Modernization of Modernization of Client Service Delivery Client Service Delivery

(MCSD) (MCSD) at at

The Connecticut Department The Connecticut Department of Social Servicesof Social Services

The Changing LandscapeThe Changing Landscape

We have significant challenges in staffing, technology, and physical plant.

We are helping more and more people every day.

Programs are increasingly complex.

Our challenges create barriers to efficient and effective service to Connecticut residents.

Applications On The RiseApplications On The Rise

395,744434,242

487,845

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

2007 2008 2009

Over 23% 2009 gain over 2007

Over 12% 2009 gain over 2008

Application Activity 2007 - 2009

Need In CT Is IncreasingNeed In CT Is Increasing

720,364747,923

797,923

650000

700000

750000

800000

2007 2008 2009

Average Annual Recipients by SFY

Average Annual Recipients 2007 - 2009

Comparing Staffing Levels to Comparing Staffing Levels to ActivityActivity

-

100,000

200,000

300,000

400,000

500,000

600,000

February 2008 February 2009 February 2010

Assistance Units

Monthly Application Activity

Eligibility Staff

Monthly Comparison of Active ‘Assistance Units’ and

Application Activity to Eligibility Staff

Call Volume Is TremendousCall Volume Is Tremendous

702,762

701,421

704,153

702,535

699,000

700,000

701,000

702,000

703,000

704,000

705,000

Nov-09 Dec-09 Jan-10 Feb-10

Sampling of Monthly Incoming Calls to Six DSS Offices

Technology is Our BIGGEST Technology is Our BIGGEST ChallengeChallenge

The technology infrastructure is non-existent. Phone systems cannot manage the

volume of calls. Each phone system is different in our

13 offices. There is limited storage for

voicemails.

Technology is Our BIGGEST Technology is Our BIGGEST ChallengeChallenge

Virtually no capability to electronically manage documents.

Reporting capabilities are severely limited and restrict the production of reports for analysis.

The Eligibility Management System (EMS) is obsolete

EMS is the primary tool for the determination and maintenance of ongoing eligibility.

EMS Has ChallengesEMS Has Challenges

The Eligibility Management System Mainframe system initially developed in

the 1980s consisting of 217 data bases, 3,419 programs, 428 screens and over 9.1 million lines of COBOL program code; and

Requires production staff on duty 24-hours a day to support the on-line system and the extensive batch processing conducted nights and on weekends.

EMS Has EMS Has ChallengesChallenges

The system determines eligibility and issues notices and benefits to approximately 389,000 assistance units and 653,000 clients each month;

Receives information entered on-line from over 1,500 terminals in 12 DSS regional offices across the state; and

Exchanges and matches data through interfaces with other state and federal agencies, as well as with towns, banks, insurance companies, and other entities to ensure the accuracy of information contained in the client and assistance unit database. 

EMS Has ChallengesEMS Has Challenges

Each programmatic change requires an

extraordinary amount of ITS staffresources to implement

modifications,create notices and support neweligibility processes.

EMS Has Challenges - ExampleEMS Has Challenges - Example Program policy was modified that required

a wording change and inclusion of a variable data element on one of the EMS notices. Modify the eligibility module with the new data

element to be passed to the nightly notice process.

Modify the notice linkage area layout (data passing area) to include the new element.

Rebuild all eligibility programs that access the notice linkage area.

EMS Has Challenges – EMS Has Challenges – Example (cont.)Example (cont.)

Modify the nightly notice process to extract the new element from the notice linkage section.

Rebuild all notice programs that use the notice linkage area .

Modify the notice to include the new data element and to display the new text.

EMS Has Challenges – Example EMS Has Challenges – Example (cont.)(cont.)

The notice text needed to be re-formatted (re-built) from the point of the first change to the end of the notice.

This is required due to the notice module does not have automatic formatting similar to MS-Word. All notices are built character by character using a COBOL program.

The change would have been more time consuming if a different font or bolding was requested.

This would be a simple change using current development

tools however it took over a month to implement in EMS.

