Rules software speeds benefits

A Colorado official has programmed a rules engine to judge the eligibility of children from low-income families for Medicaid and the state's Child Health Plan Plus.

Al Hawker, CIO of Child Health Advocates, a state-affiliated nonprofit health organization in Denver, said his office's social workers use the ILOG JRules engine developed by ILOG Inc. of Mountain View, Calif.

'We wanted to modernize systems in Colorado,' Hawker said. 'That started the whole process.'

His organization tested ILOG Jrules against Virginia's browser-based Family Access to Medical Insurance Security system, which distributes Medicaid and other benefits to children from low-income Virginia families. Hawker said the rules management software substantially reduced time and errors in distributing benefits.

'The rules engine is accurate, and the idea of instant results is attractive,' he said.

During the software implementation, Hawker's staff had to enter the complex Medicaid and state benefit policies, then 'tell it how to do the thinking,' said Bob Cooper, ILOG's government-sector vice president.

The rules engine, in a Microsoft SQL Server relational database, prompts a social worker to ask parents of needy children a series of yes-no questions. Then the Jrules system analyzes the information and presents the eligibility status in real time to the social worker, Hawker said.

Ordinarily children wait weeks before receiving insurance benefits or money, Hawker said. Now they can learn their eligibility status on the spot.

'Most social services systems run some overnight batch process on a mainframe,' Hawker said. 'To operate this one, you just need an Internet connection and a browser.' Data transfer is protected by 128-bit encryption, and social workers use passwords to gain access.

Yes, paperwork

In the future, the same 128-bit encryption could let clients file their information online, Hawker said. But some states, including Colorado, require a hard copy of parents' income statements and a signature at the time of eligibility testing. A digital signature application would be necessary for online filing, however.

Colorado officials are now considering the rules-management software for 34 of the state's other eligibility programs, he said.

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