The 2021-22 Budget: Assessment of CalHEERS Dashboard

analysis full gutter The 2021-22 Budget: Assessment of CalHEERS Dashboard March 2021 The Supplemental Report of the 2020-21 Budget and Retention System (CalHEERS). This post Act directs our office to assess a dashboard represents our assessment based on our review developed by the Department of Health Care of the dashboard and other information gathered Services (DHCS) to identify and prioritize issues from the administration and stakeholders. We then related to Medi-Cal eligibility functionality in provide opportunities for legislative oversight of the the California Healthcare Eligibility, Enrollment, dashboard and associated processes. Background CalHEERS Supports Eligibility and Enrollment Human Services Agency’s Office of Systems for Health Benefits Through Covered California Integration, in consultation with other stakeholders and Medi-Cal. CalHEERS is an information including the County Welfare Directors Association technology (IT) system, jointly administered by (CWDA) and the Service Employees International Covered California and DHCS, that allows for Union (SEIU). (SEIU represents a large number of real-time eligibility determinations for Medi-Cal— county eligibility workers in, among other activities, the state’s Medicaid program—and subsidized collective bargaining.) The administration organizes health care coverage through Covered California. each of the functionalities and fixes that are ready CalHEERS refers individuals determined by the for deployment into one of several CalHEERS system to be likely eligible for Medi-Cal to county releases during the course of the year. (A release is eligibility workers for final eligibility determination. a CalHEERS update that implements several defect County staff then use both CalHEERS and the fixes and new functionalities at once.) Releases are Statewide Automated Welfare System (SAWS) to planned sequentially over a 24-month period by determine final program eligibility. (SAWS is made the administration, with input from stakeholders. up of multiple IT systems which support such This 24-month “roadmap” of releases guides the functions as eligibility and benefit determination, continued development and operation of CalHEERS. enrollment, and case maintenance at the county Stakeholders Raised Concerns With level for some of the state’s major health and human Identification/Prioritization of Medi-Cal Eligibility services programs.) Functionalities in CalHEERS. During the Development of CalHEERS Continues After 2020-21 budget process, CWDA and SEIU notified Initial Implementation. Implemented beginning in the Legislature of, among other concerns, ongoing late 2013, CalHEERS continues to be developed issues with the development of Medi-Cal eligibility to adapt to changes in Medi-Cal and Covered functionalities in CalHEERS. CWDA and SEIU California eligibility rules, fix existing system defects, identified several defects in the system, such as the and add new functionalities. (System defects are delayed transfer of individuals between Medi-Cal technical problems with an IT system, whereas and subsidized health coverage through Covered new functionalities enhance the capabilities of an California when their income changes (which leads, IT system.) Additional functionalities and defect in some cases, to coverage delays and avoidable fixes are identified and prioritized by Covered premium charges), and the inflexible assignment of California, DHCS, and the California Health and individuals to one county even when an individual 2021-22 LAO Budget Series 1 analysis full gutter moves and their case is being processed in another Legislature Adopted Supplemental Report county. CWDA and SEIU also highlighted needed Language in 2020-21. The Legislature adopted functionalities that were first identified when supplemental report language in 2020-21 the state began implementation of CalHEERS directing our office to review DHCS’s dashboard in 2013 but have not yet been added, such as and gather information from the administration the ability for county staff to correct eligibility and stakeholders to provide an assessment of transactions between CalHEERS and SAWS. the dashboard and associated processes during In Response, DHCS Created New Dashboard the 2021-22 budget process. More specifically, to Track CalHEERS Issues. In response to CWDA the Legislature tasked our office with assessing and SEIU’s concerns, DHCS began to develop a (1) whether the dashboard comprehensively “dashboard” that would help catalog each defect captures issues known to stakeholders and the and new functionality related to Medi-Cal eligibility administration that cause delays or errors in identified by stakeholders in CalHEERS. The eligibility processing, (2) how the dashboard is administration and stakeholders then would use the being used as part of a process to set a time line dashboard to prioritize each fix and functionality for fixing the identified issues, and (3) opportunities and set time lines for their inclusion in future for legislative oversight. CalHEERS releases. Assessment Current CalHEERS Dashboard Appears to its current SAWS to a single system called the Capture Known Issues Comprehensively. Based CalSAWS. The administration and stakeholders on our review of two iterations of the CalHEERS emphasize the iterative nature of the dashboard, dashboard and information gathered from several which they view as a benefit of its design. meetings with the administration and stakeholders, Moreover, the current version of the dashboard the current CalHEERS