The HCR solution is delivered as part of the existing Income Support functionality. As you will already know, the existing Income Support functionality supports applications for and ongoing case management of Food Assistance, Cash Assistance and pre-ACA Medical Assistance coverage types. More information on what is available in support of these programs can be found in the following guides:
Initial focus has been on the integration between the application process and ongoing case management for the Insurance Affordability Programs (HCR) as provided in the earlier HCR Previews and the equivalent process for traditional Medicaid coverage types as provided by Income Support (IS).
The starting point for this integration is in Universal Access, where the sample HCR landing page includes extra links to standard Universal Access screening (the 'Check if I am eligible for other programs' link) and standard Universal Access intake (the 'Apply for other programs' link). Both Screening and Intake have been configured to include the Income Support content. After logging into, or creating an account the individual can select from the types of screening to perform (as was the case in previous versions of Universal Access) and will then proceed into the Income Support script for screening.
Upon completion, the individual is presented with a simple screening results page which displays results of Income Support screening. The MAGI-based or insurance affordability programs are not included in this screening results page - the simplified calculator on the HCR landing page provides a much simpler screening for MAGI-based programs, requiring the number of adults and children in the household along with the household income.
Intake for the Income Support programs is available from a number of different places:
Screening for other programs is performed as part of the eligibility determination for HCR, and displayed in the 'Other Government Services' section of the results. As a result of integration, the ability to 'Apply Online' has been enabled for some of the programs screened, for example, food assistance and cash assistance.
This begins the application process for one of the Income Support programs - an individual is taken into the program selection screens as part of the Universal Access intake process, the difference is that this will all be done within the eligibility results page and when the application intake process is finished, the user will be returned to the HCR eligibility results page with the status of the relevant programs updated.
Mapping functionality has been added which transfers information from the datastore used by the HCR application script to the one used by the IS application script when a user chooses to apply for one of the IS programs from the HCR results page. A generic mapper currently only transfers data items with the same name. We intend to enhance this in a subsequent release so that some non-identical data is also transferred.
If a citizen submits their HCR application from the results page and then submits an application for another IS program, as you would expect, they will be processed as two separate applications. The respective intake processes for these two applications are quite different from each other. For a start, HCR uses the new application case functionality made available within the redesigned Cúram Intake, while IS uses the previous approach which users will be familiar with from 6.0.4 and earlier whereby an application case is really a façade built on top of an integrated case.
Where the two applications can overlap is through the ability of the two different intake processes to match applicants against people who are already registered in the system. In HCR, this is an automated process, facilitated by Person Match processing; in IS this is a manual process facilitated by Client Merge processing.
To take an example, if a citizen submits a HCR application when there had previously been no record of them in the system, as part of the process of creating an application case and mapping information to it, the Person Match algorithm will be run for each of the people on the application and in this case, since no matches would be found then the individuals would be automatically registered as new participants on the system. As part of registering these people, Person Evidence would be created for things like their name, date of birth, SSN, etc. The standard straight-through process would then kick in for this application to decide whether manual intervention was required or not before authorizing the program and creating an Insurance Affordability integrated case with the necessary product delivery cases created within it.
When the IS application is submitted, each of the people on the application (which would typically, but not always, be the same people submitted on the HCR application) are initially created as prospects and the intake worker is responsible for registering them. To do this, they search for people already registered in the system with similar details and if they find someone they are happy is a match, the intake worker can then 'merge' the prospect with the actual person on the system, thereby ensuring that any evidence entered as part of this application is associated with that person. Depending on your broker configuration, evidence can also be shared from the IS application case to the HCR application case (if its still open) or the HCR integrated case, both through the Person Evidence and directly between the cases (evidence brokering will happen automatically if the configuration is in place).
If a HCR application was submitted when people had already been registered through an IS application, then the process of matching the new applicants with the existing people is automatic so long as either a conclusive match or no matches at all are found – where multiple potential matches exist, a task is created for a case worker to decide whether any of those potential matches should be used or a new person registered.
HCR Applications will ultimately turn into Insurance Affordability integrated cases; IS applications ultimately turn into Income Support integrated cases. Each case will have its own evidence set to represent what has been entered as part of the application/intake process. We intend to create relationships between the two integrated cases where some/all of the same people are involved however currently the integration available is through the person themselves. This takes two main forms:
Person Evidence does not have the concept of in-edit or incoming states for evidence so all evidence brokered from cases into Person Evidence is automatically accepted.
As well as brokering from cases to Person Evidence, evidence can also be brokered from Person Evidence to any open cases for this person (if the evidence change originated on a case, when it is brokered through Person Evidence it will only be sent to other cases and not the case on which the change originated). So, for example, if a caseworker adds phone number evidence for a given person on the Income Support integrated case, this will be brokered to that person's evidence in the participant manager and then on to the Insurance Affordability integrated case if one exists for that person. When the evidence is brokered on to the integrated case, it will appear as incoming evidence so that a caseworker can choose whether to accept it or not.