Case Study: Oklahoma Health Care Authority achieves real-time eligibility and $18M annual savings with InRule

Oklahoma HCA Delivers First Real-Time Eligibility System

The Oklahoma Health Care Authority (OHCA), Oklahoma’s Medicaid and CHIP agency, needed to modernize a legacy eligibility system that was slow, inconsistent, and limited to county office hours. Applicants could wait up to 30 days for a decision, and policy interpretation varied by county, creating data quality issues and access barriers. OHCA turned to InRule and its irAuthor rules authoring component to help retain control of business decisions while automating eligibility policy.

InRule helped OHCA build a web-based, fully automated, real-time eligibility determination system that lets applicants apply 24/7, streamlines verification and enrollment, and applies policy uniformly. The new system went live in September 2010 and delivered immediate eligibility decisions, more consistent policy application, and major cost savings. OHCA reported average savings of $4.5 million per quarter, or $18 million per year, and uninsured children ages 0–17 dropped from 17% in 2009 to 6% in 2011.

Oklahoma Health Care Authority (OKHCA)