Common use of Indirect Benefits Clause in Contracts

Indirect Benefits. Greater Public Confidence and Program Support. Automation promotes cost efficiencies and program integrity, increasing the taxpaying public’s confidence in and support for these public assistance programs. Reductions in erroneous payments and increased collections enable states and the Federal Government to devote dollars to intended recipients. All fifty states, the District of Columbia, and Puerto Rico participate in PARIS. Comparative data for the four previous quarterly matches shows the following substantial match activity: August 2018: File SSNs submitted Matched SSNs Interstate (51 states) 67,113,342 603,1155 Veterans (38 states) 9,098,732 385,617 Federal (44 states) 9,247,604 62,407 Total matched SSNs 1,051,179 May 2018: File SSNs submitted Matched SSNs Interstate (45 states) 65,478,597 563,326 Veterans (34 states) 9,004,569 340,835 Federal (35 states) 11,230,678 70,612 Total matched SSNs 974,773 Feb 2018: File SSNs submitted Matched SSNs Interstate (49 states) 71,428,973 618,949 Veterans (45 states) 8,908,310 427,898 Federal (35 states) 11,341,098 75,609 Total matched SSNs 1,122,456 Nov 2017: File SSNs submitted Matched SSNs Interstate (50 states) 65,461,419 553,611 Veterans (42 states) 8,815,613 399,480 Federal (41 states) 11,322,110 85,589 Total matched SSNs 1,038,680 The August 2018 federal file breakdown was: FILENAME # of SSNs Submitted DoD Civilian Personnel 732,079 DoD Civilian Pay 764,610 Active Duty Personnel 1,340,374 Military Active Duty 1,334,635 Military Reserve Pay 978,085 Reserve Personnel 1,259,240 Non-Appropriated Fund Civilian 123,300 Military Retired Pay 2,379,471 Military Retiree survivor Pay 335,810 Total SSNs Submitted 9,247,604 In 2007, ACF contracted with Altarum Institute (Altarum) to conduct a cost-benefit analysis of PARIS. The study’s purpose was to develop and populate cost-benefit models for possibly assessing the potential impact of PARIS on state program expenditures and integrity. The PARIS Cost-Benefit Analysis Final Report is posted on the PARIS website. The diversity of states’ approaches to PARIS, combined with a lack of tracking results, made it difficult to create a single uniform approach to calculating PARIS costs and benefits. However, models were developed to allow states to use a consistent approach to calculating costs and benefits for specific PARIS activities, such as managing clients moving from one state to another but not reporting the move, or clients not reporting income from federal sources. The analysis’ conclusion is, at a national-level, the PARIS project will produce a positive return on investment (ROI), and this conclusion appears robust under varying conditions designed to test the sensitivity of these results and to more accurately reflect the current scope of PARIS activities. National-level cost benefit results are presented in terms of ROI and in terms of actual net savings for each file and program, as well as overall savings. Sensitivity analysis is used to test the impact of assumptions about the time required to work a match, the percent of cases closed due to PARIS matches, and the number of states actually conducting follow-up investigations of PARIS matches. Nov 07 Feb 08 May 08 Aug 08 Total All $945,320 $791,088 $758,847 $1,224.921 $3,720,177 Table of Costs and Benefits assuming 100 percent closure rate on match hits: National Cost Total (Per Year, 4 Cycles Per Year): National Benefit Total (Per Year; 4 Cycles Per Year): Nov 07 Feb 08 May 08 Aug 08 Total SNAP $ 4,458,013 $ 3,710,736 $ 3,879,230 $ 7,574,655 $ 19,622,634 TANF $ 304,359 $ 369,878 $ 344,617 $ 608,859 $ 1,627,712 Medic. $58,768,122 $34,163,321 $34,647,426 $72,597,800 $200,176,669 $63,530,495 $38,243,935 $38,817,272 $80,781,314 $221,427,015 Although a similar systemic study has not been conducted in recent years, ACF estimates the current benefits of PARIS are at least as large as the 2007 estimate of $221 million. For most states, ongoing costs of PARIS operations are not commonly tracked, as most states incorporate PARIS activities into a more general, higher-level compliance activity. None of the states included in the analysis have a tracking system to allow one to track costs specifically to PARIS activities. However, some states were able to provide more recent estimates of the necessary time to create the files, submit the match, and filter and distribute the results. These estimates were averaged to approximate the annual costs per state, which are: systems processing cost of $8,000 annually (if submitting for all four quarters), annual program specialist cost of $22,265, administrative and supervisory cost of $10,810 annually, and state costs to close each case (secondary verification, notice, hearings and appeals, etc.) for a total average of $71,541.87 per state per year times 52 (50 states, District of Columbia and Puerto Rico) totals $3,720,177 million. These are assumed fixed costs for each state, the costs from investigating the matches will vary with the number of matches returned to states resulting in a higher national cost total cited above. It is important to note, improper payments avoided by the Medicaid Program would accrue to the states, savings from the TANF program would accrue to both the states and the Federal Government, and savings from the SNAP would generally accrue to the Federal Government. Success stories of states currently participating in the PARIS program located on the PARIS website cite the following experiences with the PARIS Project with regard to benefits accrued from their program participation New York State, in State Fiscal Year 2017 (April 2017 through March 2018), closed or removed active individuals from 8,923 Public Assistance (PA) cases identified on the PARIS Match. The cost savings for these individuals was $58,006,860. These savings are calculated by determining the average annual cost of an individual in each of the following case types - Federally funded TANF PA cases (which can include Medicaid and SNAP Benefits), New York funded Safety Net PA cases (which can include Medicaid and SNAP Benefits), and SNAP Only cases. We track the number of individuals closed by the PARIS Match for each of these case types. To obtain an annual cost savings for each case type, we simply multiply the number of closed individuals by the annual average cost savings for the case type. The sum of those calculations is the total annual savings for the fiscal year of over $58,000,000. The breakdown of 2017’s annual cost savings is as follows: $35,464,020 in PA (includes SNAP and Medicaid Benefits issued through PA cases, TANF and New York funded Safety Net PA cases), and $22,542,840 in SNAP Only cases. These figures do not include Medicaid only cases. Pennsylvania has participated in the PARIS Interstate and VA Matches since their inception. The results speak for themselves: The following results are for the PARIS Interstate Match from 1997 to 2017: • 407,117 matches have been loaded and 81,903 or 20% are closed. • Total cost avoidance savings are estimated to be $263 million dollars. • The average savings per match closed was $3,212. The following results are for the PARIS Veterans Match 1998 to 2017: • 98,334 were loaded and 12,346 resulted in closed or reduced benefits. • Total annualized savings are estimated to be $56.2 million dollars. • The average savings per match closed or reduced was $4,556. Total estimated annualized savings due to PARIS matches is $319.2 million. Washington State Veterans Benefit Enhancement Program (VBE) focuses on low-income U.S. military veterans and their families relying on Medicaid, and may not realize their eligibility for comprehensive federal care and benefits programs to provide better benefits while preserving their homes and financial assets. The VBE staff embarked on a pioneering effort using available federal data provided by PARIS to connect Medicaid recipients with their federal veteran’s benefits. Washington began its efforts in 2002, focusing on long-term care beneficiaries, most of them in nursing homes, and working in partnership with the Washington State Department of Veterans Affairs. Since then, the state program became a national model and best practice for using PARIS veteran’s data with 32 other states establishing similar efforts. The program is of benefit to veterans and results in redirection of Medicaid funding to others in need. The program is committed to building upon the over $83 million in savings since 2004 and benefitted over 60,000 Washington veterans and families. During the State Fiscal Year (SFY) 2018, through Veterans Benefit Enhancement efforts the State Department of Veterans Affairs reported medical cost avoidance of $8.5 million.

