The Louisiana Department of Health (LDH), Bureau of Health Services Financing, may have a requirement for an Eligibility and Case Management System.

The following information is sourced from the Request for Information (RFI) document and is subject to change upon the release of a formal solicitation.

INTRODUCTION AND PURPOSE

The Louisiana Department of Health (LDH) is issuing this Request for Information (RFI) to identify solutions that can provide a technology platform for determining eligibility and managing cases across multiple human services programs. LDH seeks to gather information from interested vendors, stakeholders, and other entities regarding capabilities, implementation approaches, pricing models, and solutions. This RFI is exploratory and non-binding. LDH encourages all capable parties to respond, regardless of company size or market share.

BACKGROUND

LDH is committed to modernizing eligibility and case management systems to prioritize accuracy, operational efficiency, rapid adaptability, and the resident experience. We welcome vendors who can contribute to these goals, whether through full system solutions or component technologies.

If your company is focused on agility, speed to market, innovation, low-code configurability, and user-centered design, we want to hear from you. This is your opportunity to help shape the future of health and human services in Louisiana.

The following information is sourced from the Request for Information (RFI) document and is subject to change upon the release of a formal solicitation.

SCOPE OF SERVICES

LDH is seeking solutions that are focused on achieving the following outcomes:

• Improved Resident Access & Experience: A seamless, single point of entry for all social services, reducing barriers, improving satisfaction, and empowering residents on their journey toward independence. Multimodal communication tools, including text messaging and secure chat.
• Enhanced Operational Efficiency: Streamlined workflows, reduced manual effort, and improved data accuracy for LDH staff, leading to increased productivity and reduced administrative burden.
• Better Data-Driven Decisions: Access to timely and accurate data for policy decisions, program effectiveness and accuracy, and resource allocation, enabling proactive management and forecasting.
• Maximized Federal Reimbursement: Accurate time tracking and reporting to optimize federal funding opportunities.
• Future-Proof Technology: A flexible and adaptable platform that can evolve with changing program needs and technological advancements. Use of Artificial Intelligence to improve staff and resident efficiency, detect fraud, waste, and abuse, and identify trends.
• Cost-Effective Ownership: Solutions that are inexpensive to modify and maintain over their lifecycle, with a focus on configuration over customization.
• Specific SNAP Reporting: Capability for robust tracking and reporting on SNAP Error Rates, including identification of common error causes and trends to support federal compliance and reduction efforts.
• Proactive Fraud, Waste, and Abuse Prevention: Robust tools and analytics to proactively detect, mitigate, and prevent fraud, waste, and abuse, improving program integrity and ensuring optimal use of resources.

The desired solution may manage eligibility determination, and, where applicable, case management and fraud, waste and abuse for the following programs and others as determined by the Department. The solution may be unified or component-based.

• Children’s Health Insurance Program (CHIP) Eligibility & Case Management
• Disaster Supplemental Nutrition Assistance Program (DSNAP) Eligibility & Case Management
• Family Independence Temporary Assistance Program (FITAP) Eligibility
• Home and Community-Based Services (HCBS) Waivers Eligibility & Case Management
• Kinship Care Subsidy Program (KCSP) Eligibility
• Long-Term Care (LTC) Eligibility & Case Management (including Nursing Home Vendor Assignments)
• Louisiana Combined Application Project (LaCAP) Eligibility
• MAGI-based Medicaid Eligibility & Case Management
• Non-MAGI-based Medicaid Eligibility & Case Management
• SNAP Employment & Training (SNAP ENT) Eligibility
• SNAP SunBucks Eligibility & Case Management
• SSI-Related Medicaid Eligibility & Case Management
• Supplemental Nutrition Assistance Program (SNAP) Eligibility & Case Management
• Supportive Training & Employment Program (STEP) Eligibility