EMS Has ChallengesEMS Has Challenges

New programs or expanded eligibility has been contracted out because EMS cannot be programmed to manage the complexity of the eligibility criteria.

HUSKY B, Charter Oak, Care4Kids

There are 500 change requests in the queue for EMS.

EMS Has ChallengesEMS Has Challenges

Utilize workarounds in EMS to implement program changes.

Work-arounds are processes designed to circumvent the computer system allowing for manual work procedures.

Requires reprogramming of EMS for implementation of any program policy or procedural changes.

EMS Has ChallengesEMS Has Challenges

Work-arounds are labor intensive for the eligibility determination process, create complexity and inefficiency. Jeopardizes program integrity which may

lead to significant federal penalties. Case in point in the Supplemental

Nutrition Assistance Program (SNAP) – SNAP has undergone significant changes in the last 5 years.

EMS Has ChallengesEMS Has Challenges DSS has been unable to make

changes in EMS to make eligibility management of the SNAP program less demanding.

As a result, SNAP eligibility is labor intensive and cumbersome.

The Food and Nutrition Service (FNS) tracks error rates for the states and monetarily penalizes those that are out of compliance with federally set targets for program administration.

EMS Has ChallengesEMS Has Challenges

CT is currently ranked 52 of 53 states and territories for its error rate. We are in danger of receiving a significant federal penalty of up to $10 million dollars per year.

A more flexible eligibility management A more flexible eligibility management system that could be programmed system that could be programmed

more easily would allow for the more easily would allow for the implementation of system supports to implementation of system supports to

simplify eligibility processing and simplify eligibility processing and subsequently reduce the error rate. subsequently reduce the error rate.

EMS Has ChallengesEMS Has Challenges

Eligibility processing is cumbersome and EMS has been called “rigid” (LPRIC, 2004).

The system negatively affects the efficiency of business operations daily.

The greatest impact is to the residents of Connecticut that need access to the services DSS provides.

EMS Has ChallengesEMS Has Challenges In the Malloy/Wyman Transition Team -

Final Report of The Policy Committee there is reference to the Social Safety Net and access to the very services DSS provides, it states “Access to services that respond to basic human needs must remain available to Connecticut's most vulnerable residents, even during difficult economic times” (Kelly and McGee, 2011).

One of the greatest tests of DSS’s ability to provide that access has been EMS.

Why ModernizeWhy Modernize

The mounting demands and increased expectations could not be addressed

with our current systems.

There Was Little Choice

Why Modernize?Why Modernize?

Currently, DSS does not have the staffing and sophisticated technology to best serve the residents of Connecticut.

Our systems and programs are complex and made more difficult by the patchwork of technology and a dated business model.

Legislators, advocates, providers, federal partners, other human service partners and, most of all, the people in the communities we serve, share our belief that we can do better with new technology.

Why Modernize?Why Modernize?

The Raymond Settlement In 2007 DSS settled a class action lawsuit. Class action law suit filed by CT Legal

Services organizations on behalf of persons with physical and mental disabilities.

Brought about as result of 2003 layoffs and office closings.

Advocates claimed inadequate accommodations available for persons with disabilities to access DSS programs.

The eligibility processes were specifically named. .

Why Modernize?Why Modernize? The Raymond vs. Rowland settlement agreement

created groundwork for a new infrastructure supported by cutting-edge technology that will revolutionize our client service delivery system through Universal Design.

Universal Design includes a broad-spectrum of solutions that create environments that are usable and effective for everyone, including people with disabilities.

Universal Design Impacts the Physical, Communication, and

Information environments of DSS. To insure that the people we serve and in particular

people with disabilities (cognitive and physical) are able to successfully interact with our systems.

Why Modernize?Why Modernize?