Indirect Benefits. Greater Public Confidence Indirect benefits include greater public confidence and Program Supportprogram support. Automation promotes cost efficiencies and program integrity, increasing the taxpaying public’s confidence in and support for these public assistance programs. Reductions in erroneous payments and increased collections enable states States and the Federal Government to devote more dollars to intended recipients. Recent Match Results All fifty statesStates, the District of Columbia, and Puerto Rico (hereafter referred to collectively as states) participate in PARIS. Comparative data Data for the four previous quarterly matches shows the following indicate a substantial amount of PARIS match activity: August 2018: Match Conducted November 2019 File (out of 52 states) SSNs submitted Matched SSNs Interstate (51 50 states) 67,113,342 603,1155 64,666,326 512,525 Veterans (38 32 states) 9,098,732 385,617 7,855,563 303,923 Federal (44 42 states) 9,247,604 62,407 9,310,471 58,856 Total matched SSNs 1,051,179 May 2018: 875,304 Match Conducted August 2019 File (out of 52 states) SSNs submitted Matched SSNs Interstate (45 48 states) 65,478,597 563,326 62,350,570 503,013 Veterans (39 states) 9,479,423 315,844 Federal (34 states) 9,004,569 340,835 Federal (35 states) 11,230,678 70,612 9,317,190 56,364 Total matched SSNs 974,773 Feb 2018: 875,221 Match Conducted Xxxx 2019 File (out of 52 states) SSNs submitted Matched SSNs Interstate (48 states) 63,171,967 555,030 Veterans (42 states) 9,380,600 393,993 Federal (27 states) 7,150,333 32,234 Total matched SSNs 981,257 Match Conducted February 2019 File (out of 52 states) SSNs submitted Matched SSNs Interstate (49 states) 71,428,973 618,949 Veterans (45 states) 8,908,310 427,898 Federal (35 states) 11,341,098 75,609 Total matched SSNs 1,122,456 Nov 2017: File SSNs submitted Matched SSNs Interstate (50 states) 65,461,419 553,611 65,937,519 673,945 Veterans (42 states) 8,815,613 399,480 9,290,415 405,337 Federal (41 0 states) 11,322,110 85,589 0 0 Total matched SSNs 1,038,680 1,079,282 Note: The August 2018 federal Federal match was not conducted in February 2019. The November 2019 Federal file breakdown was: FILENAME # of SSNs Submitted was Match Files Total Records DoD Civilian Personnel 732,079 750,840 DoD Civilian Pay 764,610 785,233 Active Duty Personnel 1,340,374 1,373,120 Military Active Duty 1,334,635 Pay 1,367,323 Military Reserve Pay 978,085 978,112 Reserve Personnel 1,259,240 1,241,552 Non-Appropriated Fund Civilian 123,300 Monthly 117,574 Military Retired Pay 2,379,471 2,363,691 Military Retiree survivor Survivor Pay 335,810 Total SSNs Submitted 9,247,604 In 2007, 333,026 Total: 9,310,471 Recent PARIS Success Stories Reported experiences received by ACF contracted with Altarum Institute (Altarum) to conduct a cost-benefit analysis of PARIS. The study’s purpose was to develop and populate cost-benefit models for possibly assessing the potential impact of PARIS on state program expenditures and integrity. The PARIS Cost-Benefit Analysis Final Report is posted on the PARIS website. The diversity of states’ approaches to PARIS, combined with a lack of tracking results, made it difficult to create a single uniform approach to calculating PARIS costs and benefits. However, models were developed to allow from states to use a consistent approach to calculating costs and benefits for specific PARIS activities, such as managing clients moving from one state to another but not reporting the move, or clients not reporting income from federal sources. The analysis’ conclusion is, at a national-level, the PARIS project will produce a positive return on investment (ROI), and this conclusion appears robust under varying conditions designed to test the sensitivity of these results and to more accurately reflect the current scope of PARIS activities. National-level cost benefit results are presented in terms of ROI and in terms of actual net savings for each file and program, as well as overall savings. Sensitivity analysis is used to test the impact of assumptions about the time required to work a match, the percent of cases closed due to PARIS matches, and the number of states actually conducting follow-up investigations of PARIS matches. Nov 07 Feb 08 May 08 Aug 08 Total All $945,320 $791,088 $758,847 $1,224.921 $3,720,177 Table of Costs and Benefits assuming 100 percent closure rate on match hits: National Cost Total (Per Year, 4 Cycles Per Year): National Benefit Total (Per Year; 4 Cycles Per Year): Nov 07 Feb 08 May 08 Aug 08 Total SNAP $ 4,458,013 $ 3,710,736 $ 3,879,230 $ 7,574,655 $ 19,622,634 TANF $ 304,359 $ 369,878 $ 344,617 $ 608,859 $ 1,627,712 Medic. $58,768,122 $34,163,321 $34,647,426 $72,597,800 $200,176,669 $63,530,495 $38,243,935 $38,817,272 $80,781,314 $221,427,015 Although a similar systemic study has not been conducted in recent years, ACF estimates the current benefits of PARIS are at least as large as the 2007 estimate of $221 million. For most states, ongoing costs of PARIS operations are not commonly tracked, as most states incorporate PARIS activities into a more general, higher-level compliance activity. None of the states included in the analysis have a tracking system to allow one to track costs specifically to PARIS activities. However, some states were able to provide more recent estimates of the necessary time to create the files, submit the match, and filter and distribute the results. These estimates were averaged to approximate the annual costs per state, which are: systems processing cost of $8,000 annually (if submitting for all four quarters), annual program specialist cost of $22,265, administrative and supervisory cost of $10,810 annually, and state costs to close each case (secondary verification, notice, hearings and appeals, etc.) for a total average of $71,541.87 per state per year times 52 (50 states, District of Columbia and Puerto Rico) totals $3,720,177 million. These are assumed fixed costs for each state, the costs from investigating the matches will vary with the number of matches returned to states resulting in a higher national cost total cited above. It is important to note, improper payments avoided by the Medicaid Program would accrue to the states, savings from the TANF program would accrue to both the states and the Federal Government, and savings from the SNAP would generally accrue to the Federal Government. Success stories of states currently participating in the PARIS program located on the PARIS website cite the following experiences with the PARIS Project with regard to benefits accrued from their program participation participating in PARIS and utilizing the Veterans Match include some of the following: New York State New York State, in State Fiscal Year 2017 2018 (April 2017 2018 through March 20182019), closed or removed active individuals from 8,923 8,593 Public Assistance (PA) cases identified on the PARIS Match. The cost savings for these individuals was $58,006,86049,351,452. These savings are calculated by determining the average annual cost of an individual in each of the following case types - Federally funded TANF Temporary Assistance for Needy Families (TANF) PA cases (which can include Medicaid and SNAP Supplemental Nutrition Assistance Program (SNAP) Benefits), New York funded Safety Net PA cases (which can include Medicaid and SNAP Benefits), and SNAP Only cases. We track New York tracks the number of individuals closed by the PARIS Match for each of these case types. To obtain an The annual cost savings for each case type is calculated by multiplying the number of closed or removed cases by average annual cost of each case type. The annual cost savings is the sum of annual cost savings for each case type, we simply multiply the number of closed individuals by the annual average cost savings for the case type. The sum of those calculations is the total annual savings for the fiscal year of over $58,000,000. The breakdown of 2017’s the 2018 year's annual cost savings is as follows: $35,464,020 28,843,104 was saved in PA Public Assistance (includes SNAP and Medicaid Benefits issued through PA Public Assistance cases, TANF and New York funded Safety Net PA cases), and $22,542,840 20,508,348 in SNAP Only cases. These figures do not include Medicaid only cases. Pennsylvania Pennsylvania has participated in the PARIS Interstate and VA Matches since their inception. The results speak for themselves: The following results are for the PARIS Interstate Match from 1997 to 20172016: • 407,117 336,085 matches have been loaded and 81,903 69,317 or 2021% are have been closed. • Total cost avoidance savings are were estimated to be $263 234.9 million dollars. • The average savings per match closed was $3,2123,389. The following results are for the PARIS Veterans Match 1998 to 20172016: • 98,334 were 77,933 have been loaded and 12,346 10,367 have resulted in closed or reduced benefits. • Total annualized savings are estimated to be $56.2 49.3 million dollars. • The average savings per match closed or reduced was $4,556. Total estimated annualized savings due to PARIS matches is $319.2 million. Washington State Veterans Benefit Enhancement Program (VBE) focuses on low-income U.S. military veterans and their families relying on Medicaid, and may not realize their eligibility for comprehensive federal care and benefits programs to provide better benefits while preserving their homes and financial assets. The VBE staff embarked on a pioneering effort using available federal data provided by PARIS to connect Medicaid recipients with their federal veteran’s benefits. Washington began its efforts in 2002, focusing on long-term care beneficiaries, most of them in nursing homes, and working in partnership with the Washington State Department of Veterans Affairs. Since then, the state program became a national model and best practice for using PARIS veteran’s data with 32 other states establishing similar efforts. The program is of benefit to veterans and results in redirection of Medicaid funding to others in need. The program is committed to building upon the over $83 million in savings since 2004 and benefitted over 60,000 Washington veterans and families. During the State Fiscal Year (SFY) 2018, through Veterans Benefit Enhancement efforts the State Department of Veterans Affairs reported medical cost avoidance of $8.5 million4,758.

