Overview of the Executive Office of Health and Human Services

This section describes the makeup and responsibilities of the Executive Office of Health and Human Services.

Overview

The Executive Office of Health and Human Services (EOHHS) is authorized by Section 16 of Chapter 6A of the Massachusetts General Laws and operates under the supervision and control of the Secretary of Health and Human Services, who is appointed by the Governor. Through its 16 departments,² EOHHS is responsible for providing a variety of human and social services to eligible citizens in the Commonwealth. In addition to providing some of these services directly, EOHHS departments also purchase services through contracts with a large network of private, mostly not-for-profit organizations. As of December 31, 2017, there were approximately 22,000 employees at EOHHS. EOHHS received state appropriations of $20,311,611,000, $21,024,779,000, and $21,690,283,000 for fiscal years 2016, 2017, and 2018, respectively.

The Department of Public Health (DPH), a department within EOHHS, was established by Chapter 17 of the General Laws. DPH’s day-to-day operations are overseen by a commissioner who is appointed by the Secretary of Health and Human Services with approval by the Governor. According to the DPH website,

DPH regulates, licenses and provides oversight of a wide range of healthcare-related professions and services. Additionally, the Department focuses on preventing disease and promoting wellness and health equity for all people.

As of December 31, 2017, there were approximately 3,000 employees at DPH. DPH received state appropriations of $548,954,000, $595,978,000, and $609,029,000 for fiscal years 2016, 2017, and 2018, respectively. These figures represent a subset of the EOHHS figures previously stated.

Virtual Gateway

The Virtual Gateway (VG) is an Internet portal designed to provide EOHHS agencies, state-contracted service providers and other community-based organizations, and the general public with online access to health and human-service information, including information about public benefits. The VG was launched in 2004 by EOHHS to serve as a single portal connecting all EOHHS agencies and was intended to streamline and standardize the public benefit application, eligibility determination, and referral processes for consumers. Although EOHHS could not provide us with the original contract for this system, the fact that it was intended to function as a single point of application for public benefits is supported by the “Request for Quotes for Consulting Services to Support the Intake, Eligibility and Referral Project,” dated January 26, 2004, which states,

This is a multi-year effort that will have semi-annual releases with the first release being June of 2004. This release will include (1) a common electronic intake form. . . .

Through this Request for Quotes, the Executive Office of Health & Human Services is procuring an IT consulting services firm to provide, on a fixed price basis: (1) the application development and implementation of (a) a common electronic intake form. . . . The programs that are targeted for the first release are: Mass Health, Children’s Medical Security Plan, Healthy Start, [Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)], Food Stamps, Child Care, Women’s Health, Substance Abuse Treatment and Free Care.

Further, the “Statement of Work between the Commonwealth of Massachusetts and Deloitte Consulting LLP” for the project, dated March 16, 2004, states,

Deloitte will be responsible for delivering the business services with [an] interface for Pre-Screening, Common Intake, Consents and/or Authorizations, and Application Tracking. The functionality and interface definitions of the above mentioned services will initially be developed and configured to satisfy the [Intake, Eligibility and Referral Project] Release 1 implementation requirements.

EOHHS officials told us that the VG provides access to a number of business systems primarily used for billing purposes by contractors responsible for providing services on behalf of the Commonwealth. Based on descriptions provided to us by EOHHS management, during our fieldwork we identified six main systems operating within the VG.

Systems Operating Within the VG

System	Purpose and Users
Eos	Used by DPH and state-contracted service providers to perform intake and provide benefits to WIC participants.
Minimum Data Set—Home Care	Used by health insurance companies to submit clinical assessments of elderly patients to the Office of Medicaid for reimbursement for those patients’ participation in senior care organizations or the Program of All-Inclusive Care for the Elderly.
Money Follows the Person	A five-year demonstration that ended on December 31, 2016. It was funded by a federal grant from the Centers for Medicare & Medicaid Services and used by the Office of Medicaid to assist elderly people, and people with disabilities, as they transitioned from facility-based care to the community.
Turning 22	An application added to the VG in 2017 that allows EOHHS to perform the planning process for young adults with severe disabilities as they leave special education and transition into the adult service system.
Veterans’ Annuity Program	Used by the Department of Veterans’ Services as a repository for documentation submitted by disabled veterans or by the parents or spouses of deceased veterans to receive annuities paid twice a year in recognition of the veterans’ service.
Women’s Health Network	Used by DPH as a clinical data management system to track outreach performed to make women aware of the need for screenings for breast and cervical cancer; data collected is shared with the federal Centers for Disease Control and Prevention, which provide funding for the program.