In Order To Successfully Implement Universal Design For Improved Client Access Better Quality Outcomes Enhanced Customer Service Cost Reduction Create a Technological Framework for

the Future

Modernization Is CriticalModernization Is Critical

We Have To Do BetterWe Have To Do Better

We recognize and acknowledge Limited access/entry points Outdated facilities…costly facility storage Inadequate phone systems Dated business model In need of technology Limited staffing Lack of ease for community partners

to assist in client services

We Have To Do BetterWe Have To Do Better We looked at what was working

successfully in other states Visited FL facilities and reviewed the

operations Spoke in depth with officials from other

states that have implemented PA, MA, WI, CA

Held and continue to hold focus groups across CT

Staff at all levels of DSS are involved in workgroups for implementation

Modernization is a comprehensive response to the Modernization is a comprehensive response to the issues we face and provides a framework for issues we face and provides a framework for

expansionexpansion

It’s Time For ModernizationIt’s Time For Modernization It’s time to make changes to our

business model and utilize the technology available to support positive change.

Modernization will streamline our business processes and as it does, your agencies and clients will gain Quicker response time Ability to self-serve Access

Modernization of Client Service Modernization of Client Service Delivery (MCSD )Delivery (MCSD ) Initiated in

September of 2008. Capitalizes on new

technology, Raymond Settlement funding and best practices from other states.

Does not replace EMS but creates the framework to do so eventually.

Modernization of Client Service Modernization of Client Service DeliveryDelivery Currently in the design phase.

Negotiating terms and conditions with vendor.

21 month implementation timeline (once contract is finalized).

What exactly will MCSD do?

DSS

Services

Web Front-End

Benefits Center

Service Center

IVR

Process Center

Doc Imaging

Dedicated Units

Community Partners

Community Partners

Modernization of Client Service Modernization of Client Service DeliveryDelivery

Modernization – Modernization – Meeting the Meeting the ChallengeChallenge

Paper, Paper, Paper, Paper, PaperPaper

Document Manageme

nt

Meeting the ChallengeMeeting the Challenge – – Document Document ManagementManagement

Document Management will simplify access to documents through the use of scanning and indexing.

Paper documents and other files will be sent to a central repository for scanning and DSS staff will be able to access documents almost immediately from their desktop computer.

Meeting the ChallengeMeeting the Challenge – – Document Document ManagementManagement

Document management will also allow for the implementation of workflow. Documents will be scanned and

indexed to a person’s case.

Once a document is received, an electronic work order is created, the work is assigned to a DSS staff person through the use of technology, the DSS staff process the application, redetermination, or change.

Meeting the ChallengeMeeting the Challenge – – Document Document ManagementManagement

A Document Management System will process the approximately 3.7 million pages per month (44 million pages per year) – our current volume.

Document management will eliminate wasted time for workers searching for paper and clients replacing lost documents.

We will be able to access information the moment we need it, wherever we need it.

WITHOUT TOUCHING WITHOUT TOUCHING PAPER !!!!PAPER !!!!

Meeting the ChallengeMeeting the Challenge – – Document Document ManagementManagement

This will improve timeliness, customer satisfaction and quality assurance.

Massachusetts reports that health assistance application processing time was reduced by 50% with the implementation of a document management system.

Community partners no longer have to assist clients with the task of locating paperwork to resubmit to DSS because it has been lost.

No more frustrated clients who can’t get their cases processed because of misplaced forms or documentation.

Modernization –Modernization – Meeting the Meeting the ChallengeChallenge

Physical Physical PlantPlant

Inadequate to Inadequate to address high address high volume and volume and movement of movement of peoplepeople

Processing Centers

Service Centers

Meeting the ChallengeMeeting the Challenge – – Processing Processing CentersCenters

Processing Centers will be a part of the current regional offices.

The DSS staff will be providing the case maintenance functions such as processing redeterminations and applications, TANF activities for time limited program participants, processing computer matches, and managing Long-Term Care Cases.

Meeting the ChallengeMeeting the Challenge – – Service Service CentersCenters

The regional offices will also be Service Centers.

Service Centers will provide access to self-service tools, as well as the opportunity for one-on-one assistance.

Service Centers will be redesigned to accommodate people with a variety of disabilities, including: cognitive, physical, auditory and visual.