Indirect Benefits. Greater Public Confidence Indirect benefits include greater public confidence and Program Supportprogram support. Automation promotes cost efficiencies and program integrity, increasing the taxpaying public’s confidence in and support for these public assistance programs. Reductions in erroneous payments and increased collections enable states States and the Federal Government to devote more dollars to intended recipients. Recent Match Results All fifty statesStates, the District of Columbia, and Puerto Rico (hereafter referred to collectively as states) participate in PARIS. Comparative data Data for the four previous quarterly matches shows the following indicates a substantial amount of PARIS match activity: Match Conducted November 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (50 States) 71,013,384 688,760 Veterans (37 States) 9,912,083 366,909 Federal (31 States) 9,310,471 49,090 Total matched SSNs 1,104,759 Match Conducted August 2018: 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (52 States) 68,816,402 659,785 Veterans (39 States) 9,833,648 372,329 Federal (45 States) 9,321,176 66,969 Total matched SSNs 1,099,083 Match Conducted Xxxx 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (49 States) 66,817,120 537,501 Veterans (39 States) 9,769,818 360,307 Federal (42 States) 9,278,459 55,932 Total matched SSNs 953,740 Match Conducted February 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (51 statesStates) 67,113,342 603,1155 62,303,730 469,703 Veterans (38 states42 States) 9,098,732 385,617 9,678,865 333,328 Federal (44 states0 States) 9,247,604 62,407 9,338,225 51,064 854,095 Total matched SSNs 1,051,179 May 2018: File SSNs submitted Matched SSNs Interstate (45 states) 65,478,597 563,326 Veterans (34 states) 9,004,569 340,835 The November 2020 Federal (35 states) 11,230,678 70,612 Total matched SSNs 974,773 Feb 2018: File SSNs submitted Matched SSNs Interstate (49 states) 71,428,973 618,949 Veterans (45 states) 8,908,310 427,898 Federal (35 states) 11,341,098 75,609 Total matched SSNs 1,122,456 Nov 2017: File SSNs submitted Matched SSNs Interstate (50 states) 65,461,419 553,611 Veterans (42 states) 8,815,613 399,480 Federal (41 states) 11,322,110 85,589 Total matched SSNs 1,038,680 The August 2018 federal file breakdown was: FILENAME # of SSNs Submitted was Match Files Total Records DoD Civilian Personnel 732,079 791,786 DoD Civilian Pay 764,610 797,588 Active Duty Personnel 1,340,374 1,383,591 Military Active Duty 1,334,635 Pay 1,370,592 Military Reserve Pay 978,085 958,572 Reserve Personnel 1,259,240 1,219,554 Non-Appropriated Fund Civilian 123,300 Monthly 108,405 Military Retired Pay 2,379,471 2,388,637 Military Retiree survivor Survivor Pay 335,810 Total SSNs Submitted 9,247,604 In 2007, 338,080 Total: 9,356,805 Recent PARIS Success Stories Reported experiences received by ACF contracted with Altarum Institute (Altarum) to conduct a cost-benefit analysis of PARIS. The study’s purpose was to develop and populate cost-benefit models for possibly assessing the potential impact of PARIS on state program expenditures and integrity. The PARIS Cost-Benefit Analysis Final Report is posted on the PARIS website. The diversity of states’ approaches to PARIS, combined with a lack of tracking results, made it difficult to create a single uniform approach to calculating PARIS costs and benefits. However, models were developed to allow states to use a consistent approach to calculating costs and benefits for specific PARIS activities, such as managing clients moving from one state to another but not reporting the move, or clients not reporting income from federal sources. The analysis’ conclusion is, at a national-level, the PARIS project will produce a positive return on investment (ROI), and this conclusion appears robust under varying conditions designed to test the sensitivity of these results and to more accurately reflect the current scope of PARIS activities. National-level cost benefit results are presented in terms of ROI and in terms of actual net savings for each file and program, as well as overall savings. Sensitivity analysis is used to test the impact of assumptions about the time required to work a match, the percent of cases closed due to PARIS matches, and the number of states actually conducting follow-up investigations of PARIS matches. Nov 07 Feb 08 May 08 Aug 08 Total All $945,320 $791,088 $758,847 $1,224.921 $3,720,177 Table of Costs and Benefits assuming 100 percent closure rate on match hits: National Cost Total (Per Year, 4 Cycles Per Year): National Benefit Total (Per Year; 4 Cycles Per Year): Nov 07 Feb 08 May 08 Aug 08 Total SNAP $ 4,458,013 $ 3,710,736 $ 3,879,230 $ 7,574,655 $ 19,622,634 TANF $ 304,359 $ 369,878 $ 344,617 $ 608,859 $ 1,627,712 Medic. $58,768,122 $34,163,321 $34,647,426 $72,597,800 $200,176,669 $63,530,495 $38,243,935 $38,817,272 $80,781,314 $221,427,015 Although a similar systemic study has not been conducted in recent years, ACF estimates the current benefits of PARIS are at least as large as the 2007 estimate of $221 million. For most states, ongoing costs of PARIS operations are not commonly tracked, as most states incorporate PARIS activities into a more general, higher-level compliance activity. None some of the states included in the analysis have a tracking system to allow one to track costs specifically to PARIS activities. However, some states were able to provide more recent estimates of the necessary time to create the files, submit the match, and filter and distribute the results. These estimates were averaged to approximate the annual costs per state, which are: systems processing cost of $8,000 annually (if submitting for all four quarters), annual program specialist cost of $22,265, administrative and supervisory cost of $10,810 annually, and state costs to close each case (secondary verification, notice, hearings and appeals, etc.) for a total average of $71,541.87 per state per year times 52 (50 states, District of Columbia and Puerto Rico) totals $3,720,177 million. These are assumed fixed costs for each state, the costs from investigating the matches will vary with the number of matches returned to states resulting in a higher national cost total cited above. It is important to note, improper payments avoided by the Medicaid Program would accrue to the states, savings from the TANF program would accrue to both the states and the Federal Government, and savings from the SNAP would generally accrue to the Federal Government. Success stories of states currently participating in the PARIS program located on the PARIS website cite the following experiences with the PARIS Project with regard to regarding benefits accrued from their program participation participating in PARIS include the following: New York StateState The New York State Office of Temporary and Disability Assistance, in State Fiscal Year 2017 2019 (April 2017 2019 through March 20182020), closed or removed active individuals from 8,923 6,493 Public Assistance (PA) cases identified on the PARIS Match. The cost savings for these individuals was $58,006,86039.0 million. These savings are calculated by determining the average annual cost of an individual in each of the following case types - Federally funded TANF Temporary Assistance to Needy Families (TANF) PA cases (which can include Medicaid and SNAP Supplemental Nutrition Assistance Program (SNAP) Benefits), New York funded Safety Net PA cases (which can include Medicaid and SNAP Benefits), and SNAP Only cases. We track New York tracks the number of individuals closed by the PARIS Match for each of these case types. To obtain an The annual cost savings for each case type is calculated by multiplying the number of closed or removed cases by average annual cost of each case type. The annual cost savings is the sum of annual cost savings for each case type, we simply multiply the number of closed individuals by the annual average cost savings for the case type. The sum of those calculations is the total annual savings for the fiscal year of over $58,000,000. The breakdown of 2017’s the 2019 year's annual cost savings is as follows: $35,464,020 24.76 million was saved in PA Public Assistance (includes SNAP and Medicaid Benefits issued through PA Public Assistance cases, TANF and New York funded Safety Net PA cases), and $22,542,840 14.24 million in SNAP Only cases. These figures do not include Medicaid only cases. Pennsylvania Pennsylvania has participated in the PARIS Interstate and VA Matches since their inception. The results speak for themselves: The following results