Update on Efforts to Modernize State’s Eligibility Systems

In March, the Texas Health and Human Services Commission (HHSC) announced that it would end its contract with Accenture for call center operations and other services to support eligibility determination for Medicaid, Food Stamps, the Children’s Health Insurance Program (CHIP) and Temporary Assistance to Needy Families (TANF). HHSC has signed short-term contracts to ensure that services continue without disruption, and the agency is gathering information to determine how those services should be provided in the future.

Short-term contracts

HHSC received federal approval for three short-term contracts with Maximus to ensure that all services currently being provided continue without disruption.

• Enrollment broker services: Maximus will perform enrollment broker services to help Medicaid and CHIP clients enroll in managed care plans. The company first provided this service in Texas in 1997.
• Call center operations: Maximus will operate the four new call centers created to expand the ways Texans can apply for services. The call centers have answered almost 7 million calls – including 400,000 calls after 5 p.m. The centers also support a new website that has allowed more than 75,000 Texans to complete an online screening to see if they qualify for state services.
• CHIP application processing: Maximus will provide the system and employees to process CHIP applications. CHIP processing has been handled by a private vendor using a vendor-owned computer system since the program’s inception in 2000. HHSC is working to integrate CHIP into the state’s new computer system to improve the coordination between CHIP and Medicaid. This will also give the state more flexibility in determining the most effective way to provide those services.

Maintenance and support of the state’s computer system for eligibility determination – the Texas Integrated Eligibility Redesign System (TIERS) – is scheduled to transition from Accenture to Deloitte on June 30, 2007.

Next steps

With the short-term contracts in place, HHSC can focus on developing a longer-term procurement strategy to determine the best way to provide these services in the future. HHSC plans to release requests for information (RFIs) for CHIP application processing, enrollment broker services, and call center operations and support. HHSC also will host vendor forums in June on these services. Once HHSC has analyzed the information from the RFI process, draft requests for proposals (RFPs) will be developed. All interested parties will have an opportunity to review and provide comments on the RFPs.

HHSC also plans to issue procurements for TIERS maintenance and support services and for an independent validation and verification contractor to monitor performance of the state’s eligibility systems.