 

During our review of the functionality of the six systems described in the table above, and our meetings with VG system administrators, we determined that only one system, Eos, is used to process applications for public benefits. Eos is used by DPH and WIC providers³ to enroll WIC participants. WIC applicants cannot access Eos and must visit a WIC provider to apply for WIC benefits. Therefore, this part of our audit work focused on DPH’s use of this system as it pertains to its administration of individuals’ enrollment in WIC.

EOHHS officials are aware of the value of establishing a more integrated eligibility and enrollment system, as evidenced by the fact that on February 22, 2018, the agency issued a “Request for Quotes for an Integrated Eligibility and Enrollment Processes Consultant” to design an integrated eligibility and enrollment system:

Through this Request for Quotes (RFQ) EOHHS seeks a qualified vendor who will identify a solution that will provide an agency client [i.e., consumer] with an application experience for benefits at multiple agencies that feels like a single integrated process. Upon completion of this engagement (Phase 1) EOHHS may post a second [Request for Quotes] or [Request for Response] (Phase 2) to solicit a qualified vendor to implement the technology solution(s) identified in Phase 1. The vendor selected for Phase 1 shall be prohibited from bidding and participating in any way in Phase 2 RFQ.

The deadline for submitting quotes was March 30, 2018, and on June 28, 2018, EOHHS executed a $1.35 million contract with KPMG LLP for the design of an integrated eligibility and enrollment system.

WIC

WIC is a supplemental food program funded by the US Department of Agriculture (USDA) and administered by DPH. WIC provides supplemental food, healthcare referrals, and nutrition education to eligible women, infants, and children who are found to be nutritionally at risk. Eligible consumers are presented with a WIC electronic benefit transfer card at the end of the certification process. This card is loaded with the family’s approved benefits and can be used at specified grocery stores. Some categories of benefits specify the size of item that can be purchased but do not specify any particular brand, as with milk, cheese, eggs, and peanut butter. Other categories, such as whole-grain bread, pasta, or infant food, specify the brand and size that can be purchased. As a prerequisite for receiving federal funds for this program, DPH must submit a state plan to the USDA Food and Nutrition Service annually that details how DPH will administer WIC in accordance with federal regulations. The state plan must include program goals and objectives, budgeted administration and food costs, estimates of the number of participants, and details regarding participant eligibility.

To be eligible for WIC benefits through DPH, an applicant must be a Massachusetts resident, have a household income at or below 185% of the federal poverty level,⁴ and belong to at least one of the following qualifying categories:

• pregnant women (up to six weeks after the pregnancy ends)
• breastfeeding women (up to the infant’s first birthday)
• non-breastfeeding postpartum women (up to six months after the pregnancy ends)
• infants (up to their first birthday)
• children (up to their fifth birthday)

Participants are automatically considered income-eligible for WIC benefits if they receive Supplemental Nutrition Assistance Program⁵ (SNAP), Transitional Aid to Families with Dependent Children,⁶ or MassHealth⁷ benefits. To apply for WIC benefits, a consumer can visit a local WIC provider or initiate the application process online, at the DPH/WIC website; those who begin the application online must visit a WIC provider in person to complete the process. As of June 2018, there were 31 WIC providers managing 120 locations. WIC benefits are issued quarterly.

The average annual numbers of WIC participants during federal fiscal years⁸ 2016, 2017, and 2018 were 114,419, 112,763, and 108,593, respectively.

Data Sharing

EOHHS management explained to us that the VG is a portal designed to provide information hosting and management, but according to EOHHS legal counsel, EOHHS agencies cannot share applicant data with one another because each EOHHS agency has its own set of privacy rules and there are federal restrictions that prevent the agencies from sharing applicant information.