As more and more people take advantage of DSS services via the phone or internet, the volume of people who come to a DSS service center will diminish.

Regional offices will be redesigned to facilitate self-service activities. Computers to apply or complete a

redetermination online. Phones to be connected directly to Benefits

Centers in 3 CT locations. Fax machines to send documents to the

document management center for indexing. Self service areas will be supported with DSS staff

to assist people who prefer to use these systems.

DSS staff will be available to see people who want to or DSS staff will be available to see people who want to or need to be seen as a result of the program they are on need to be seen as a result of the program they are on

or applying for.or applying for.

Meeting the ChallengeMeeting the Challenge – – Service Service CentersCenters

Meeting the ChallengeMeeting the Challenge – – Service CentersService Centers Some people will still need to be seen

by DSS staff.

Certain types of programs such as SAGA cash and time-limited TFA require people to see an eligibility worker.

People may need extra support to be able to apply for or stay on our programs. People with physical or cognitive

disabilities may need or prefer a face-to-face contact.

Some may simply prefer to see a DSS staff person.

Modernization –Modernization – Meeting the Meeting the ChallengeChallenge

Phone SystemsPhone Systems Differ from office to Differ from office to

officeoffice Cannot direct callers Cannot direct callers

to appropriate staffto appropriate staff Voicemail not able Voicemail not able

to manage volume to manage volume of callsof calls

Interactive Interactive Voice Voice

Response Response (IVR)(IVR)

Meeting the Challenge – Meeting the Challenge – IVRIVR When a client calls, they have the option of

speaking to a worker, or using the new “IVR” (available in English and Spanish).

Organizations, public and private, are increasingly turning to IVR to reduce the cost of common questions, service, inquiry and support calls to and from their organization.

IVR allows the use of pre-recorded voice prompts and menus to present information and options to callers, and touch-tone telephone keypad entry to gather responses without the intervention of staff.

Enables a caller to access specific case information, general program information, or connect to a DSS worker.

Meeting the Challenge – Meeting the Challenge – IVRIVR People can call and request to have

forms mailed to them, for example, applications, redeterminations, change reports and budget verifications; check the status of their case; verify that their mail was received by us and other steps.

With these types of calls, that do not require an interaction between the caller and a DSS staff person, IVR will save time for both the caller and DSS.

Callers who need more specific information will be directed to a DSS staff person at a virtual Benefits Center.

Meeting the Challenge – Meeting the Challenge – IVRIVR Successful Child Support IVR system within DSS for

approximately 8 years.

IVR provides real-time access to child support information for custodial parties, noncustodial parents, employers, other state child support agencies, and the general public.

Approximately 185,000 calls per month are currently processed by the IVR with only 4% of callers opting out to a customer service representative.

Since implementation, the number of individuals utilizing the IVR has increased.

Enhancements to available information and IVR script has substantially reduced the need for customer service assistance.

Meeting the Challenge – Meeting the Challenge – IVRIVR

If a caller wants or needs to speak with a DSS staff person, there will be a seamless transfer.

The call will be handled in most instances by an eligibility worker, who can respond to the concern of the caller and process any change on his/her case. In most instances, the calls are eligibility related. In the

case of medical providers or other types of calls, the caller will be transferred to the appropriate area of DSS.

Benefits centers will be a part of our current regional offices. Three locations across the state to provide

necessary system redundancy. People call in to one toll-free number and call can be

responded to from anywhere. Does not require new offices.

Modernization –Modernization – Business Model Business Model ChangesChanges

A refined business model supported with new technology provides additional supports to insure access and efficiency. Service Centers – the regional offices will be

available for clients and our partners. Processing Centers – located in the regional offices

staff will be dedicated to the case maintenance functions that are needed to maintain eligibility.

Benefits Centers – located in three regional offices and manages eligibility functions via telephone for the entire state.

Dedicated units – specialized work like that of the current Regional Processing Units, will be administered with dedicated DSS staff to account for the complexities of TFA, LTC, and the RPU.

