State agencies running eligibility programs face persistent challenges. Application volumes ebb and flow throughout the year, and workers are hard to find, train, and keep. Federal compliance regulations must be followed strictly to secure maximum federal dollars and maintain funding. For one state agency, North Highland deployed a scalable, “hands-on” workforce solution that improved state eligibility timeliness from the bottom half to the top quarter of all states.
The Challenge
A state Health and Human Service agency faced mounting federal pressure. Eligibility processing times had climbed well above federal standards, ranking the state in the bottom half nationally. This put hundreds of millions of dollars in federal matching funds at risk.
The agency faced a significant workforce gap and had spent a full year attempting to hire internally without success. Beyond the immediate capacity crisis, the agency needed to sunset legacy systems requiring manual conversion of over 100,000 records while managing increased eligibility demand.
All operations had to run remotely with no physical office space available. The agency needed a partner who could scale rapidly, maintain quality, and operate with minimal oversight.
Our Approach: A Replicable Model for Eligibility Operations
Predictive planning enables proactive capacity management.
North Highland developed a statistical forecasting model that predicted eligibility demand months in advance—accurate to within 5%. This approach, now used by multiple states, enables agencies to plan proactively rather than react to backlogs. The state used this model to support funding decisions and inform ongoing capacity planning.
In an effort to clear up the massive state backlog, the state asked North Highland to rapidly scale up to over 500 remote workers with an expectation to keep accuracy high through multi-modal training and embedded quality feedback. The program was scaled from managing one work type to twelve, demonstrating the flexibility required for today's complex eligibility environments. Performance climbed to 95% accuracy and held steady, matching experienced state workers. This approach has application across eligibility programs where quality and compliance are non-negotiable.
Intentional culture-building reduced turnover in a fully remote environment, creating workforce stability that's critical for sustained performance
When the team discovered cases languishing 100-200 days in queues that state workers couldn't access, North Highland researched root causes, trained staff, and cleared the backlog. The team also proactively identified opportunities to optimize federal funding matches. Combined, these insights reduce administrative burden and maximize available resources.
The impact on state staff was minimal with North Highland managing day-to-day operations of our team including training, quality assurance, and performance reporting. This model allows agency staff to focus on policy and strategic priorities more than operational management.
The Value
The state jumped 13 spots in CMS timeliness rankings. Processing times dropped by 73% in the first year, then improved by another 59% the following year for MAGI redeterminations. This preserved hundreds of millions in federal funding while demonstrating operational excellence.
The numbers tell an important story: 870,000+ cases processed at 95% accuracy. But the impact runs deeper. While managing demand surges, the team converted 100,000+ beneficiaries from legacy systems, completing a migration that has been overdue for a decade.
Recognizing these successes, the state continues to engage North Highland for ongoing eligibility support. With North Highland’s support, the agency has developed a forecasting model and training infrastructure, empowering independent capacity decisions. This customizable model is now used by other states to support federal funding requests and inform capacity planning.
This engagement demonstrates that agencies can transform eligibility operations under pressure, moving from compliance risk to operational excellence. The model is also replicable across HHS programs and states facing similar challenges.
Applications Across Eligibility Programs
State agencies are consistently facing the same challenges with eligibility operations: federal compliance mandates, workforce shortages, technology transitions, and volume unpredictability. North Highland’s approach addresses all four by combining workforce deployment with analytical problem-solving and comprehensive program management, all while operating with minimal client burden.
SNAP Payment Error Reduction
States face mounting federal pressure to reduce SNAP payment error rates. The same scalable workforce model, quality assurance processes, and accuracy standards demonstrated here apply directly to SNAP eligibility operations. When federal penalties threaten state budgets, proven execution combined with minimal administrative burden makes the difference. North Highland's approach has helped states address eligibility backlogs while meeting error reduction targets.
Medicaid Eligibility Operations
Rapid capacity scaling while maintaining CMS accuracy and timeliness standards. The model deploys trained teams that match state worker performance from day one, allowing agencies to meet timeliness standards without multi-year hiring and training cycles.
Quality Assurance and Compliance Reviews
Flexible, trained teams address audit backlogs of reviews mandated by CMS and maintain oversight standards. The approach adapts to changing priorities while sustaining quality—critical for programs under federal scrutiny.
Facing eligibility operations challenges? Contact North Highland to discuss how this proven workforce model can help your state improve timeliness, maintain quality, and build sustainable capacity across Medicaid, SNAP, and other eligibility programs.
