NC DHHSOverview of Work Support Strategies and NC FAST

Sherry BradsherNational Governor’s Association Meeting

September 20, 2012

Slide 1

What is NC FAST

• The NC FAST Program is designed to improve the way NC DHHS and the 100 county departments of social services provide benefits and services to the people of North Carolina.

• NC FAST introduces new technological tools and business processes that will enable staff to reduce time spent on repetitive and cumbersome paperwork, and allow state and county staff to better focus their efforts on the complex issues presented by North Carolina families in need.

Slide 2

9 NC DHHS Program Areas Impacted by NC FAST

Economic Benefits• Child Care

• Food and Nutrition Services

• Medicaid

• Work First

• Energy Assistance- Low Income Energy

Assistance Program (LIEAP)

- Crisis Intervention Program (CIP)

• Special Assistance

• Refugee Assistance

Services• Child Welfare

• Adult and Family Services

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Slide 4

• North Carolina Families Accessing Services Through Technology (NCFAST) is implementing technologies and processes which improve how North Carolina provides benefits and services to its citizens

• NCFAST is rolling-out a new online eligibility system for a dozen income-related programs. This includes an online application, eligibility and enrollment for all Medicaid programs

• The North Carolina Health Benefit Exchange will leverage the NCFAST solution, built on the Cúram Business Application Suite (CBAS) commercial off-the-shelf (COTS) solution

• Additionally, NCFAST will implement the Cúram for Health Care Reform (HCR) module which includes screening, eligibility, and case management functionality and enables integration with a plan shopping vendor (to be selected)

NCFAST Overview

Slide 5

• Case Management

– NC DHHS supervises the North Carolina human service programs administered by the 100 county departments of social services.

– The divisions, sections and offices of NC DHHS reflect state and federally initiated program areas.

– In the early 1980s, North Carolina implemented mainframe systems. Functionality was added to accommodate related programs and program rule changes.

– 19 legacy systems have been identified that are within scope ofNC FAST, and which collect, maintain and process information about applicants and recipients.

– These legacy systems are disparate and not well suited to support the growing demands of economic benefits, child welfare, adult care and aging services, health insurance reform, and related changes in accountability to share and integrate information.

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• Case Management (continued)

– Redundant entry, which includes entering the same client data in multiple systems, is currently necessary because these systems do not adequately share data, resulting in duplicated work, increased risk of errors and increased time for gathering and entering information.

– NC DHHS requires a highly integrated case management system across all services and benefits programs to pull together today’s islands of information into a single-solution system and provide functionality that does not exist today.

– The NC FAST Case Management solution represents the steps toward achieving the objectives that will result in improved operations for NC DHHS social services.

Case Management Integration Projects

1. Global Case Management and Food and Nutrition Services

2. P2&6 Eligibility Information System (EIS)• Part 1: Screening and Intake for Work First (TANF), Medicaid,

Special Assistance, and Refugee Assistance• Part 2: Eligibility for Work First (TANF), Medicaid, Special

Assistance and Refugee Assistance

3. Low Income Energy Assistance Program (LIEAP), Child Care, and Crisis Intervention Program (CIP)

4. Child Services and Aging and Adult Services

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PROGRAMSSNAP/FNSMedicaidChild CareWork FirstEnergy AssistanceSpecial AssistanceRefugee Assistance

REQUIREMENT AREASIncome and Asset RequirementsRequired Verification DocumentsCountable/Non-countable IncomeCountable/Non-countable ResourcesReporting and RecertificationMethodology and Base Periods for Calculating Income

DHHS Streamlining Effort to Align EligibilityCriteria across Multiple Programs

Integrated Health & HSHCE

HCE

Slide 8

NCFAST / Health Benefit Exchange – Context Diagram

Slide 9

ProvidersCounty Workers Citizens Employers Insurance

Carriers

State and County Systems

Brokers

Federal Data Hub

Enterprise Service Bus

County CM Systems

DMV

ESCQuarterly Wage

New Hire ACTS

Health Benefit Exchange

North Carolina Work Support Strategies (WSS)

Action Plan OverviewSummer 2012

Slide 10

Work Support Strategies Grant

• At the conclusion the planning year, NC developed an Action Plan for achieving a more effective and efficient service delivery model (February, 2012).

