Washington state's Public Assistance Reporting Information System (PARIS) allowed them to identify war veterans who were enrolled in Medicaid but not taking advantage of federal veterans' benefits. The state then notified them of the benefits to which they were entitled, and moved them off of state Medicaid and onto federal programs.
Since 2004, Washington state has saved more than $30 million using this system, while helping veterans get access to more comprehensive care.
History of PARIS
PARIS, a 20-year-old system operated by the U.S. Department of Health and Human Services’ Administration for Children and Families, was originally intended to help states identify Medicaid recipients who were cheating the system by applying for benefits in multiple states.
In 2002, Bill Allman, then an employee of the Washington Department of Social and Health Services, began looking for a way to see if the veterans he was helping were eligible for federal veterans' benefits.
The information he was looking for was in PARIS. Using the system in a way no one had thought to try before, Allman, now the president of PARIS, realized savings for his state and greater benefits for the veterans he was helping. Allman launched the Veterans Benefit Enhancement Project, now a core component of PARIS. He now advises more than 30 states looking to realize the same savings he found for the state of Washington.
“Medicaid dollars, particularly long-term medicaid dollars, are going up at the rate of 200 to 250 percent," Allman said. "By 2015, it will go up by 300 percent."
As Medicaid costs rise and an increasing number of veterans are unable to pay back their long-term care Medicaid loans, the state is often forced to put liens on veterans' homes. There's no reason for veterans to be put in a position like that, Allman said, especially when they may not need to be on Medicaid in the first place. “When we tell them about the benefits they're entitled to, they always say the same thing,” Allman said. “They say, 'Why did no one tell me about this before?'"
Following the PARIS mandate
All states are now required to participate in PARIS, per a 2010 mandate from the Centers for Medicare and Medicaid Services. Naturally, states want to get the most out of the system they are required to use, by following Allman's lead. “I want every state to do this,” Allman said. With the Affordable Care Act, Allman pointed out, states will need to offer health care options to all citizens anyway, so it would be in the states' best interest to shift some of the support to the federal level.
California ran a pilot program from 2009 to 2011. Limited to a handful of counties, the pilot focused on veterans classified as 100 percent disabled, saving the state $1.6 million. A report on the pilot deemed the program cost-efficient and suggested that it be expanded.
One of the biggest challenges in California was dealing with large sets of overlapping data. While more than 16,000 matches were initially identified as potentially eligible to be moved to federal benefits, duplicates and other complications reduced that number to just 4,000. Of those, just 990 veterans were contacted to gather further information on their eligibility. In the end, just 24 veterans were taken off Medi-Cal and moved to federal benefits. The savings to the state were significant, however, and the veterans also benefitted as they could now pay living expenses with VA benefits, which never need to be repaid.
The program continues to be effective in California, but Manuel Urbina of the California Department of Health and Human Services Medi-Cal Eligibility Division said the state needs dedicated personnel in order to expand implementation. “For this to be successful,” Urbina said, “the state experience has been that you need people to do dedicated case management. ... The return on investment equation is there. We didn't invest hardly anything, and we got this large return, so the potential is there.”
Additional outreach needed
What the Veterans Benefit Enhancement Project does is very basic, Allman said. The program is simply identifying veterans who would benefit from federal funding and then educating them. The problem for states is identifying who those veterans are. A report by the U.S. Government Accountability Office (GAO) found that 62 percent of veterans may be eligible for enhanced monthly VA benefits, but only 22 percent of veterans receive those benefits. The GAO recommended that the VA conduct more focused outreach to educate veterans in order to address the disparity.
“It bothers me that states don't do outreach on their own or that the VA doesn't do some kind of national campaign to help veterans understand what the benefits are,” Allman said. “So I think it's up to the states to do the outreach for the VA.” Being a veteran himself, and passionate about helping people, Allman said that the money states can save through this program has always been a secondary consideration to him. He concedes, however, that the potential savings is compelling motivation for states to educate their veterans and consider adopting his system.