are for the PARIS Interstate Match from 1997 to 20172016: • 407,117 336,085 matches have been loaded and 81,903 69,317 or 2021% are have been closed. • Total cost avoidance savings are were estimated to be $263 234.9 million dollars. • The average savings per match closed was $3,2123,389. The following results are for the PARIS Veterans Match 1998 to 20172016: • 98,334 were 77,933 have been loaded and 12,346 10,367 have resulted in closed or reduced benefits. • Total annualized savings are estimated to be $56.2 49.3 million dollars. • The average savings per match closed or reduced was $4,5564,758. Total In 2019 alone: • 76,115 interstate matches were reviewed and 13,517 (18%) closed, for an estimated annualized savings due to PARIS matches is $319.2 million. Washington State Veterans Benefit Enhancement Program (VBE) focuses on low-income U.S. military veterans and their families relying on Medicaid, and may not realize their eligibility for comprehensive federal care and benefits programs to provide better benefits while preserving their homes and financial assets. The VBE staff embarked on a pioneering effort using available federal data provided by PARIS to connect Medicaid recipients with their federal veteran’s benefits. Washington began its efforts in 2002, focusing on long-term care beneficiaries, most of them in nursing homes, and working in partnership with the Washington State Department of Veterans Affairs. Since then, the state program became a national model and best practice for using PARIS veteran’s data with 32 other states establishing similar efforts. The program is of benefit to veterans and results in redirection of Medicaid funding to others in need. The program is committed to building upon the over $83 million in savings since 2004 and benefitted over 60,000 Washington veterans and families. During the State Fiscal Year (SFY) 2018, through Veterans Benefit Enhancement efforts the State Department of Veterans Affairs reported medical cost avoidance of $8.5 million.28.08 million ($2,077 per closure) • 13,842 interstate matches were reviewed and 1,375 (10%) closed, for an estimated savings of $5.44 million ($3,955 per closure)

Indirect Benefits. Greater Public Confidence and Program Support. : Automation promotes cost efficiencies and program integrity, increasing integrity so that the taxpaying public’s public may have confidence in that efforts to recover funds and support for these public assistance programsprevent further liability on the part of the States and Federal Government is subject to every reasonable effort. Reductions in erroneous payments and increased increase collections enable states States and the Federal Government to devote more dollars to intended recipients. All fifty statesStates, the District of Columbia, Columbia and Puerto Rico participate in PARIS. Comparative data Data for the four previous quarterly matches shows the following indicate a substantial amount of PARIS match activity: August 2018November 2015: File SSNs submitted Submitted Matched SSNs Interstate (51 states) 67,113,342 603,1155 Veterans (38 states) 9,098,732 385,617 Federal (44 states) 9,247,604 62,407 Total matched SSNs 1,051,179 May 2018: File SSNs submitted Matched SSNs Interstate (45 states) 65,478,597 563,326 62,442,474 419,219 Veterans (34 states) 9,004,569 340,835 8,016,489 319,300 Federal (35 38 states) 11,230,678 70,612 10,196,437 76,838 Total matched SSNs 974,773 Feb 2018815,357 August 2015: File SSNs submitted Matched SSNs Interstate (49 states) 71,428,973 618,949 Veterans (45 states) 8,908,310 427,898 Federal (35 states) 11,341,098 75,609 Total matched SSNs 1,122,456 Nov 2017: File SSNs submitted Submitted Matched SSNs Interstate (50 states) 65,461,419 553,611 64,798,660 416,283 Veterans (42 31 states) 8,815,613 399,480 8,016,489 275,794 Federal (41 states) 11,322,110 85,589 10,196,437 75,199 Total matched SSNs 1,038,680 767,276 May 2015: File SSNs Submitted Matched SSNs Interstate (43 states) 58,141,616 269,523 Veterans ( 0 states) 0 0 Federal (34 states) 10,149,491 59,051 Total matched SSNs 328,574 • Veterans computer matching agreement expired 10/16/2014 February 2015: File SSNs Submitted Matched SSNs Interstate (43 states) 57,233,450 318,072 Veterans ( 0 states) 0 0 Federal (37 states) 10,124,845 66,907 Total matched SSNs 384,979 • Veterans computer matching agreement expired 10/16/2014 November 2014: The August 2018 federal Nov 2015 Federal file breakdown was: FILENAME # of SSNs Submitted DoD Civilian Personnel 732,079 DoD Civilian Pay 764,610 Active Duty Personnel 1,340,374 MATCHES Non-Appropriate Fund 4,304 Military Reserve 2,566 Military Retired 14,198 Military Active Duty 1,334,635 Military Reserve Pay 978,085 Reserve Personnel 1,259,240 Non-Appropriated Fund 17,444 Civilian 123,300 Military Retired Pay 2,379,471 27,068 Civilian DOD 4,789 Military Retiree survivor Pay 335,810 Survivor 6,469 Total SSNs Submitted 9,247,604 Matches 76,838 In 2007, ACF the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services (DHHS) contracted with Altarum Institute (Altarum) to conduct a cost-cost- benefit analysis of the Public Assistance Reporting Information System (PARIS). The study’s purpose of this study was to develop and populate cost-benefit models for possibly assessing that could be used to assess the potential impact of PARIS on state State program expenditures and integrity. The PARIS Cost-Benefit Analysis Final Report is posted on the PARIS website. The diversity of statesStates’ approaches to PARIS, combined with a lack of tracking results, made it difficult to create a single uniform approach to calculating PARIS costs and benefits. However, models were developed to that would allow states States to use a consistent approach to calculating costs and benefits for specific PARIS activities, such as managing clients moving who moved from one state State to another but did not reporting report the move, or clients that did not reporting report income from federal Federal sources. The analysis’ conclusion is, at At a national-level, the PARIS project will produce a positive return on investment (ROI)investment, and this conclusion appears robust under varying conditions designed to test the sensitivity of these results and to more accurately reflect the current scope of PARIS activities. National-level cost benefit results are presented in terms of ROI returns on investment (ROI) and in terms of actual net savings for each file and program, as well as overall savingsoverall. Sensitivity analysis is used to test the impact of assumptions about the time required to work a match, the percent of cases closed due to PARIS matches, and the number of states States that actually conducting conduct follow-up investigations of PARIS matches. Nov 07 Feb 08 May 08 Aug 08 Total All $945,320 $791,088 $758,847 $1,224.921 $3,720,177 Table of Costs and Benefits assuming 100 percent closure rate on match hits: National Cost Total (Per Year, 4 Cycles Per Year): National Benefit Total (Per Year; 4 Cycles Per Year): Nov 07 Feb 08 May 08 Aug 08 Total SNAP $ 4,458,013 $ 3,710,736 $ 3,879,230 $ 7,574,655 $ 19,622,634 TANF $ 304,359 $ 369,878 $ 344,617 $ 608,859 $ 1,627,712 Medic. $58,768,122 $34,163,321 $34,647,426 $72,597,800 $200,176,669 $63,530,495 $38,243,935 $38,817,272 $80,781,314 $221,427,015 Although a similar systemic study has not been conducted in recent years, ACF estimates the current benefits of PARIS are at least as large as the 2007 estimate of $221 million. For most states, ongoing costs of PARIS operations are not commonly tracked, as most states incorporate PARIS activities into a more general, higher-level compliance activity. None of the states included in the analysis have a tracking system to allow one to track costs specifically to PARIS activities. However, some states were able to provide more recent estimates of the necessary time to create the files, submit the match, and filter and distribute the results. These estimates were averaged to approximate the annual costs per state, which are: systems processing cost of $8,000 annually (if submitting for all four quarters), annual program specialist cost of $22,265, administrative and supervisory cost of $10,810 annually, and state costs to close each case (secondary verification, notice, hearings and appeals, etc.) for a total average of $71,541.87 per state per year times 52 (50 states, District of Columbia and Puerto Rico) totals $3,720,177 million. These are assumed fixed costs for each state, the costs from investigating the matches will vary with the number of matches returned to states