South Carolina DHHS Improves Eligibility and Enrollment for Medicaid

South Carolina’s Department of Health and Human Services (DHHS) decided to redesign the enrollment and eligibility determination process for all Medicaid programs administered in the state. Unnecessary interactions (from redundant customer visits, calls, and mail) were negatively impacting the agency’s ability to keep up with their work.

DHHS selected Change & Innovation Agency (C!A) to help design, develop, and deploy new eligibility and enrollment practices for its Medicaid services and benefits in an effort to realize process efficiencies.

C!A assisted in redesigning teams to create work processes that are faster, more accurate, flexible, and focused on using precious eligibility worker time only on value-added tasks. As-is process mapping was conducted, barriers and bottlenecks were identified, and new processes were developed.

The new processes have enabled DHHS to:

  • Serve 89% of lobby clients in the same day
  • All MAGI/non-MAGI application pathways are cleared daily
  • Mitigate the effects of caseload increases for all Medicaid programs without needing to hire additional state staff.
  • Eliminated thousands of backlogged cases

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