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Optum Integrated Eligibility Services

Our pre-built, modular platform provides an integrated solution for all Health and Human Services (HHS) programs and State Insurance Exchanges to create a seamless experience for clients.

Looking for hCentive? hCentive state-based insurance exchange and Medicaid eligibility technology are now part of Optum.

Our flexible, services-based platform scales to meet your state's needs. Across the enterprise, our solution provides a single online application for all programs, and staff with visibility into client enrollment across programs. We help reduce administrative inefficiencies and improve client experiences.

Optum Integrated Eligibility

Solution Models

Intake Assessment Module

Clients use a single online application for all HHS programs, including Medicaid, SNAP, TANF, CHIP and state insurance exchange qualified health plans (QHPs). Our user-friendly registration and change-of-circumstance processes save time and reduce errors, while creating a streamlined eligibility experience for clients. 

Enrollment Module

This module offers real-time processing and enrollment management, including overrides, redeterminations, renewals and more. It also integrates with QHPs unique to each state. This eliminates the need to build a separate state insurance exchange.

Eligibility Determination Module

This configurable rules engine is pre-loaded with federal rules for HHS programs, including Medicaid, SNAP, TANF, CHIP and state insurance exchange QHPs. This module offers benefit screening and full eligibility determination.

Benefit Management Module

Benefit managers work through a single, configurable dashboard and workflow tool. Our agency portal enables staff to view case and client application details and manage the complete lifecycle of the case. That includes determination, change of circumstance and more.

State Insurance Exchange QHP Shopping and Plan Management Module

This module provides the additional functionality to fully administer and manage state insurance exchanges as an integrated part of your eligibility infrastructure. There is no need to build a separate website or back-end system to manage QHPs. Our module also provides marketplace shopping for consumers to identify and compare plans.

Reporting and Analytics Module

Our solution integrates data from all agencies, programs and state insurance exchanges. This enables states to gather and report analytics to help improve processes and services and better understand multiprogram service use and costs.

Benefits of Our Solution

Configurable, flexible, efficient

Our pre-built, modular solution can be easily configured to your state. Our platform allows you to roll out capabilities incrementally. This gives you time to address organizational change while gaining immediate processing benefits.

Unparalleled insurance exchange experience

We have a proven track record helping HHS agencies turn around projects and deliver on results. We were the data services hub contractor and special advisor for We also assisted six states in improving the performance of their health insurance exchanges.

Your trusted partner

As your trusted partner, we are dedicated to delivering successful integration services to your state on time and on budget. We are experts in interoperability and data analytics. That means we have the experience and expertise to address the program issues of today, while providing strategic support for your agency goals as you look to address the issues of tomorrow.