CALIFORNIA HEALTH ELIGIBILITY, ENROLLMENT AND RETENTION SYSTEM (CALHEERS) PROJECT, Office Of Systems Integration (OSI)
California Department of Health Care Services (DHCS)
California’s Medi-Cal Eligibility and Enrollment business process serve over 13M Medi-Cal Members with an annual Medicaid budget of $90 billion. The Eligibility and Enrollment business process is complex and spans across multiple systems – three SAWS (CIV, LEADER, CalWIN), MEDS, EDD, FTB, SSA, and USCIS etc. Adding the new Health Benefit Exchange to the existing business process made significant changes to the business process models and compounded the data exchange complexities. Moreover, the CalHEERS goal for real-time eligibility determination caused service enablement of the existing legacy system partners to deliver business functions in real-time.
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