Questions

1. Which states or jurisdictions are seen as leaders in eligibility modernization or innovation, and why? What can Louisiana learn from their approaches?
2. What are the most critical early investments or decisions a state can make to ensure long-term sustainability and cost-effective operations post-implementation?
3. What procurement approaches (e.g., modular procurement, ecosystem RFPs, outcome-based contracting) have proven effective for states undertaking similar transformations?
4. Aside from transferring an integrated system from another state and customizing it, or customizing one of the state’s existing eligibility systems, what other approaches could Louisiana adopt to migrate from the current systems to a coordinated enterprise?
5. What are the pros and cons of integrated “one system” solutions vs. modular or federated ecosystems, based on what you’ve seen across jurisdictions?
6. What functions could be stand-alone vs. needing to be tightly coupled and/or procured from the same source? (e.g. portals, verifications, business rules engine)
7. What are common pitfalls or barriers that states encounter when trying to modernize multiple eligibility and case management systems? How can they be avoided?
8. How have other states balanced the speed of delivery with the need for stability and quality? What iterative delivery approaches have worked well in complex benefit systems?
9. What are the most effective transition strategies you’ve seen when moving from legacy to modern eligibility systems, particularly when consolidating programs?
10. What innovative capabilities should Louisiana consider now to future-proof the system (e.g., digital assistants, predictive analytics, rules as code, no-code configuration tools)?
11. What are the top 3 innovations in the past 3-5 years that improve system performance, reduce system maintenance and enhancement costs, improve user experience, and/or drive process efficiency, and where have they been implemented?
12. What emerging technologies or methodologies in the eligibility system marketplace have proven most effective for proactively detecting fraud, waste, and abuse (FWA)?
13. Where can artificial intelligence and generative AI play a role in simplifying and streamlining benefit delivery?
14. In what ways is artificial intelligence (AI) or machine learning (ML) being used successfully in eligibility systems to proactively identify suspicious patterns or activities related to FWA?
15. In what ways are you fine tuning the use of AI to prevent issues with bias, fairness, or explainability?
16. In what ways can AI support a more efficient, accurate, and cost-effective transition of legacy code and data to a modern platform?
17. What trends in SaaS and PaaS platforms are enabling states to modernize faster, with less customization and lower overall costs?
18. What design choices (e.g., centralized vs. distributed intake, mobile-first vs. desktop-first design, layered vs. unified data models) have significant tradeoffs? What should Louisiana consider before deciding?
19. What are industry best practices for navigating the complexities and challenges of effectively utilizing the Federal Data Services Hub across multiple eligibility programs, particularly when managing policy restrictions around cross-program information access and usage?
20. What best practices or innovative models exist in the marketplace for cross-program data sharing, balancing efficiency, resident experience, and regulatory compliance, particularly in environments serving multiple health and human services programs?
21. What are the current best practices in reporting and analytics capabilities across eligibility and case management systems for managing and addressing FWA?
22. How are states and jurisdictions leveraging eligibility system integration with external data sources or cross-agency data sharing to strengthen FWA detection capabilities? What best practices exist in this area?
23. What role does user-centered design play in large-scale eligibility systems today? What’s the most effective way for Louisiana to involve residents and eligibility staff in design and testing?
24. From both an eligibility worker’s efficiency perspective and a resident’s access perspective, what are the most critical functional components of an eligibility system that should be combined with these programs?
25. How are states training and supporting eligibility workers during major system transitions to maintain productivity and morale?
26. What training strategies, staff development resources, or change management approaches are proving most effective for enhancing staff capacity to detect, manage, and mitigate FWA during significant system transitions?
27. What is your recommended approach for managing parallel operations during the transition to ensure continuity of service for residents and staff?
28. What does a mature, data-driven eligibility operation look like, and what capabilities or investments help states get there?
29. What lessons learned or best practices can you share from past statewide implementations, especially in multi-program environments?
30. What opportunities and challenges exist for Louisiana to pursue a co-tenancy model, sharing an integrated eligibility system with one or more other states, to successfully structure governance, cost allocation, data security, and customization?
31. What KPIs and performance monitoring framework do you recommend for an integrated eligibility system, and how should Louisiana structure dashboards, reporting, and continuous improvement mechanisms to ensure measurable benefits over time?
32. What is your approach to implement and test accessibility throughout the design and development processes to remain compliant with Section 508 Amendment to the Rehabilitation Act of 1973? Specifically, all web content (not subject to exception from the DOJ final rule [28 CFR Part 35, Subpart H]) must comply with Web Content Accessibility Guidelines (WCAG) 2.1, Level AA.
33. What is your approach to using open APIs, data standards (NIEM, HL7 FHIR), or event-driven design in your system design?
34. Describe your use of CI/CD pipelines, automated testing, or DevSecOps practices in your development and deployment processes.
35. Describe your approach to portability, modular replacement, or exit strategies to prevent long-term vendor lock-in.

Desired Technical Capabilities