver these benefits efficiently and effectively.”
In a state with spotty internet access, officials aren’t focusing all of their efforts on online benefit applications.
“You should only have one application to fill out, and that application should be simple and easy to use,” Madison said. “You should also be able to do that in the way that works best for you. You should be able to do that online, in person, over the phone or on paper.”
In order to make progress toward that goal, officials say they’re tackling the integrated eligibility project in smaller chunks rather than as a whole. That approach is more manageable financially, and officials say it offers a better chance for success.
The problem-plagued rollout of Vermont Health Connect now serves as a warning about trying to do too much, too quickly. “There are a lot of lessons that we learned in there about how not to do (information technology) projects,” Madison said.
There have been some positive steps toward integrated eligibility in recent years, officials say. That includes the stabilization of Vermont Health Connect; meeting federal requirements for income-eligible Medicaid; and implementing a new asset-verification program for those applying for benefits.
The asset-verification program got off to a rocky start last year, in part due to issues with financial institutions, said Thani Boskailo of the Department of Vermont Health Access. But she told lawmakers that the program now is running more smoothly.
“We’re a year in, and the changes have been tremendous,” Boskailo said.
Additional progress is expected this year, including a new, consolidated paper application for all health benefits. That’s not a technology project, but Madison said it’s an important step toward state benefits becoming more user-friendly.
Also, the state later this year will introduce a self-service document uploader designed to make it easier to send in documentation for benefits. The uploader is supposed to shrink that mountain of paper in Waterbury.
Madison acknowledged that not everyone will want to upload their pay stubs and other documents.
“That’s why it’s really important that we still have in-person and mail available to people,” she said. “But even if you could get rid of 25 or 50 percent of those documents, that’s a huge win.”
The expected arrival of a single online-application portal in August 2020 will be a much bigger sign of progress. But Madison said there’s a lot of work to do before that, and she said schedule changes are possible.
The integrated eligibility project already has been delayed by years. There are many reasons for those delays, including the Vermont Health Connect mess.
But in general, Madison – who took the lead on the eligibility project a little over a year ago – said she believes the delays are because “technology is advancing more rapidly than our institutions.”
“We are trying to play catch-up,” she said in an interview. “As customer expectations are changing, and the federal landscape is changing, and the technology market is changing, we are trying to adapt to it. And government is not traditionally the most nimble.”
Madison said state officials are trying to become more nimble, and also more efficient.
A total price tag for the integrated eligibility project wasn’t available last week, but it’s at least in the tens of millions of dollars. Much of that is federal money, and Madison said the Centers for Medicare and Medicaid Services has approved two more years of funding for the project.
Madison said she could not disclose how much additional state money is needed next fiscal year until Gov. Phil Scott delivers his budget address on Thursday.
Currently, the integrated eligibility project is projecting combined state and federal spending of about $13 million a year. That’s less than it used to be, and it could go lower, Madison said.
“I think we’ve done a lot of work to try to tighten up our budget and get leaner,” she said.
