Child Care Administrator’s Improper Payments Information Technology Guide

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B. Profile of System Solutions (continued)

2. Eligibility Determination and Case Management Systems

Many States automate child care intake, eligibility determination, and case management functions to increase accuracy and timeliness. Automated case management systems perform several functions, including:

• Collecting demographic data;
• Calculating eligibility determination;
• Enforcing program policies;
• Tracking the eligibility periods; and
• Sending notifications to clients and workers.

Workers or clients may enter data into the application. The system verifies the data by integrating internal and external data sources to verify information and perform an eligibility calculation.

a. How the Solution Addresses Improper Payments

The solution addresses the challenges of preventing and identifying improper payments by:

• Eliminating eligibility calculation errors;
• Using system edits to prevent data entry errors;
• Interfacing with other program automated systems to verify eligibility information;
• Tracking eligibility timeframes and triggering recertification notices; and
• Voiding payment authorizations for any non-licensed or closed provider facility.

b. Example System Names and States

Keying in Data Accurately, Reliably, and Efficiently (KIDCare), Arkansas

Kansas System for Child Care and Realizing Economic Self Sufficiency (KsCARES), Kansas

c. Implementation Overview

KIDCare ( Arkansas)

The Keying in Data Accurately, Reliably, and Efficiently (KIDCare) system was implemented in July 2005 as part of Arkansas’ effort to improve program integrity and reduce improper payments in the child care subsidy program. KIDCare system functionality includes:

• Up-front error checking through built-in edits;
• Interfacing with external data sources, including TANF and the Social Security Administration (SSA) databases;
• Tracking the eligibility period for clients; and
• Excluding payments to non-approved or closed child care providers, even if a participant received services at the facility.

KIDCare maintains interfaces to the systems supporting the State’s TANF, Child Support and Social Security Administration (SSA) programs in order to verify Social Security Numbers (SSNs) or other reported income information. Accessing data from other program sources during eligibility determination and re-determination allows workers to reduce the use of fake SSNs, and to verify current reported income.

KIDCare improves the accuracy of eligibility determination through the following system functionality:

• Uses program-specific guidelines to accurately determine eligibility;
• Triggers re-determinations for clients when changes occur that affect eligibility;
• Tracks case status, program and periods of eligibility;
• Provides interfaces with other systems, reduces data entry, maintains data integrity, and validates information;
• Facilitates business processes for workers and supervisors by using system alerts, which are messages sent to workers either on-screen or via email that inform them of required actions; and
• Supports worker activities and provides management with critical data by providing reports and notices.

KIDCare also supports budget management by automatically formulating and allocating funds for 75 counties. The system prevents expenditures that exceed allocated amounts assigned to each local jurisdiction, yielding significant time savings for State staff.

KIDCare uses a server-client configuration and uses SQL Server and Visual Basic software.

KsCARES ( Kansas)

The Kansas System for Child Care and Realizing Economic Self Sufficiency (KsCARES) has played a significant role in preventing and identifying improper payments in the subsidized child care program. Kansas obtained the system from Wyoming and then modified it extensively to fit its policy requirements.

KsCARES has extensive edits that help enforce policies and perform the calculations used for eligibility determination, including:

• Indicating whether income is countable based on income type;
• Enforcing maximum hours for child care service plans during a month;
• Preventing duplicate benefit issuances; and
• Determining the reimbursement rates automatically, based on the child's age, provider's individual rate, and the State’s maximum rates.

In addition to strengthening the eligibility processes, KsCARES offers helpful reporting and case management capabilities that assist in identifying improper payments and managing claims against improper payments. KsCARES tracks both case eligibility and payments and then automatically runs reports to identify possible instances of overpayment when benefits are issued for extended periods of time (e.g., beyond eligibility re-determination) or after a case is closed. Once Kansas identifies an improper payment, KsCARES provides functionality to establish and track claims.

The software and hardware used by the KsCARES includes Natural, COBOL programs, IBM mainframe, and ADABAS Database Management System (DBMS).

d. Costs

KsCARES cost an estimated $2.3 million to develop.

Arkansas was not able to provide development costs.

e. Challenges

Training and meeting accessibility requirements constitute two important implementation challenges. To effectively use the system, all existing staff and any new staff must participate in hands-on KsCARES training. Additionally, the State continues to enhance the system to meet the accessibility requirements contained in Section 508 of Rehabilitation Act.

KIDCare was designed to consider the management of the child care budget process, including allocating all child care funds across counties, using an allocation formula. A design challenge was to allow prioritized spending of funds while tracking allocated, obligated, available, billed, and paid funds. Another challenge was to ensure compatibility with the State’s accounting system, the Arkansas Administrative Statewide Information System.

f. Benefits

Solution benefits include:

• Automating rate determinations to prevent many payment errors;
• Reporting to enable staff to identify possible payment errors after benefit issuance; and
• Eliminating manual processes related to eligibility determination, monitoring, and claims tracking.