Modernization – Modernization – Meeting the Meeting the ChallengeChallenge

Web Web

Front EndFront End

Limited HoursLimited HoursLimited Entry Limited Entry PointsPointsLimited AccessLimited AccessPaper, Paper, Paper, Paper, PaperPaper

Meeting the ChallengeMeeting the Challenge - - Web Front EndWeb Front End Our response is a web-based application

similar to online banking. A web-based front-end will interface with our eligibility management system. Creates “anywhere” access for applications, redeterminations, and case information via the internet.

Through the use of Web Front-End, an individual: Can apply or conduct his/her

redetermination online Can report changes online. Can find out the status of his/her

benefitsLiterally from anywhere Literally from anywhere where there is internet where there is internet

access.access.

Meeting the ChallengeMeeting the Challenge - - Web Front EndWeb Front End Allows people to submit an application or

comply with program rules through the redetermination process without having to come to a DSS office.

Other states like Pennsylvania, Florida and Wisconsin have had great success and residents report greater and easier access to services.

Other states report community partners play a critical role in providing that access.

Wisconsin reports 40% of its applications are submitted through the web front-end, ACCESS.

What About EMS?What About EMS? EMS Has Challenges!!

Cost estimates to replace EMS run anywhere from $100 million to $150 million.

DSS began the modernization effort to respond to the mounting challenges and to create a framework so that EMS can eventually be replaced.

Fiscal costs prevented DSS from expanding the scope of modernization into replacement of EMS.

A New OpportunityA New Opportunity In the later part of 2010, The Centers for Medicare and

Medicaid Services (CMS) issued a proposed rule that would expand the interpretation of existing regulations governing MMIS systems to allow for enhanced funding of automated eligibility systems for Medicaid (Covington, 2010).

Enhanced Federal financial participation (FFP) would be available to include 90% for design, development and installation and 75% for operation and maintenance for Medicaid eligibility systems. (Covington, 2010).

Design, development and installation need to be completed by December 31, 2015.

Approximately $2.9 billion dollars is available for states who select to replace their eligibility systems.

A New OpportunityA New Opportunity Along with the existing pressures on

EMS, we have new expectations resulting from

the Affordable Care Act. The Affordable Care Act (ACA) requires states

to set up health care exchanges for the purchase and sale of health insurance in 2014.

Included in the ACA is the condition that individuals are permitted to apply for Medicaid and CHIP (Children's Health Insurance Program – HUSKY in CT) through the exchange or the state Medicaid agency – any door (HealthCare.gov, 2010).

A New OpportunityA New Opportunity

The exchange and state Medicaid agency must facilitate electronic applications, minimize paper documentation and ensure continued enrollment of eligible individuals and families (Jost, 2010).

There is an expectation of system integration, maintenance of ongoing eligibility, streamlining and simplification of eligibility processes for health insurance provision under the ACA (Covington, 2010).

A New OpportunityA New Opportunity

Recognizing the ITS restraints of most states to operationalize the conditions of the ACA, the federal government has initiated guidance and financial support to help states prepare for implementation.

This is an UNPRECEDENTED financial opportunity in the world of eligibility management systems.

A New OpportunityA New Opportunity

In guidance issued jointly from Health and Human Services (HHS), Office of Consumer Information and Insurance Oversight (OCIIO) and the Centers for Medicare & Medicaid Services (CMS) in November 2010, the expectation is clear.

We expect IT systems to support a first-class customer experience, as well as seamless coordination between the Medicaid and CHIP programs and the Exchanges and between the Exchanges and plans, employers, and navigators. We also expect these systems to generate robust data in support of program evaluation efforts and ongoing improvements in program delivery and outcomes. (p. 3)

EMS Cannot Meet The EMS Cannot Meet The ChallengeChallenge

MCSD Will Bring Some Relief To Eligibility Determinations And Maintenance

HOWEVER

It Does Not Address The CORE Issue

The Need To Replace EMS

Data Collection &

Reporting P

aper

, Pap

er,

Pape

rStaffi

ng

The Raymond Settlement Federal Penalties

Increased Need

ProgramComplexity

Afforda

ble

Care

ActPhone Systems

EMS

New

Pr

ogra

ms

DSS Services

The Replacement of EMSThe Replacement of EMS

DSS proposes a planning process to identify expectations and explore the costs and resources needed to determine the feasibility of replacing EMS.