dashboard appears to appears comprehensive and suggests progress capture known defects and required additional towards improved identification and prioritization of functionalities related to Medi-Cal eligibility and Medi-Cal eligibility functionality issues in CalHEERS. prioritize them for inclusion in CalHEERS releases. Frequent and Collaborative Engagement The dashboard identifies whether a Medi-Cal Between Administration and Stakeholders Has eligibility functionality issue is the result of a system Helped to Clarify Issues to Be Resolved and defect or a lack of additional functionality, explains Associated Time Lines to Address Issues. In the business impact of each issue, and targets a addition to DHCS’s development of a dashboard, specific CalHEERS release for inclusion of each the administration also expanded CalHEERS defect fix or additional functionality. Issues remain Project Steering Committee membership to unresolved until deployed as part of a CalHEERS include the SAWS consortia; made the CalHEERS release, at which point county eligibility workers Project Steering Committee responsible for the are required to confirm with the administration that continued development and maintenance of the issues are in fact resolved. Any additional issues dashboard; and then scheduled monthly meetings that arise because of a CalHEERS release (such as with DHCS, CWDA, and SEIU to review and update a system defect caused by the addition of a new the dashboard. Based on our meetings with the functionality) are added to the dashboard. While administration and stakeholders, these changes the majority of issues are targeted to be addressed have been positive for both the administration and in CalHEERS releases over the next 24 months stakeholders. Frequent collaboration to review (informing the 24-month CalHEERS roadmap), and update the dashboard appears to clarify for some issues are scheduled to be addressed in both the administration and stakeholders what a 2024 release once the state migrates from issues need to be resolved and on what time 2021-22 LAO Budget Series 2 analysis full gutter line. As defect fixes and new functionalities are prioritized on the dashboard. County eligibility deployed as part of CalHEERS releases, continued workers are in the process of confirming with the engagement will be necessary to determine administration whether these issues are in fact whether issues are being resolved fully. resolved. It is our understanding from stakeholders Recent Major CalHEERS Release Successfully that the process will take several months to Deployed, Includes Several Defect Fixes complete, so whether additional issues will arise and Functionalities on Dashboard. The from the CalHEERS release is unclear. The next CalHEERS release successfully deployed on CalHEERS release is scheduled for June 2021 February 15, 2021 included five new sets of and includes (as of March 2021) one new set of functionalities and eight defect fixes identified and functionalities and seven defect fixes currently on the dashboard. Opportunities for Legislative Oversight As subsequent CalHEERS releases are planned Direct DHCS to Develop a Less Technical, for deployment, the Legislature can use the More Focused Version of CalHEERS releases as opportunities to evaluate whether Dashboard to Facilitate Legislative Oversight. the dashboard and associated process changes The Legislature also could direct DHCS to are adequately addressing Medi-Cal eligibility develop a less technical version of the CalHEERS functionality issues in CalHEERS. dashboard to show the Legislature—in a Require Annual Report on CalHEERS System user-friendly and focused way—how fixes and Releases. The Legislature could require the functionalities on the dashboard would improve administration to report annually on the defect fixes Medi-Cal eligibility processes. The current version and new functionalities on the dashboard that have of the CalHEERS dashboard does appear to been included in CalHEERS releases over the prior capture defects and functionalities related to year. The report also could describe how the fixes Medi-Cal eligibility and prioritize them in future and functionalities are designed to address known CalHEERS releases. However, the language and Medi-Cal eligibility functionality issues in CalHEERS, organization of the dashboard is very technical, and whether any new issues have been added to and does not directly connect the resolution of the dashboard because of the CalHEERS releases. one or more system defects or the addition of Finally, the report could summarize results of the new system functionalities to, for example, goals stakeholder process to confirm whether a release for the Medi-Cal program. A simplified version in fact addressed the issues it was designed to that explicitly shows how the resolution of issues address. Annual monitoring of CalHEERS releases on the dashboard would, for example, decrease for inclusion of defect fixes and new functionalities the amount of time required for county eligibility on the dashboard would provide the Legislature workers to determine program eligibility would help the opportunity to evaluate the effectiveness of the inform the Legislature’s oversight of the dashboard dashboard and associated process changes. and associated process changes going forward. LAO Publications This report was prepared by Brian Metzker, and reviewed by Mark C. Newton and Carolyn Chu. The Legislative Analyst’s Office (LAO) is a nonpartisan office that provides fiscal and policy information and advice to the Legislature. 2021-22 LAO Budget Series 3