Editor’s Note: In a new legislatively-mandated report for the Hilltop Institute at the University of Maryland at Baltimore County, Manatt Health:

  • Presents an overview of current entry points into health and human services in Maryland, focusing primarily on Medicaid and Marketplace coverage;
  • Describes promising approaches that other states are adopting to provide efficient, coordinated access to health coverage and social service programs; and
  • Offers recommendations for improving access to health coverage programs in Maryland and for reducing inefficiencies.

The article below summarizes key findings and highlights. Click here to download a free copy of the full report. ____________________________________

Inventory of Current Entry Points

Maryland residents can apply for health coverage and social service programs through a broad number of “entry points,” including through online websites operated by the Maryland Health Benefit Exchange (MHBE) and Department of Human Resources (DHR); by contacting a call center; or by receiving assistance from local health department staff, local department of social services staff, navigators, certified applications counselors, hospitals or insurance brokers. The wide array of entry points gives consumers many different opportunities to apply for and renew coverage, and allows them to select an approach consistent with their personal circumstances and needs.

While these efforts contribute to a smoother enrollment experience for Maryland consumers, at the same time, Maryland families still often must work with multiple entry points, if they happen to have members who qualify for coverage on different grounds or require both healthcare and social services. This imposes an administrative burden on Maryland residents and, as importantly, may result in the state expending unnecessary resources to gather and verify information on multiple occasions from the same applicant.

Best Practices

As in Maryland, states around the country are taking a new look at how best to improve and coordinate enrollment into health and social service programs. To identify best practices, we drew on published literature, as well as interviews with officials in Colorado, Idaho, New York and Michigan to identify best practices. The best practices identified include:

1. Fundamental organizational and cultural change

  • Establish unified oversight of health and social service programs and a consolidated eligibility and enrollment system.
  • Pursue a paradigm shift away from program-to-program eligibility determinations to a consumer-centric approach.
  • In a unified system, preserve consumers’ right to choose elected health and social service programs.

2. Alignment of policies across programs

  • Align definitions and requirements across programs.
  • Establish automatic linkages in eligibility between health and social service programs.
  • Align the timing of renewals or automatic renewals across programs.

3. Improvement of business processes

  • Empower eligibility workers to provide same day, “end-to-end” service.
  • Establish protocols that facilitate coordinated handoffs across programs.

4. Integration of IT systems

  • Implement an integrated eligibility system.
  • Implement a shared platform to reduce duplications and streamline eligibility and enrollment processes across programs.
  • Consider more discrete IT tools to create efficiencies across programs.

5. Data analytics to drive performance improvement

  • Collect and analyze program data for continuous improvement.


Based on the analysis of Maryland entry points and emerging best practices in other states, the report identifies a series of recommendations for further improving the efficiency and effectiveness of entry points to Maryland’s health coverage programs. Some of the recommended efforts already are under active consideration or slated to occur, while others may require a significantly longer timeline for implementation.

1. Establish a task force on coordination of health and social service programs.

The task force should be dedicated to sustaining and strengthening cross-agency collaboration on improving coordination across health and social service programs. It should build on and leverage existing coordination efforts and should be led out of the governor’s office to facilitate cross-agency participation.

2. Establish key performance metrics on access to health and social service programs and provide for public reporting.

The metrics should include basic data on applications, renewals and use of various entry points for health and social service programs, as well as measures that capture the effectiveness of coordination across programs.

3. Establish a seamless approach to evaluating an individual for all forms of Medicaid eligibility (i.e., both Modified Adjusted Gross Income (MAGI) and non-MAGI Medicaid).

Maryland should work toward a seamless eligibility and enrollment experience for individuals seeking both MAGI and non-MAGI Medicaid, minimizing the need for handoffs between systems and consumer assistance workers.

4. Create a data platform to facilitate data exchange between health and social service programs.

The state should pursue a shared data platform that can facilitate information sharing across health and social service programs.

5. Create an automatic eligibility linkage between Temporary Assistance for Needy Families (TANF)/Supplemental Nutrition Assistance Program (SNAP) and Medicaid.

Use the option available under federal law to automatically provide Medicaid to TANF and selected SNAP recipients, eliminating the need for them to undergo a separate determination of eligibility for health coverage.

6. Review the role of eligibility workers and other assisters to provide a seamless experience to consumers.

Conduct an assessment of the role of navigators and eligibility workers in all agencies to determine if their responsibilities could be modified or expanded to provide consumers with a more seamless experience that allows them to apply for coverage, receive an eligibility determination, and enroll in a specific plan during a single session.

7. Provide Medicaid beneficiaries with the ability to select a Medicaid managed care plan through the Maryland Health Connection (MHC).

Implement plans to modify MHC to allow consumers found eligible for Medicaid to select their managed care plan, eliminating an unnecessary delay in the initiation of managed coverage.

8. Systematically build referrals and “warm handoffs” between the Department of Human Resources, the Maryland Health Benefit Exchange and the Department of Health and Mental Hygiene.

Conduct a review of how to improve handoffs when consumers must be referred to a different agency, systematically identifying when and how such referrals should be conducted.

9. Establish unified back-end systems for customer relationship management and documentation storage for health coverage programs.

Establish a single, unified customer relationship management system for health coverage programs that can be used by navigators, call center staff, local health departments, and local departments of social services, so they can provide coordinated services to consumers. In addition, establish a unified system for storing documentation and other eligibility information for health programs.


Maryland has established a strong platform from which to continue to improve health and social service programs. It is clear, however, that more could be done to improve the entry points, creating a more efficient and consumer-friendly way to enroll people in coverage and social service programs.

As they proceed policymakers will need to be mindful of the potential for shifts in the federal government’s willingness to finance eligibility and enrollment systems and other changes given the priorities of the new Trump administration and Congress. Even so, Maryland should be able to continue making significant strides in efficiently providing consumers with access to health and social service programs, drawing on best practices from other states and its own rich history and experience.