resulting in a higher national cost total cited above. It is important to note, improper payments avoided by the Medicaid Program would accrue to the states, savings from the TANF program would accrue to both the states and the Federal Government, and savings from the SNAP would generally accrue to the Federal Government. Success stories of states currently participating in the PARIS program located on the PARIS website cite the following experiences with the PARIS Project with regard to benefits accrued from their program participation New York State, in State Fiscal Year 2017 (April 2017 through March 2018), closed or removed active individuals from 8,923 Public Assistance (PA) cases identified on the PARIS Match. The cost savings for these individuals was $58,006,860. These savings are calculated by determining the average annual cost of an individual in each of the following case types - Federally funded TANF PA cases (which can include Medicaid and SNAP Benefits), New York funded Safety Net PA cases (which can include Medicaid and SNAP Benefits), and SNAP Only cases. We track the number of individuals closed by the PARIS Match for each of these case types. To obtain an annual cost savings for each case type, we simply multiply the number of closed individuals by the annual average cost savings for the case type. The sum of those calculations is the total annual savings for the fiscal year of over $58,000,000. The breakdown of 2017’s annual cost savings is as follows: $35,464,020 in PA (includes SNAP and Medicaid Benefits issued through PA cases, TANF and New York funded Safety Net PA cases), and $22,542,840 in SNAP Only cases. These figures do not include Medicaid only cases. Pennsylvania has participated in the PARIS Interstate and VA Matches since their inception. The results speak for themselves: The following results are for the PARIS Interstate Match from 1997 to 2017: • 407,117 matches have been loaded and 81,903 or 20% are closed. • Total cost avoidance savings are estimated to be $263 million dollars. • The average savings per match closed was $3,212. The following results are for the PARIS Veterans Match 1998 to 2017: • 98,334 were loaded and 12,346 resulted in closed or reduced benefits. • Total annualized savings are estimated to be $56.2 million dollars. • The average savings per match closed or reduced was $4,556. Total estimated annualized savings due to PARIS matches is $319.2 million. Washington State Veterans Benefit Enhancement Program (VBE) focuses on low-income U.S. military veterans and their families relying on Medicaid, and may not realize their eligibility for comprehensive federal care and benefits programs to provide better benefits while preserving their homes and financial assets. The VBE staff embarked on a pioneering effort using available federal data provided by PARIS to connect Medicaid recipients with their federal veteran’s benefits. Washington began its efforts in 2002, focusing on long-term care beneficiaries, most of them in nursing homes, and working in partnership with the Washington State Department of Veterans Affairs. Since then, the state program became a national model and best practice for using PARIS veteran’s data with 32 other states establishing similar efforts. The program is of benefit to veterans and results in redirection of Medicaid funding to others in need. The program is committed to building upon the over $83 million in savings since 2004 and benefitted over 60,000 Washington veterans and families. During the State Fiscal Year (SFY) 2018, through Veterans Benefit Enhancement efforts the State Department of Veterans Affairs reported medical cost avoidance of $8.5 million.

Indirect Benefits. Greater Public Confidence Indirect benefits include greater public confidence and Program Supportprogram support. Automation promotes cost efficiencies and program integrity, increasing the taxpaying public’s confidence in and support for these public assistance programs. Reductions in erroneous payments and increased collections enable states States and the Federal Government to devote more dollars to intended recipients. Recent Match Results All fifty statesStates, the District of Columbia, and Puerto Rico (hereafter referred to collectively as states) participate in PARIS. Comparative data Data for the four previous quarterly matches shows the following indicates a substantial amount of PARIS match activity: Match Conducted November 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (50 States) 71,013,384 688,760 Veterans (37 States) 9,912,083 366,909 Federal (31 States) 9,310,471 49,090 Total matched SSNs 1,104,759 Match Conducted August 2018: 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (52 States) 68,816,402 659,785 Veterans (39 States) 9,833,648 372,329 Federal (45 States) 9,321,176 66,969 Total matched SSNs 1,099,083 Match Conducted Xxxx 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (49 States) 66,817,120 537,501 Veterans (39 States) 9,769,818 360,307 Federal (42 States) 9,278,459 55,932 Total matched SSNs 953,740 Match Conducted February 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (51 statesStates) 67,113,342 603,1155 62,303,730 469,703 Veterans (38 states42 States) 9,098,732 385,617 9,678,865 333,328 Federal (44 states0 States) 9,247,604 62,407 9,338,225 51,064 Total matched SSNs 1,051,179 May 2018: File SSNs submitted Matched SSNs Interstate (45 states) 65,478,597 563,326 Veterans (34 states) 9,004,569 340,835 854,095 The November 2020 Federal (35 states) 11,230,678 70,612 Total matched SSNs 974,773 Feb 2018: File SSNs submitted Matched SSNs Interstate (49 states) 71,428,973 618,949 Veterans (45 states) 8,908,310 427,898 Federal (35 states) 11,341,098 75,609 Total matched SSNs 1,122,456 Nov 2017: File SSNs submitted Matched SSNs Interstate (50 states) 65,461,419 553,611 Veterans (42 states) 8,815,613 399,480 Federal (41 states) 11,322,110 85,589 Total matched SSNs 1,038,680 The August 2018 federal file breakdown was: FILENAME # of SSNs Submitted was Match Files Total Records DoD Civilian Personnel 732,079 791,786 DoD Civilian Pay 764,610 797,588 Active Duty Personnel 1,340,374 1,383,591 Military Active Duty 1,334,635 Pay 1,370,592 Military Reserve Pay 978,085 958,572 Reserve Personnel 1,259,240 1,219,554 Non-Appropriated Fund Civilian 123,300 Monthly 108,405 Military Retired Pay 2,379,471 2,388,637 Military Retiree survivor Survivor Pay 335,810 Total SSNs Submitted 9,247,604 In 2007, 338,080 Total: 9,356,805 Recent PARIS Success Stories Reported experiences received by ACF contracted with Altarum Institute (Altarum) to conduct a cost-benefit analysis of PARIS. The study’s purpose was to develop and populate cost-benefit models for possibly assessing the potential impact of PARIS on state program expenditures and integrity. The PARIS Cost-Benefit Analysis Final Report is posted on the PARIS website. The diversity of states’ approaches to PARIS, combined with a lack of tracking results, made it difficult to create a single uniform approach to calculating PARIS costs and benefits. However, models were developed to allow states to use a consistent approach to calculating costs and benefits for specific PARIS activities, such as managing clients moving from one state to another but not reporting the move, or clients not reporting income from federal sources. The analysis’ conclusion is, at a national-level, the PARIS project will produce a positive return on investment (ROI), and this conclusion appears robust under varying conditions designed to test the sensitivity of these results and to more accurately reflect the current scope of PARIS activities. National-level cost benefit results are presented in terms of ROI and in terms of actual net savings for each file and program, as well as overall savings. Sensitivity analysis is used to test the impact of assumptions about the time required to work a match, the percent of cases closed due to PARIS matches, and the number of states actually conducting follow-up investigations of PARIS matches. Nov 07 Feb 08 May 08 Aug 08 Total All $945,320 $791,088 $758,847 $1,224.921 $3,720,177 Table of Costs and Benefits assuming 100 percent closure rate on match hits: National Cost Total (Per Year, 4 Cycles Per Year): National Benefit Total (Per Year; 4 Cycles Per Year): Nov 07 Feb 08 May 08 Aug 08 Total SNAP $ 4,458,013 $ 3,710,736 $ 3,879,230 $ 7,574,655 $ 19,622,634 TANF $ 304,359 $ 369,878 $ 344,617 $ 608,859 $ 1,627,712 Medic. $58,768,122 $34,163,321 $34,647,426 $72,597,800 $200,176,669 $63,530,495 $38,243,935 $38,817,272 $80,781,314 $221,427,015 Although a