Budget option has been submitted to OPM for $2.5 million dollars for FY2012 to begin this planning process.

The Replacement of EMSThe Replacement of EMS There may be the opportunity to renegotiate the

scope of the vendors for MCSD and reallocate monies into an initiative to replace EMS.

What will be required in the planning phase? Maximization of federal financial participation through

approvable Cost Allocation methodology. Cost Benefit Analysis. The creation of an Advanced Planning Document (APD)

to obtain federal approval and federal financial participation.

The creation of a RFP. Identification of business requirements.

Utilize a contractor and DSS resources to support this process.

The Replacement of The Replacement of EMSEMS

The cost of the planning process is $2.5 million and assumes 50 – 90% federal reimbursement.

Costs for the replacement of EMS will be estimated in time for the Governor’s budget adjustment for SFY 2013.

The Replacement of EMSThe Replacement of EMS

There may be the opportunity to apply for federal reimbursement at the 90% level for parts of MCSD.

The planning process will identify these opportunities.

The Cost of Replacing EMS?The Cost of Replacing EMS? While we cannot estimate the total cost of

replacement of EMS, the most current information from other states expenditures run from $100 million to $300 million dollars. Recent examples from other states are included below. Michigan - planning started in 2004 and

implemented statewide in 2009. The original contract $70M plus.

Tennessee - planning started in 2004 and implementation has been delayed until 2012. Original contract around $50M plus.          

The Cost of Replacing EMS?The Cost of Replacing EMS? New Jersey - planning started around 2005,

the project is just getting started. Original contract $50M plus.

Wyoming – planning started in the early 2000’s and was aborted around 2008. Original Contract around $20M plus.

Los Angeles - estimating that it will cost $530M plus to replace its eligibility system.  The estimated start date for system development is this month.

New York - system cost nearly $330M.

The Cost of Replacing EMS?The Cost of Replacing EMS?

While it is important to consider other states examples, each eligibility management system is as unique as each Medicaid program.

There is an adage that says – if you have seen one Medicaid program, you have seen one Medicaid program.

What Do The Costs Include? What Do The Costs Include? New eligibility

management system for CT that can meet today’s and tomorrow's growing expectations.

Proven eligibility management system – clear examples of performance in other states.

Skilled and experienced support for development and implementation.

What Do The Costs What Do The Costs Include?Include? Integration of technologies available in the

public domain and proprietary technologies. Meets criteria set by CMS under the proposed

rule change “Ensure that States make appropriate use and

reuse of components and technologies available off the shelf or with minimal customization to maximize return on investment and minimize project risk”

“We intend to work with States to identify promising State systems that can be leveraged and used by other States”

What Do The Costs Include?What Do The Costs Include? Assurance that a new eligibility

management system can easily and cost effectively integrate with other technologies. Securely Timely Accurately

What If We Don’t Replace What If We Don’t Replace EMS?EMS?

It is unlikely we will be able to meet the demands of the ACA and the exchange.

The current pressures on the regional offices will expand. Resulting in… Federal penalties Inefficient eligibility processing

The system negatively affects the efficiency of business operations daily.

That being said Greatest impact is to the residents of

Connecticut that need access to the services DSS provides.

What If We Don’t Replace What If We Don’t Replace EMS?EMS?

We are unable to manage the expanding complexity of programs in EMS now.

Staying the course is no longer an option.

Snapshot of the Western region comparing 2008 and 2010. Staffing. Growth in applications. Growth in caseload.

