HCR streamlines the application process by presenting the individual with a single application script for the insurance affordability programs. This makes the process of applying for assistance significantly shorter than would traditionally be the case when screening a client for multiple assistance programs. Using a single application script and entry point, citizens can be considered for a number of different programs for which they and their households may be potentially eligible.
The HCR application script collects only the information that is necessary to make a determination for insurance affordability. The online application is defined with a Cúram Intelligent Evidence Gathering (IEG) script that guides the citizen through a series of steps that collect the appropriate information for the programs for which the citizen is applying. IEG permits administrators to create and maintain flexible, question-and-answer based scripts to gather information. The Cúram Rules Engine is also used to control the presentation and ordering of questions, and the navigation of question scripts. Screens are dynamically rendered at runtime based on the question scripts defined using the IEG Editor. Question pages are displayed to the individual based on defined preconditions and are dynamically presented based on the answers supplied. The HCR application script is designed to be as simplified and streamlined as possible. There are no resource tests or complex income calculations necessary. A simplified MAGI approach is used in order to determine a household's income. This is different from the traditional Medicaid application, for which extensive information is captured for household, income, resources and expenses. Household eligibility is determined for the insurance affordability offerings using basic information supplied by the individual about themselves, their household, and their household income.
Information entered by the individual and captured in the application is considered client-attested information, which can be compared to information recorded for the client on other trusted external systems via the federal data hub. The use of technology and electronic validation (or 'e-verification') of identity, household, insurance and financial information from other sources greatly increases the accuracy of the eligibility determination, thus speeding up the decision process for citizen and case worker alike. E-verification negates the need for clients to provide supporting documentation for their application.
'Reasonable compatibility' between information entered on an application and information retrieved via the federal hub provides greater flexibility, allowing the agency to define what constitutes verification. Reasonable compatibility ensures that there does not need to be an exact match for a state to accept data as verified. For example, a client address that differs from the address held on another system may be marked as reasonably compatible, and therefore verified, by a state if both addresses are within the exchange service area. If the income available for a client via trusted data sources determines the client to be eligible for Medicaid but the client attests to a different income amount on the application which also determines the client eligible for Medicaid then this information is considered reasonably compatible and requires no supporting documentation to be provided by the client for verification. This moves towards real-time or near real-time determinations for individuals applying online whose eligibility can be verified, or considered reasonably compatible online.
Any outstanding verifications that could not be electronically verified are collected into a list and presented to the citizen before displaying the application results. These discrepancies are represented to a caseworker as 'outstanding verifications' against a piece of evidence attested by the applicant or when such evidences are missing as 'Advisor Issues'. However; presenting the details to the citizen as part of the online application makes them aware of the items that are delaying a complete determination. Any result presented is provisional, dependent upon the client providing supporting documentation to a caseworker.As a follow up action on receiving the supporting documentation a caseworker could mark the outstanding verifications as 'Verified', close an Advisor Issue manually by providing appropriate reasons or modify the client attested data to reflect the information available through the trusted data sources to resolve the inconsistency. The provisional determination may or may not permit issuance of benefits depending on the program and the reasonable opportunity or inconsistency requirements associated with that program.