similar systemic study has not been conducted in recent years, ACF estimates the current benefits of PARIS are at least as large as the 2007 estimate of $221 million. For most states, ongoing costs of PARIS operations are not commonly tracked, as most states incorporate PARIS activities into a more general, higher-level compliance activity. None some of the states included in the analysis have a tracking system to allow one to track costs specifically to PARIS activities. However, some states were able to provide more recent estimates of the necessary time to create the files, submit the match, and filter and distribute the results. These estimates were averaged to approximate the annual costs per state, which are: systems processing cost of $8,000 annually (if submitting for all four quarters), annual program specialist cost of $22,265, administrative and supervisory cost of $10,810 annually, and state costs to close each case (secondary verification, notice, hearings and appeals, etc.) for a total average of $71,541.87 per state per year times 52 (50 states, District of Columbia and Puerto Rico) totals $3,720,177 million. These are assumed fixed costs for each state, the costs from investigating the matches will vary with the number of matches returned to states resulting in a higher national cost total cited above. It is important to note, improper payments avoided by the Medicaid Program would accrue to the states, savings from the TANF program would accrue to both the states and the Federal Government, and savings from the SNAP would generally accrue to the Federal Government. Success stories of states currently participating in the PARIS program located on the PARIS website cite the following experiences with the PARIS Project with regard to regarding benefits accrued from their program participation New York State, participating in State Fiscal Year 2017 (April 2017 through March 2018), closed or removed active individuals from 8,923 Public Assistance (PA) cases identified on PARIS include the PARIS Match. The cost savings for these individuals was $58,006,860. These savings are calculated by determining the average annual cost of an individual in each of the following case types - Federally funded TANF PA cases (which can include Medicaid and SNAP Benefits), New York funded Safety Net PA cases (which can include Medicaid and SNAP Benefits), and SNAP Only cases. We track the number of individuals closed by the PARIS Match for each of these case types. To obtain an annual cost savings for each case type, we simply multiply the number of closed individuals by the annual average cost savings for the case type. The sum of those calculations is the total annual savings for the fiscal year of over $58,000,000. The breakdown of 2017’s annual cost savings is as follows: $35,464,020 in PA (includes SNAP and Medicaid Benefits issued through PA cases, TANF and New York funded Safety Net PA cases), and $22,542,840 in SNAP Only cases. These figures do not include Medicaid only cases. Pennsylvania has participated in the PARIS Interstate and VA Matches since their inception. The results speak for themselves: The following results are for the PARIS Interstate Match from 1997 to 2017: • 407,117 matches have been loaded and 81,903 or 20% are closed. • Total cost avoidance savings are estimated to be $263 million dollars. • The average savings per match closed was $3,212. The following results are for the PARIS Veterans Match 1998 to 2017: • 98,334 were loaded and 12,346 resulted in closed or reduced benefits. • Total annualized savings are estimated to be $56.2 million dollars. • The average savings per match closed or reduced was $4,556. Total estimated annualized savings due to PARIS matches is $319.2 million. Washington State Veterans Benefit Enhancement Program (VBE) focuses on low-income U.S. military veterans and their families relying on Medicaid, and may not realize their eligibility for comprehensive federal care and benefits programs to provide better benefits while preserving their homes and financial assets. The VBE staff embarked on a pioneering effort using available federal data provided by PARIS to connect Medicaid recipients with their federal veteran’s benefits. Washington began its efforts in 2002, focusing on long-term care beneficiaries, most of them in nursing homes, and working in partnership with the Washington State Department of Veterans Affairs. Since then, the state program became a national model and best practice for using PARIS veteran’s data with 32 other states establishing similar efforts. The program is of benefit to veterans and results in redirection of Medicaid funding to others in need. The program is committed to building upon the over $83 million in savings since 2004 and benefitted over 60,000 Washington veterans and families. During the State Fiscal Year (SFY) 2018, through Veterans Benefit Enhancement efforts the State Department of Veterans Affairs reported medical cost avoidance of $8.5 million.following:

Indirect Benefits. Greater Public Confidence Indirect benefits include greater public confidence and Program Supportprogram support. Automation promotes cost efficiencies and program integrity, increasing the taxpaying public’s confidence in and support for these public assistance programs. Reductions in erroneous payments and increased collections enable states States and the Federal Government to devote more dollars to intended recipients. Recent Match Results All fifty statesStates, the District of Columbia, and Puerto Rico (hereafter referred to collectively as states) participate in PARIS. Comparative data Data for the four previous quarterly matches shows the following indicates a substantial amount of PARIS match activity: Match Conducted November 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (50 States) 71,013,384 688,760 Veterans (37 States) 9,912,083 366,909 Federal (31 States) 9,310,471 49,090 Total matched SSNs 1,104,759 Match Conducted August 2018: 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (52 States) 68,816,402 659,785 Veterans (39 States) 9,833,648 372,329 Federal (45 States) 9,321,176 66,969 Total matched SSNs 1,099,083 Match Conducted Xxxx 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (49 States) 66,817,120 537,501 Veterans (39 States) 9,769,818 360,307 Federal (42 States) 9,278,459 55,932 Total matched SSNs 953,740 Match Conducted February 2020 File (out of 52 States) SSNs submitted Matched SSNs Interstate (51 statesStates) 67,113,342 603,1155 62,303,730 469,703 Veterans (38 states42 States) 9,098,732 385,617 9,678,865 333,328 Federal (44 states0 States) 9,247,604 62,407 9,338,225 51,064 854,095 Total matched SSNs 1,051,179 May 2018: File SSNs submitted Matched SSNs Interstate (45 states) 65,478,597 563,326 Veterans (34 states) 9,004,569 340,835 The November 2020 Federal (35 states) 11,230,678 70,612 Total matched SSNs 974,773 Feb 2018: File SSNs submitted Matched SSNs Interstate (49 states) 71,428,973 618,949 Veterans (45 states) 8,908,310 427,898 Federal (35 states) 11,341,098 75,609 Total matched SSNs 1,122,456 Nov 2017: File SSNs submitted Matched SSNs Interstate (50 states) 65,461,419 553,611 Veterans (42 states) 8,815,613 399,480 Federal (41 states) 11,322,110 85,589 Total matched SSNs 1,038,680 The August 2018 federal file breakdown was: FILENAME # of SSNs Submitted was Match Files Total Records DoD Civilian Personnel 732,079 791,786 DoD Civilian Pay 764,610 797,588 Active Duty Personnel 1,340,374 1,383,591 Military Active Duty 1,334,635 Pay 1,370,592 Military Reserve Pay 978,085 958,572 Reserve Personnel 1,259,240 1,219,554 Non-Appropriated Fund Civilian 123,300 Monthly 108,405 Military Retired Pay 2,379,471 2,388,637 Military Retiree survivor Survivor Pay 335,810 Total SSNs Submitted 9,247,604 In 2007, 338,080 Total: 9,356,805 Recent PARIS Success Stories Reported experiences received by ACF contracted with Altarum Institute (Altarum) to conduct a cost-benefit analysis of PARIS. The study’s purpose was to develop and populate cost-benefit models for possibly assessing the potential impact of PARIS on state program expenditures and integrity. The PARIS Cost-Benefit Analysis Final Report is posted on the PARIS website. The diversity of states’ approaches to PARIS, combined with a lack of tracking results, made it difficult to create a single uniform approach to calculating PARIS costs and benefits. However, models were developed to allow states to use a consistent approach to calculating costs and benefits for specific PARIS activities, such as managing clients moving from one state to another