Seamless integration of medical benefits systems for higher efficiency

The challenge

Aside from companies using Salesforce and the Lightning Platform to help them manage customer relationships and empower their sales teams to close deals faster than ever, you can find Salesforce being used to meet various business needs across almost every industry, including government organizations. One state government is using Salesforce to improve the efficiency of their publicly funded medical assistance programs. The state’s goal is to ensure that 100% of its residents are insured. With this goal in mind, they set out to improve the process of applying for and managing publicly funded medical benefits, such as Medicaid and CHIP. The enrollment application was already available online, but they knew that the process still needed a major overhaul.

The approach

The state needed to find a way to ensure that incoming enrollment requests could be managed and quicken the verification process of eligibility.

It was also important to design a site that would have a friendly user interface that would encourage people to use the system across devices without needed additional training.

More importantly, all this needed to be achieved keeping in mind the strictest control over the confidential user data without danger of being breached.

The solution

Improve the enrollment process 

The state built out an internal Salesforce application for county agents to manage incoming enrollment requests and verify eligibility. The new system also makes it easy for caseworkers to contact the applicant if more information or additional documents are required. The application also automates processes such as assigning caseworkers and alerting residents that their application was received, and streamlines many of the workflows involved in the enrollment process. The state also uses MuleSoft to integrate the application with other systems such as SSI, Veterans Services, and Molina/DXC (the main insurance provider for many state-funded programs). These integrations provide a more streamlined approach to eligibility verification and claim submissions. In some cases, the SSI integration even allows residents to be enrolled in Medicaid automatically, without having to apply for it separately, if they qualify for Medicaid under SSI.

Make it convenient for the residents

 The state also built public-facing pages for residents to fill out an application, and a portal for applicants to manage their application details, update information about each family member, upload documents, and view the status of their enrollment and benefits. The entire application is mobile-friendly and cross-browser compatible, so residents can use the system from any PC or mobile device.

What about privacy and security?

In order to stay within the state’s privacy and security guidelines, the application takes advantage of Salesforce’s Government Cloud solution. Government Cloud is a separately partitioned instance of the Salesforce CRM and platform, specifically for use by federal, state, and local governments. Government Cloud complies with various DoD, FedRAMP, and SOC requirements, and Salesforce is continually engaged with FedRAMP and DoD officials to stay aligned with government expectations.