StaffingStaffing Snapshot of Western Regional Offices

Monthly Application Activity Per Monthly Application Activity Per WorkerWorkerSnapshot of Western Regional Offices

Monthly Application Activity by OfficeMonthly Application Activity by Office Snapshot of Western Regional Offices

Assistance Units Per Worker – Active Assistance Units Per Worker – Active

CasesCases Snapshot of Western Regional Offices

Assistance Units by OfficeAssistance Units by Office Snapshot of Western Regional Offices

Percentage Increase in WorkloadPercentage Increase in Workload Snapshot of Western Regional Offices

DSS RecommendationDSS Recommendation

EMS is rigid and inefficient. EMS cannot meet today’s demands

and will not be able to support the expectations of the Affordable Care Act.

This is an unprecedented opportunity for enhanced federal funding.

Modernization will still go forward while exploring EMS replacement.

DSS RecommendationDSS Recommendation In government there are few moments

when there is leadership support, a political will and the ability to access new federal dollars to implement the change everybody wants.

This is one of those moments. Replacing EMS and accessing enhanced

federal funding to do so is an action item that will deliver efficiency, effectiveness and better service.

Changing The Face Of DSSChanging The Face Of DSS

Reference ListReference List Covington & Burling LLP. (2010). Covington & Burling LLP. (2010). ACA Advisory #55: CMS Proposal For ACA Advisory #55: CMS Proposal For

Enhanced Funding For Eligibility Systems. Enhanced Funding For Eligibility Systems. Retrieved December 17, 2010, Retrieved December 17, 2010, from from www.cov.comwww.cov.com

Department of Health and Human Services, Office of Consumer Information Department of Health and Human Services, Office of Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services. (2010). and Insurance Oversight, Centers for Medicare & Medicaid Services. (2010). Guidance for Exchange and Medicaid Information Technology (IT) SystemsGuidance for Exchange and Medicaid Information Technology (IT) Systems. . Retrieved December 17, 2010, from Retrieved December 17, 2010, from http://www.hhs.gov/ociio/regulations/joint_cms_ociio_guidance.pdfhttp://www.hhs.gov/ociio/regulations/joint_cms_ociio_guidance.pdf

HealthCare.gov. A federal government Website managed by the HealthCare.gov. A federal government Website managed by the U.S. Department of Health & Human ServicesU.S. Department of Health & Human Services. . Regulations and Guidance. Regulations and Guidance. Retrieved December 29, 2010, from Retrieved December 29, 2010, from http://http://www.healthcare.govwww.healthcare.gov

Jost, T. S.. Jost, T. S.. Health Insurance Exchanges and the Affordable Care Act: Eight Health Insurance Exchanges and the Affordable Care Act: Eight Difficult IssuesDifficult Issues. The Commonwealth Fund, September 2010. Retrieved . The Commonwealth Fund, September 2010. Retrieved December 17, 2010, from December 17, 2010, from http://http://www.commonwealthfund.orgwww.commonwealthfund.org

Kelly, Linda J. and McGee, Joseph J.. Kelly, Linda J. and McGee, Joseph J.. Malloy/Wyman Transition Team - Final Malloy/Wyman Transition Team - Final Report Of The Policy CommitteeReport Of The Policy Committee. January, 2011. Retrieved January 11, 2011 . January, 2011. Retrieved January 11, 2011 from from http://www.governor.ct.gov/malloy/lib/malloy/0-Executive_Summary.pdfhttp://www.governor.ct.gov/malloy/lib/malloy/0-Executive_Summary.pdf

Krigsmanm, M. Krigsmanm, M. Three truths of IT success.Three truths of IT success. April 5, 2010. Retrieved January April 5, 2010. Retrieved January 20, 2011 from 20, 2011 from http://www.zdnet.com/blog/projectfailureshttp://www.zdnet.com/blog/projectfailures

Legislative Program Review & Investigations Committee. (2004). Legislative Program Review & Investigations Committee. (2004). Medicaid Medicaid Eligibility Determination ProcessEligibility Determination Process. Retrieved January 3, 2010 from . Retrieved January 3, 2010 from http://http://www.cga.ct.govwww.cga.ct.gov