Tablets have become a key component of operational reform at the federal level, enabling increased productivity for field workers, reduced facilities costs and greater flexibility in service delivery, among other benefits. However, there is even more untapped potential when it comes to adopting tablets in the federal space. Tablets are highly functional and versatile devices by themselves, but outfitting a tablet with an appropriate peripheral device, like a keyboard, can improve its performance significantly. This Center for Digital Government issue brief describes how peripheral keyboards can bring added functionality to tablet operations at minimal extra cost, helping federal government users operate more efficiently and productively than ever before.
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The federal data hub intended to connect state health exchanges with federal agencies appears to be the most significant hurdle for a timely launch of the insurance marketplaces, according to a new Government Accountability Office (GAO) report.
Seven surveyed states identified the hub as “the major operational challenge” that they face, according to the GAO. Whether that challenge is resolved could determine whether the exchanges are ready to open on Oct. 1, 2013, the date set for their launch by the Affordable Care Act.
“States said, by and large: We’re doing the best we can. We’ve been doing this a while. We think we’re going to be ready, but it’s anybody’s guess because it’s so evolving, especially with the data services hub,” says Stan Czerwinski, who headed the group that authored the GAO report. “State systems have to connect with federal systems, which are still being developed. The challenge is hooking into these systems without knowing what they will look like.”
The data hub — in laymen’s terms, a huge digital warehouse capable of sending information to other online servers — plays a crucial role in the exchanges, which are websites that will allow the uninsured to shop for health coverage and access federal tax subsidies to help them purchase it. The tax subsidies, for example, are supposed to be based on a person’s income; the lower your income, the higher your subsidy.
The exchange is supposed to transmit the income information entered by an applicant to the hub, which will then verify the information with the Internal Revenue Service. That verification is then transmitted back to the exchange, so the person can access their subsidy. The hub will also relay information between the exchanges and other federal agencies, such as the U.S. Citizenship and Immigration Service and the U.S. Department of Homeland Security.
It sounds simple, but it’s a significant headache for the 17 states that, so far, are building their own exchanges. For starters, the hub hasn’t been completely built yet, nor have the rules that will govern its use been finalized. Because tax information will be exchanged through the hub, there is a laundry list of privacy and security standards that must be met. In addition, the IRS is accustomed to receiving and then processing this kind of information over long periods of time, up to a month, while the exchange is supposed to provide verification in almost real-time. Nobody is sure if and how the hub will be equipped to handle that workload.
All the while, states are already building the technical infrastructure for their exchanges, which includes a website and an eligibility system, without knowing exactly how their exchange is supposed to connect with the hub. It’s a major problem with four months left until the exchanges are supposed to be operational, and Czerwinski believes “this is going to go way up until the very last day.”
One state was so pessimistic that officials told the GAO they expected to be still modifying their exchange’s IT infrastructure to connect with the hub into 2014. For its part, the Obama administration told the GAO that it had provided states with information on how to connect with the hub through webinars and conferences, though that apparently has not assuaged states’ concerns.
“Until they’re able to do this testing to make sure that all these points connect, it’s still unknown,” Czerwinski says. “I think they agree that it’s the biggest challenge area and will need adjusting from day one.”
Caroline Pearson, who tracks state ACA implementation at Avalere Health, a consulting firm, said the GAO report underlines an overarching problem with health exchange IT development: it’s hard to know how states are doing. Some steps, such as accepting applications for health plans to be sold on the exchanges, are public, but the GAO’s findings are one of the few public disclosures of progress on the IT side.
“This does feel like an area where there could be pitfalls in rollout. There are a million ways it could go poorly,” Pearson says. “We have touch points and checkpoints on so many other things. All of that is a little more public, but it is really hard for me to assess whether a state’s exchange is going to crash on Oct. 1.”
Officials at the U.S. Department of Health and Human Services did not immediately respond to requests for comment. GAO interviewed officials from the District of Columbia, Iowa, Minnesota, Nevada, New York, Oregon and Rhode Island for the report.
This story was originally published by GOVERNING magazine.
Photo from Shutterstock.
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One man’s effort in Washington state to help veterans find federal benefits has grown into independent efforts by dozens of states. Repurposing an existing reporting tool, states are not only connecting veterans to better benefits, but also saving millions in Medicaid costs.
Washington state’s Public Assistance Reporting Information System (PARIS) allowed them to identify war veterans who were enrolled in Medicaid but not taking advantage of federal veterans’ benefits. The state then notified them of the benefits to which they were entitled, and moved them off of state Medicaid and onto federal program.