However, management at the state’s Department of Transitional Assistance (DTA), which administers SNAP, explained that DTA shares data with DPH, which performs matching to identify women and children who, based on their participation in SNAP and other demographic information, are eligible for, but not enrolled in, WIC. Management at DPH indicated that the Office of Medicaid shares data with DPH for people who are enrolled in MassHealth and meet the additional eligibility requirements of WIC. Each quarter, DTA and the Office of Medicaid provide DPH with a list of children (anyone under age five) and pregnant women who were enrolled in SNAP or MassHealth during the quarter being reported. DPH performs data matching⁹ by comparing the list of SNAP beneficiaries extracted from DTA’s Benefit Eligibility and Control Online Network information system, known as BEACON, to the WIC beneficiaries in Eos. DPH also compares the MassHealth beneficiaries extracted from the state’s Medicaid Management Information System to the WIC beneficiaries in DPH’s information system.

The data-matching process generates four reports: (1) a matched report listing women who were enrolled for SNAP benefits during the quarter and were also receiving WIC benefits, (2) a matched report listing children who were enrolled for SNAP benefits during the quarter and were also receiving WIC benefits, (3) an unmatched report listing women who were enrolled for SNAP benefits during the quarter but were not receiving WIC benefits, and (4) an unmatched report listing children who were enrolled for SNAP benefits during the quarter but were not receiving WIC benefits. The same matched and unmatched reports are generated as a result of the comparison between the reports of MassHealth and WIC beneficiaries. According to DPH officials, people who appear to be eligible for WIC benefits through the data-matching process are notified via mailed postcards.

WIC Provider Interviews

We conducted interviews at a sample of WIC provider locations to gather information related to Eos and to get WIC providers’ perspectives regarding any barriers to access to WIC benefits that may exist. During these interviews, WIC provider program directors, nutritionists, and administrative staff members discussed what they believed to be barriers; their responses are discussed in detail in the “Other Matters” section of this report.

WIC Participant Satisfaction Surveys Conducted by DPH

DPH solicits WIC participant feedback by conducting an annual participant satisfaction survey. We received and reviewed the results of the 2016 survey. DPH indicated that participant complaints from the survey were shared with local program management and discussed with them at annual budget negotiations. DPH also indicated that it takes the survey results very seriously and has worked to address customer-service issues to improve the WIC experience. Overall, the survey indicated that WIC participants are generally pleased with WIC.

2.    The departments are the Department of Children and Families, the Department of Developmental Services, the Executive Office of Elder Affairs, the Department of Mental Health, the Department of Transitional Assistance, the Department of Public Health, the Department of Veterans’ Services, the Department of Youth Services, the Massachusetts Commission for the Blind, the Massachusetts Commission for the Deaf and Hard of Hearing, the Massachusetts Rehabilitation Commission, the Office of Medicaid, the Office for Refugees and Immigrants, the Soldiers’ Home in Chelsea, the Soldiers’ Home in Holyoke, and the Board of Registration in Medicine.

3.    Although DPH is responsible for the overall administration of WIC, it establishes contractual business relationships with private entities operating out of freestanding offices (WIC providers) to execute the daily operations of the program, including processing applications, determining eligibility, and issuing WIC benefits to eligible people.

4.    The US Department of Health and Human Services annually publishes federal poverty guidelines based on family size and income that are used by various state and federal agencies to determine income eligibility for benefits. For example, for 2017 the federal poverty level was $16,240 for a family of two and $24,600 for a family of four.

5.    This program (formerly the Food Stamps Program) is administered by the Department of Transitional Assistance and provides nutritional benefits to eligible low-income people and families.

6.    This program is administered by the Department of Transitional Assistance and provides nutritional benefits to eligible low-income families with dependent children.

7.    The Commonwealth’s Medicaid program, known as MassHealth, is administered by EOHHS through the Office of Medicaid.

8.    The federal fiscal year runs from October 1 through September 30.

9.    The records from each information system are compared using date of birth and last name first. The two records are then considered matched if any four of the following six data fields are the same: first name, middle initial, address line 1, address line 2, city, and ZIP code. The two records are considered unmatched if fewer than four of the six data fields are the same.

Date published:	September 9, 2019