Court rulings related to the law's constitutionality, notwithstanding, there's arguably plenty in the bill for states and localities to be anxious about. Just the daunting prospect of setting up health insurance exchanges, as required by the new law, is enough to give lawmakers from coast to coast migraine headaches.
There are, on the other hand, not only provisions in the bill to like, but to embrace and run with. One of those provisions has to do with bringing some consistency, simplicity and common sense to how citizens apply for the whole range of health and human services benefits, from Medicaid to food stamps to Medicare.
Obviously, this is all complicated and will take time to play out, but just as obviously, states and localities are going to be dealing with a massive wave of new standards and requirements related to eligibility, enrollment, information sharing and client privacy. (For a quick primer on what's coming down the pike, read this.)
States and localities are also going to be facing a massive wave of new clients -- particularly on the Medicaid side -- and that's where what unfolds in various states over the next two years gets a little hairy.
There is a lot of federal money on the table right now to help states manage and meet the requirements around health care exchanges and universal coverage. But if states build another technology silo to handle Medicaid and health care exchanges with some primitive or tenuous connection to health and human services, they are missing a huge opportunity, says David Hansell, acting assistant secretary with the Administration for Children and Families at the U.S. Department of Health and Human Services.
In his basic stump speech, Hansell argues that the ACA has presented states with an opportunity for "a peaceful revolution in the way we think and do business in health and human services," adding that "the conditions are uniquely right for states and the federal government to band together and storm the barricades of old-think." In his speech, Hansell characterizes the ACA as "a made-to-order impetus for innovation across the span of health and human services programs," especially its "emphasis on designing integrated, consumer-friendly enrollment systems."
That's the key: This isn't just about setting up health care exchanges or ensuring everyone has health insurance. What it's about -- or should be about -- is connecting all health and human services programs through eligibility, and building into new eligibility and enrollment systems the capacity to improve services -- and management of those services -- across programs. By integrating data on services provided and outcomes attained, there will not only be "no wrong door," but there will be the ability to do very real, very efficient wrap-around service delivery from cradle to grave.
But if states don't get all the stakeholders in the room from the start -- from top health care executives to foster-care caseworkers -- to offer their input on how to build the right IT system that can be used not only to bring all clients in the same door, but also to manage and monitor all programs from Medicaid to the Supplemental Nutrition Assistance Program, then they will have squandered a perhaps once-in-a-lifetime opportunity.
It is a moment, as Hansell points out, for those in the human services business to get directly involved in how ACA ends up reshaping state and local IT systems and human services delivery. Whichever way human services folks decide to turn in bringing about this change, one thing is for sure: They should have started yesterday.