but not reporting the move, or clients not reporting income from federal sources. The analysis’ conclusion is, at a national-level, the PARIS project will produce a positive return on investment (ROI), and this conclusion appears robust under varying conditions designed to test the sensitivity of these results and to more accurately reflect the current scope of PARIS activities. National-level cost benefit results are presented in terms of ROI and in terms of actual net savings for each file and program, as well as overall savings. Sensitivity analysis is used to test the impact of assumptions about the time required to work a match, the percent of cases closed due to PARIS matches, and the number of states actually conducting follow-up investigations of PARIS matches. Nov 07 Feb 08 May 08 Aug 08 Total All $945,320 $791,088 $758,847 $1,224.921 $3,720,177 Table of Costs and Benefits assuming 100 percent closure rate on match hits: National Cost Total (Per Year, 4 Cycles Per Year): National Benefit Total (Per Year; 4 Cycles Per Year): Nov 07 Feb 08 May 08 Aug 08 Total SNAP $ 4,458,013 $ 3,710,736 $ 3,879,230 $ 7,574,655 $ 19,622,634 TANF $ 304,359 $ 369,878 $ 344,617 $ 608,859 $ 1,627,712 Medic. $58,768,122 $34,163,321 $34,647,426 $72,597,800 $200,176,669 $63,530,495 $38,243,935 $38,817,272 $80,781,314 $221,427,015 Although a similar systemic study has not been conducted in recent years, ACF estimates the current benefits of PARIS are at least as large as the 2007 estimate of $221 million. For most states, ongoing costs of PARIS operations are not commonly tracked, as most states incorporate PARIS activities into a more general, higher-level compliance activity. None some of the states included in the analysis have a tracking system to allow one to track costs specifically to PARIS activities. However, some states were able to provide more recent estimates of the necessary time to create the files, submit the match, and filter and distribute the results. These estimates were averaged to approximate the annual costs per state, which are: systems processing cost of $8,000 annually (if submitting for all four quarters), annual program specialist cost of $22,265, administrative and supervisory cost of $10,810 annually, and state costs to close each case (secondary verification, notice, hearings and appeals, etc.) for a total average of $71,541.87 per state per year times 52 (50 states, District of Columbia and Puerto Rico) totals $3,720,177 million. These are assumed fixed costs for each state, the costs from investigating the matches will vary with the number of matches returned to states resulting in a higher national cost total cited above. It is important to note, improper payments avoided by the Medicaid Program would accrue to the states, savings from the TANF program would accrue to both the states and the Federal Government, and savings from the SNAP would generally accrue to the Federal Government. Success stories of states currently participating in the PARIS program located on the PARIS website cite the following experiences with the PARIS Project with regard to regarding benefits accrued from their program participation participating in PARIS include the following: New York StateState The New York State Office of Temporary and Disability Assistance, in State Fiscal Year 2017 2019 (April 2017 2019 through March 20182020), closed or removed active individuals from 8,923 6,493 Public Assistance (PA) cases identified on the PARIS Match. The cost savings for these individuals was $58,006,86039.0 million. These savings are calculated by determining the average annual cost of an individual in each of the following case types - Federally funded TANF Temporary Assistance to Needy Families (TANF) PA cases (which can include Medicaid and SNAP Supplemental Nutrition Assistance Program (SNAP) Benefits), New York funded Safety Net PA cases (which can include Medicaid and SNAP Benefits), and SNAP Only cases. We track New York tracks the number of individuals closed by the PARIS Match for each of these case types. To obtain an The annual cost savings for each case type is calculated by multiplying the number of closed or removed cases by average annual cost of each case type. The annual cost savings is the sum of annual cost savings for each case type, we simply multiply the number of closed individuals by the annual average cost savings for the case type. The sum of those calculations is the total annual savings for the fiscal year of over $58,000,000. The breakdown of 2017’s the 2019 year's annual cost savings is as follows: $35,464,020 24.76 million was saved in PA Public Assistance (includes SNAP and Medicaid Benefits issued through PA Public Assistance cases, TANF and New York funded Safety Net PA cases), and $22,542,840 14.24 million in SNAP Only cases. These figures do not include Medicaid only cases. Pennsylvania Pennsylvania has participated in the PARIS Interstate and VA Matches since their inception. The results speak for themselves: The following results are for the PARIS Interstate Match from 1997 to 20172016: • 407,117 336,085 matches have been loaded and 81,903 69,317 or 2021% are have been closed. • Total cost avoidance savings are were estimated to be $263 234.9 million dollars. • The average savings per match closed was $3,2123,389. The following results are for the PARIS Veterans Match 1998 to 20172016: • 98,334 were 77,933 have been loaded and 12,346 10,367 have resulted in closed or reduced benefits. • Total annualized savings are estimated to be $56.2 49.3 million dollars. • The average savings per match closed or reduced was $4,5564,758. Total In 2019 alone: 76,115 interstate matches were reviewed and 13,517 (18%) closed, for an estimated annualized savings due to PARIS matches is $319.2 million. Washington State Veterans Benefit Enhancement Program (VBE) focuses on low-income U.S. military veterans and their families relying on Medicaid, and may not realize their eligibility for comprehensive federal care and benefits programs to provide better benefits while preserving their homes and financial assets. The VBE staff embarked on a pioneering effort using available federal data provided by PARIS to connect Medicaid recipients with their federal veteran’s benefits. Washington began its efforts in 2002, focusing on long-term care beneficiaries, most of them in nursing homes, and working in partnership with the Washington State Department of Veterans Affairs. Since then, the state program became a national model and best practice for using PARIS veteran’s data with 32 other states establishing similar efforts. The program is of benefit to veterans and results in redirection of Medicaid funding to others in need. The program is committed to building upon the over $83 million in savings since 2004 and benefitted over 60,000 Washington veterans and families. During the State Fiscal Year (SFY) 2018, through Veterans Benefit Enhancement efforts the State Department of Veterans Affairs reported medical cost avoidance of $8.5 million.28.08 million ($2,077 per closure) 13,842 interstate matches were reviewed and 1,375 (10%) closed, for an estimated savings of $5.44 million ($3,955 per closure)

Indirect Benefits. Greater Public Confidence and Program Support. : Automation promotes cost efficiencies and program integrity, increasing integrity so that the taxpaying public’s public may have confidence in that efforts to recover funds and support for these public assistance programsprevent further liability on the part of the States and Federal Government is subject to every reasonable effort. Reductions in erroneous payments and increased increase collections enable states States and the Federal Government to devote more dollars to intended recipients. All fifty statesStates, the District of Columbia, Columbia and Puerto Rico participate in PARIS. Comparative data Data for the four previous quarterly matches shows the following indicate a substantial amount of PARIS match activity: August 2018Feb 2013: File SSNs submitted Matched SSNs Interstate (47 states) 63,643,541 519,055 Veterans (46 states) 6,910,955 372,368 Federal (38 states) 10,068,695 (estimate) 79,828 Total matched SSNs 971,251 Nov 2012: File SSNs submitted Matched SSNs Interstate (43 states) 52,454,831 444,800 Veterans (42 states) 6,709,144 328,626 Federal (35 states) 10,068,695 (estimate) 92,722 Total matched SSNs 866,148 Aug 2012: File SSNs submitted Matched SSNs Interstate (51 states) 67,113,342 603,1155 57,464,681 508,237 Veterans (38 48 states) 9,098,732 385,617 6,600,566 365,420 Federal (44 states) 9,247,604 