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Integrated Eligibility and Enrollment (IE&E) System

Integrated Eligibility and Enrollment (IE&E) Summary

Vermont's Integrated Eligibility and Enrollment (IE&E) Program envisions a world in which eligible Vermonters have a simple and easy way to apply for, access, and maintain healthcare and financial benefits without coverage gaps. The IE&E Program seeks to implement a new IE&E system to ensure Vermonters have a personalized, welcoming, and comprehensive enrollment experience. The IE&E System Modernization (IEESM) approach includes expanding current system functionality to allow for functional enhancements. Functional enhancements include a user-centric customer-facing access point that ensures Vermonters have access to all applicable services and a single system for State staff to access health and financial benefits information.  

The IE&E Program will pursue a phased, modular procurement strategy to implement a “customer-focused” system that starts with a Customer Portal, Case Management, and Rules Engine. The IE&E Program will build the new IE&E system outside legacy systems to ensure systems and services remain intact as new functionality is delivered. The IE&E Program will ensure that the new IE&E system is extensible for future scalability and flexibility, leverage new and existing technologies, comply with relevant State and Federal laws and regulations, and provide maximum value for customers, staff, and taxpayers. The IEESM implementation approach will deliver incremental and timely business value and improved customer experience outcomes for Vermonters and state staff. 

Program Overview 

Approximately 1 in 3 Vermonters each year rely on the State to provide economic and healthcare benefits. Many operational and technical inefficiencies exist today, leaving Vermonters with an eligibility and enrollment experience that needs to be more cohesive, coordinated, and manageable. Vermonters applying for benefits must submit the same information multiple times and deal with call centers with limited access and coordination across programs. Vermonters sometimes need help understanding what information they need to provide, and sharing information is challenging. Vermonters face lengthy approval timelines and confusing information and cannot apply for all benefits simultaneously. State staff also face challenges as they deliver these services as processes are very manual and labor intensive, and customer information exists across multiple systems.

The IEESM approach will optimize eligibility, enrollment, and member management functionality for all in-scope programs from current eligibility and enrollment systems. The IE&E system will be composed of functional modules allowing Vermonters to apply for and receive health coverage and financial assistance benefits through a user-centric access point that is personalized, welcoming, and comprehensive.