Adapting Eligibility Systems With Technology Automation and Differentiated Income Data

State agencies and Equifax discuss Medicaid unwinding challenges and successes.

At the 2024 State Healthcare IT Connect Summit, representatives from Equifax, state agencies, and private sector professionals discussed the challenges and successes they encountered during the COVID-19 Public Health Emergency (PHE) Medicaid unwinding process. Session panelists included Marshall Wilmot, Deputy Assistant Director of Arizona Health Care Cost Containment (AHCCCS), Jake Parlett, Systems Manager Eligibility Services Division at the Utah Department of Workforce Services, and Juan Cole, Vice President of Strategy and Solutions Consulting, Equifax.

The panelists shared insights on challenges faced, best practices, and lessons learned when navigating the complexities of unwinding with a focus on the interplay between policy changes, data management, and technological solutions during and post-pandemic. Key to the discussion was the importance of proactive planning, data integration, process improvements, and technological innovation in effectively managing complex eligibility systems. 

Session summary and highlights:

Challenges: Pain Points and Policy Changes During and Post-Pandemic

  • Varying renewal dates within households, creating the need to reach out multiple times.

  • Data challenges, such as outdated addresses, leading to returned mail.

  • Uncertainty surrounding the unwinding timeline.

  • New and shifting requirements throughout the process.

Solutions and Processes: Automation Benefits and Lessons Learned

The panelists underscored the pivotal role of data and process improvements in effectively navigating the unwinding process. Additionally, they emphasized the value of data sharing agreements, including connections to the federal data services hub and state hub, in helping facilitate efficient income verification and eligibility determinations.

Solutions to their data challenges:

  • Access Arizona, the Arizona benefit eligibility system, addressed the challenge of varying renewal dates by aligning renewal dates for all household members, streamlining the process and reducing confusion for beneficiaries.

  • To mitigate the issue of outdated addresses, Access Arizona implemented a national change of address check, significantly reducing return mail volume. The agency incorporated QR codes on response-required renewal forms, allowing for efficient address updates and preventing procedural discontinuances.

  • Utah proactively tackled data issues by categorizing cases based on eligibility and potential ineligibility, prioritizing those with clear ineligibility for expedited processing.

  • Both Arizona and Utah leveraged integrated eligibility systems, which allowed for automated data ingestion and income verification, reducing the burden on caseworkers.

Process enhancements, played a crucial role in maintaining contact with beneficiaries:

  • Arizona adopted a proactive communication strategy that utilized emails, text messages, and robocalls to inform individuals about upcoming renewals and address changes, contributing to greater retention rates throughout the unwinding period.

  •  Utah worked to modernize its online portal, resulting in a significant increase in online renewals and improved accessibility for beneficiaries.

Improve Medicaid Program Integrity With Near Real-time Data From Equifax

While challenges persist, particularly in areas such as self-employed income verification and policy implementation, the panelists expressed optimism about the potential of AI to transform the future of eligibility determination. By embracing these lessons and leveraging emerging technologies, states can continue to improve the efficiency and effectiveness of their eligibility systems, helping deliver right-sized benefits to the eligible individuals in need.

To learn more about how Equifax is supporting state agencies in navigating the complexities of Medicaid unwinding, visit