Conducting an Eligibility and Enrollment Systems Inventory and Plan for New York State

Grantee Name

Social Interest Solutions

Funding Area

Expanding Health Care Coverage

Publication Date

July 2015

Grant Date:

January 2011 – December 2011

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Shortly after the passage of the Affordable Care Act, NYHealth recognized the complexity of readying New York State for health reform implementation.

Executing a new, seamless eligibility and enrollment system would require a sophisticated and in-depth technology gap analysis of the State’s current systems, as well as an assessment of applications that could be used for the NY State of Health Marketplace, the State’s official exchange. New system architecture would have to be developed to receive, process, and transmit information among consumers, the Marketplace, employers, health plans, and relevant federal data hubs.

In January 2011, NYHealth awarded a grant to Social Interest Solutions (SIS), with the Lewin Group serving as a subcontractor, to conduct an inventory of the State’s systems and examine existing information technology (IT) assets and deficiencies. In June 2011, NYHealth awarded SIS a second grant to provide the State with consulting support services to help establish the Marketplace.

Outcomes and Lessons Learned

Identified current technology assets and functions that could be leveraged for the Marketplace and gaps in that would need to be addressed to create a consumer-friendly system;
Created a checklist guide for comparing and contrasting current eligibility and enrollment system capabilities with federal requirements;
Produces a final report, “Preparing New York’s Information Technology Infrastructure for Health Reform: A Gap Analysis,” for New York State; and
Provided the State with technical assistance to meet different benchmarks for establishing the Marketplace

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Conducting an Eligibility and Enrollment Systems Inventory and Plan for New York State

Grantee Name

Funding Area

Publication Date

Grant Date:

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Shortly after the passage of the Affordable Care Act, NYHealth recognized the complexity of readying New York State for health reform implementation.

Outcomes and Lessons Learned

Related Links

Examining Federal Health Reform on New York State

Implementing Federal Health Care Reform: A Roadmap for New York State

Examining Market-Based Options for New York’s Health Insurance Exchange