62,407 10,068,695 (estimate) 85,221 Total matched SSNs 1,051,179 958,878 May 20182012: File SSNs submitted Matched SSNs Interstate (45 42 states) 65,478,597 563,326 47,967,238 358,052 Veterans (34 40 states) 9,004,569 340,835 6,491,488 314,551 Federal (35 36 states) 11,230,678 70,612 10,068,695 (estimate) 82,769 Total matched SSNs 974,773 755,372 The Feb 2018: File SSNs submitted Matched SSNs Interstate (49 states) 71,428,973 618,949 Veterans (45 states) 8,908,310 427,898 2013 Federal (35 states) 11,341,098 75,609 Total matched SSNs 1,122,456 Nov 2017: File SSNs submitted Matched SSNs Interstate (50 states) 65,461,419 553,611 Veterans (42 states) 8,815,613 399,480 Federal (41 states) 11,322,110 85,589 Total matched SSNs 1,038,680 The August 2018 federal file breakdown was: FILENAME # of SSNs Submitted DoD Civilian Personnel 732,079 DoD Civilian Pay 764,610 Active Duty Personnel 1,340,374 MATCHES Non-Appropriate Fund 3,610 Military Reserve 21,600 Military Retired 11,477 Military Active Duty 1,334,635 Military Reserve Pay 978,085 Reserve Personnel 1,259,240 Non-Appropriated Fund 9,865 Civilian 123,300 Military Retired Pay 2,379,471 27,096 Civilian DOD 3,173 Military Retiree survivor Pay 335,810 Survivor 6,288 Total SSNs Submitted 9,247,604 Matches 79,828 In 2007, ACF the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services (DHHS) contracted with Altarum Institute (Altarum) to conduct a cost-benefit analysis of the Public Assistance Reporting Information System (PARIS). The study’s purpose of this study was to develop and populate cost-benefit models for possibly assessing that could be used to assess the potential impact of PARIS on state State program expenditures and integrity. The PARIS Cost-Benefit Analysis Final Report is posted on the PARIS website. The diversity of statesStates’ approaches to PARIS, combined with a lack of tracking results, made it difficult to create a single uniform approach to calculating PARIS costs and benefits. However, models were developed to that would allow states States to use a consistent approach to calculating costs and benefits for specific PARIS activities, such as managing clients moving who moved from one state State to another but did not reporting report the move, or clients that did not reporting report income from federal Federal sources. The analysis’ conclusion is, at At a national-level, the PARIS project will produce a positive return on investment (ROI)investment, and this conclusion appears robust under varying conditions designed to test the sensitivity of these results and to more accurately reflect the current scope of PARIS activities. National-level cost benefit results are presented in terms of ROI returns on investment (ROI) and in terms of actual net savings for each file and program, as well as overall savingsoverall. Sensitivity analysis is used to test the impact of assumptions about the time required to work a match, the percent of cases closed due to PARIS matches, and the number of states States that actually conducting conduct follow-up investigations of PARIS matches. Nov 07 Feb 08 May 08 Aug 08 Total All $945,320 $791,088 $758,847 $1,224.921 $3,720,177 Table of Costs and Benefits assuming 100 percent closure rate on match hits: National Cost Total (Per Year, 4 Cycles Per Year): National Benefit Total (Per Year; 4 Cycles Per Year): Nov 07 Feb 08 May 08 Aug 08 Total SNAP $ 4,458,013 $ 3,710,736 $ 3,879,230 $ 7,574,655 $ 19,622,634 TANF $ 304,359 $ 369,878 $ 344,617 $ 608,859 $ 1,627,712 Medic. $58,768,122 $34,163,321 $34,647,426 $72,597,800 $200,176,669 $63,530,495 $38,243,935 $38,817,272 $80,781,314 $221,427,015 Although a similar systemic study has not been conducted in recent years, ACF estimates the current benefits of PARIS are at least as large as the 2007 estimate of $221 million. For most states, ongoing costs of PARIS operations are not commonly tracked, as most states incorporate PARIS activities into a more general, higher-level compliance activity. None of the states included in the analysis have a tracking system to allow one to track costs specifically to PARIS activities. However, some states were able to provide more recent estimates of the necessary time to create the files, submit the match, and filter and distribute the results. These estimates were averaged to approximate the annual costs per state, which are: systems processing cost of $8,000 annually (if submitting for all four quarters), annual program specialist cost of $22,265, administrative and supervisory cost of $10,810 annually, and state costs to close each case (secondary verification, notice, hearings and appeals, etc.) for a total average of $71,541.87 per state per year times 52 (50 states, District of Columbia and Puerto Rico) totals $3,720,177 million. These are assumed fixed costs for each state, the costs from investigating the matches will vary with the number of matches returned to states resulting in a higher national cost total cited above. It is important to note, improper payments avoided by the Medicaid Program would accrue to the states, savings from the TANF program would accrue to both the states and the Federal Government, and savings from the SNAP would generally accrue to the Federal Government. Success stories of states currently participating in the PARIS program located on the PARIS website cite the following experiences with the PARIS Project with regard to benefits accrued from their program participation New York State, in State Fiscal Year 2017 (April 2017 through March 2018), closed or removed active individuals from 8,923 Public Assistance (PA) cases identified on the PARIS Match. The cost savings for these individuals was $58,006,860. These savings are calculated by determining the average annual cost of an individual in each of the following case types - Federally funded TANF PA cases (which can include Medicaid and SNAP Benefits), New York funded Safety Net PA cases (which can include Medicaid and SNAP Benefits), and SNAP Only cases. We track the number of individuals closed by the PARIS Match for each of these case types. To obtain an annual cost savings for each case type, we simply multiply the number of closed individuals by the annual average cost savings for the case type. The sum of those calculations is the total annual savings for the fiscal year of over $58,000,000. The breakdown of 2017’s annual cost savings is as follows: $35,464,020 in PA (includes SNAP and Medicaid Benefits issued through PA cases, TANF and New York funded Safety Net PA cases), and $22,542,840 in SNAP Only cases. These figures do not include Medicaid only cases. Pennsylvania has participated in the PARIS Interstate and VA Matches since their inception. The results speak for themselves: The following results are for the PARIS Interstate Match from 1997 to 2017: • 407,117 matches have been loaded and 81,903 or 20% are closed. • Total cost avoidance savings are estimated to be $263 million dollars. • The average savings per match closed was $3,212. The following results are for the PARIS Veterans Match 1998 to 2017: • 98,334 were loaded and 12,346 resulted in closed or reduced benefits. • Total annualized savings are estimated to be $56.2 million dollars. • The average savings per match closed or reduced was $4,556. Total estimated annualized savings due to PARIS matches is $319.2 million. Washington State Veterans Benefit Enhancement Program (VBE) focuses on low-income U.S. military veterans and their families relying on Medicaid, and may not realize their eligibility for comprehensive federal care and benefits programs to provide better benefits while preserving their homes and financial assets. The VBE staff embarked on a pioneering effort using available federal data provided by PARIS to connect Medicaid recipients with their federal veteran’s benefits. Washington began its efforts in 2002, focusing on long-term care beneficiaries, most of them in nursing homes, and working in partnership with the Washington State Department of Veterans Affairs. Since then, the state program became a national model and best practice for using PARIS veteran’s data with 32 other states establishing similar efforts. The program is of benefit to veterans and results in redirection of Medicaid funding to others in need. The program is committed to building upon the over $83 million in savings since 2004 and benefitted over 60,000 Washington veterans and families. During the State Fiscal Year (SFY) 2018, through Veterans Benefit Enhancement efforts the State Department of Veterans Affairs reported medical cost avoidance of $8.5 million.