Since 2004, Washington state has saved more than $30 million using this system, while helping veterans get access to more comprehensive care.
History of PARIS
PARIS, a 20-year-old system operated by the U.S. Department of Health and Human Services’ Administration for Children and Families, was originally intended to help states identify Medicaid recipients who were cheating the system by applying for benefits in multiple states.
In 2002, Bill Allman, then an employee of the Washington Department of Social and Health Services, began looking for a way to see if the veterans he was helping were eligible for federal veterans’ benefits.
The information he was looking for was in PARIS. Using the system in a way no one had thought to try before, Allman, now the president of PARIS, realized savings for his state and greater benefits for the veterans he was helping. Allman launched the Veterans Benefit Enhancement Project, now a core component of PARIS. He now advises more than 30 states looking to realize the same savings he found for the state of Washington.
“Medicaid dollars, particularly long-term medicaid dollars, are going up at the rate of 200 to 250 percent,” Allman said. “By 2015, it will go up by 300 percent.”
As Medicaid costs rise and an increasing number of veterans are unable to pay back their long-term care Medicaid loans, the state is often forced to put liens on veterans’ homes. There’s no reason for veterans to be put in a position like that, Allman said, especially when they may not need to be on Medicaid in the first place. “When we tell them about the benefits they’re entitled to, they always say the same thing,” Allman said. “They say, ‘Why did no one tell me about this before?'”
Following the PARIS mandate
All states are now required to participate in PARIS, per a 2010 mandate from the Centers for Medicare and Medicaid Services. Naturally, states want to get the most out of the system they are required to use, by following Allman’s lead. “I want every state to do this,” Allman said. With the Affordable Care Act, Allman pointed out, states will need to offer health care options to all citizens anyway, so it would be in the states’ best interest to shift some of the support to the federal level.
Officials in more than 30 states are now in various stages of implementing the Veterans Benefit Enhancement Project.
California ran a pilot program from 2009 to 2011. Limited to a handful of counties, the pilot focused on veterans classified as 100 percent disabled, saving the state $1.6 million. A report on the pilot deemed the program cost-efficient and suggested that it be expanded.
One of the biggest challenges in California was dealing with large sets of overlapping data. While more than 16,000 matches were initially identified as potentially eligible to be moved to federal benefits, duplicates and other complications reduced that number to just 4,000. Of those, just 990 veterans were contacted to gather further information on their eligibility. In the end, just 24 veterans were taken off Medi-Cal and moved to federal benefits. The savings to the state were significant, however, and the veterans also benefitted as they could now pay living expenses with VA benefits, which never need to be repaid.
The program continues to be effective in California, but Manuel Urbina of the California Department of Health and Human Services Medi-Cal Eligibility Division said the state needs dedicated personnel in order to expand implementation. “For this to be successful,” Urbina said, “the state experience has been that you need people to do dedicated case management. … The return on investment equation is there. We didn’t invest hardly anything, and we got this large return, so the potential is there.”
Additional outreach needed
What the Veterans Benefit Enhancement Project does is very basic, Allman said. The program is simply identifying veterans who would benefit from federal funding and then educating them. The problem for states is identifying who those veterans are. A report by the U.S. Government Accountability Office (GAO) found that 62 percent of veterans may be eligible for enhanced monthly VA benefits, but only 22 percent of veterans receive those benefits. The GAO recommended that the VA conduct more focused outreach to educate veterans in order to address the disparity.
“It bothers me that states don’t do outreach on their own or that the VA doesn’t do some kind of national campaign to help veterans understand what the benefits are,” Allman said. “So I think it’s up to the states to do the outreach for the VA.” Being a veteran himself, and passionate about helping people, Allman said that the money states can save through this program has always been a secondary consideration to him. He concedes, however, that the potential savings is compelling motivation for states to educate their veterans and consider adopting his system.
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The spread of HIV/AIDS is an epidemic that continues to affect the U.S. and most parts of the world today.
To help fight this disease, the U.S. Department of Health and Human Services unveiled the HIV testing and care services locator Web tool through Aids.gov.
The tool, also available as a free mobile app, more easily finds government data on HIV/Aids prevention.
By entering a ZIP code in the web tool, a Google map is generated to show the locations of services like HIV testing sites, health centers and substance abuse clinics.
The new tool pulls data from multiple federal government agencies including the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the U.S. Department of Housing and Urban Development.