• North Carolina became one of six states to receive funding for Implementation (04/12-03/15).

• North Carolina was one of nine states to participate in the WSS Planning Year, during which a state-county project team reviewed, analyzed, and reflected on data, national best practices, and current operations (March, 2011-February, 2012).

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Tenets of WSS Initiative1. Families will tell their story once and receive the services they need.2. There will be no wrong door to accessing benefits. Clients will have a

choice in when, where, and how they receive benefits.3. Community partners will provide new avenues for accessing services.4. The state and counties will work together to make operational

improvements, maximize the use of technology, and make the service delivery system as efficient as possible.

5. Customer service, efficiency, and data will drive the development of service delivery models and the development of staffing roles.

6. Counties will retain flexibility in how they implement, but outcomes, performance, and a positive customer experience will provide the ultimate measure of success.

7. Accessing benefits will not be a hindrance to working families. Service delivery will be designed in a way that supports working families and their ability to maintain employment.

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Planning Year Activities

Slide 13

Activity Finding

County Operations

Review

• Programs collect much of the same eligibility information• Administrative churning occurs frequently • Communication across program areas is oftentimes limited

Data Analysis

• Enrollment has increased significantly in recent years• Application processing time varies greatly from county to county• Nearly half of recipients receive more than one benefit• Many cases denied for procedural reasons• More capacity is needed to collect and analyze data

Policy Review

• Opportunities were identified to streamline policies across programs

• Policy requirements tend to vary by program, resulting in a confusing application/recertification processes for clients and staff

• There is no body dedicated to focusing on joint policy development

Planning Year Activities

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Activity Finding

Client Surveys

• Many clients coming into a DSS office already receive one program, and are applying for another

• Clients would most like to see shorter wait times, the ability to apply for multiple benefits simultaneously, and receive benefits sooner

County Promising Practices

• A review of promising new practices in counties led to streamlined services, staff-time savings, and improved client experience

• Examples included express application Center (Wilson), task management model (McDowell), integrated caseloads (Brunswick), case banking (Mecklenburg), intake teams (Sampson), and electronic document management (Robeson)

Implementation

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Anticipated Results

Slide 16

Reduction in administrative

churn

Increased operational efficiency

Improved quality assurance

Increased value of DSS-Client

interaction

Increased human capital among

clients, staff, and communities

Help families move beyond

crisis mode and get back on track

Maximize client self-sufficiency

Measures

Slide 17

The Action Plan includes several quantitative targets. Examples:

• In the first year, case processing times will be reduced by 75%.• Within three years, 75% of programs that support working families,

including Medicaid, FNS and child care cases will be processed in one day.

• Within three years, the percentage of denials for procedural reasons in FNS and Medicaid will be reduced by 75%.

• 100% of staff will have their own professional development plan that is addressed and updated on a regular basis.

The Action Plan includes several quantitative targets. Examples:

• In the first year, case processing times will be reduced by 75%.• Within three years, 75% of programs that support working families,

including Medicaid, FNS and child care cases will be processed in one day.

• Within three years, the percentage of denials for procedural reasons in FNS and Medicaid will be reduced by 75%.

• 100% of staff will have their own professional development plan that is addressed and updated on a regular basis.

The Action Plan also includes two major long-term goals:

• Help families move beyond crisis mode and get back on track.• Maximize client self-sufficiency.

The Action Plan also includes two major long-term goals:

• Help families move beyond crisis mode and get back on track.• Maximize client self-sufficiency.

WSS Structure

Slide 18