Rethinking Integrated Eligibility: Process Intelligence and AI as a catalyst for social services and government transformation

Written by: Bill Detwiler, Corey Edson, and Jade Littleton

State-level health and human services agencies are under growing pressure to deliver essential social service programs, such as Medicaid, SNAP, and TANF, efficiently and accurately. Integrated Eligibility (IE) programs were created to simplify access to these services by allowing individuals to apply for multiple benefits through a single, integrated process. In theory, these programs would reduce redundancy, eliminate confusion, and improve the experience for those seeking support. In practice, however, the complexity of managing overlapping programs, inconsistent data, disconnected systems, and constantly evolving policy requirements has made IE systems (IES) increasingly difficult for states to administer effectively. In fiscal year 2023, only 4 states were in compliance with the USDA Food and Nutrition Services timeliness target of 95% Application Processing Timeliness Rate (APT Rate). In fiscal year 2024, only 4 states had a SNAP payment error rate less than 5%.

The passage of H.R. 1 (i.e., One Big Beautiful Bill) in July 2025—a sweeping federal law that overhauls IE programs—has added to these challenges. The legislation introduces more stringent eligibility rules, mandatory work and reporting requirements, increased redetermination frequency, and funding reductions across Medicaid and SNAP. As states race to understand the implications of these changes, they face rising administrative burden, heightened compliance risk, and a greater likelihood of service disruptions for vulnerable populations.

To navigate these challenges governments must embrace a new era of public sector productivity—an era defined by a process-first, data-driven approach to improving social service programs—without cutting essential programs or jobs—and made possible by artificial intelligence (AI) and Process Intelligence (PI).

The great disconnect in public sector social services

Unfortunately, as Bastian Nominacher, co-CEO and co-founder of Celonis, wrote for the World Economic Forum, “Making processes work is easier said than done…”

This is especially true when it comes to IE programs. These notoriously complex processes are especially challenging due to:

1. Evolving and complex eligibility criteria: Each program (e.g., SNAP, TANF, and Medicaid) has its own set of rules and requirements, making it difficult for states to develop and manage a seamless process that accurately assesses and verifies eligibility for all programs simultaneously.
2. Disparate, disconnected systems: States often use disparate, systems to manage social service programs (e.g., one system for application and eligibility determinations, one for electronic benefit transfer (EBT) distribution, and another for Medicaid coverage/claims). This fragmentation often results in data silos and prevents states from having a unified view of an individual’s eligibility across multiple programs.
3. Policy changes and variability: Federal and state-level policy changes can frequently alter eligibility requirements, benefits, or administrative processes, requiring states to constantly update their systems, processes, and staff training to stay compliant.
4. Resource constraints: Many states are facing budgetary limitations, leading to understaffing, outdated technology, and insufficient resources to effectively manage these complex programs.

All of these challenges can result in delays and errors in processing applications and providing vital benefits to vulnerable populations. They can also result in substantial financial penalties if federal and state processing regulations (e.g. USDA FNS for SNAP) are not followed.

Process Intelligence: Enabling AI and empowering process excellence in health and human services

Historically, process management initiatives for IE programs have been rigid, one-time, and subjective exercises. The SNAP improvement guidance from the USDA FNS is a prime example of this and reads:

“There are two main strategies for a root cause analysis focused on timeliness:

1. Process mapping lets State agencies visualize the application or recertification process and understand the interactions between the steps. Process mapping can reveal “pain points,” such as places where cases are touched by multiple workers or are waiting for verifications. Effective process maps include (1) how long each step took, (2) which steps depended on previous actions, and (3) what caused any delays.
2. Quality assurance reviews can reveal why a case was not processed on time. Experienced staff who did not process the case review it to identify the points that caused the delay. State agencies can also look for patterns across groups of cases.“

This guidance requires interviewing stakeholders, reviewing documentation, and visually charting out workflows based on assumptions or limited observations. Manual process mapping exercises like this, which are part of traditional business process management (BPM), are time-consuming, prone to subjectivity, and quickly outdated—especially in dynamic environments like integrated eligibility systems. In contrast, Process Intelligence enables real-time visibility, automation, and continuous improvement of public sector operations.

Celonis helps agencies create a living digital twin of their operations that is system-agnostic and unbiased. It extracts raw data from source systems, applications, and devices, using the latest mining and machine learning technologies to transform that data, and build a comprehensive, system-independent foundation of how processes run. Celonis then enriches this data foundation with the unique context for how an agency operates: institutional rules and policies, benchmarks, KPIs, process models, and more. This digital twin is at the heart of the Celonis platform and provides a common language, known as Process Intelligence, for understanding and improving how organizations run. The Celonis Process Intelligence platform then empowers people and AI to build intelligent solutions that continuously improve operations, not just by fixing problems but by preventing them altogether.

With Celonis, states can drive value across several key objectives in Integrated Eligibility programs by:

1. Improving Auditability: Pinpointing root causes of payment errors and delays through end-to-end process visibility, enabling faster resolution and prevention of future inaccuracies or inefficiencies.
2. Increasing Efficiency: Streamlining IE workflows through automation and targeted recommendations to reduce backlogs and delays without increasing staffing.
3. Enhancing Collaboration: Enhancing communication and consistency across departments, teams, and systems.
4. Optimizing Field Capacity: Optimizing resource allocation to reduce caseworker reassignment and idle time during peak periods.
5. Reducing Compliance Risk: Monitoring adherence to federal and state processing regulations to avoid penalties and ensure program integrity.

In short, Celonis analyzes where public sector processes break down, improves them with automation and smart actions, and monitors performance to keep everything on track. This isn’t just theory — it’s how public sector leaders are unlocking faster, fairer benefits delivery at scale.

For example, the Georgia Department of Human Services uses Celonis to connect to their IE systems and create solutions that enable them to:

• Identify opportunities and implement corrective measures to improve the processing timeliness for SNAP, Medicaid, and TANF cases
• Gain full audit visibility into individual case histories with Celonis Case Explorer
• Benchmark performance across districts, counties, and offices, empowering the department to identify best practices and drive data-informed improvements across the entire state
• Prioritize a backlog of applications, periodic reports, and recertifications through the use of a pending case prioritization app

When processes work, government works

People often disagree on the “what” when it comes to spending their tax dollars, but they rarely, if ever, disagree on the “how”. People expect politicians and policy makers to be effective stewards of public money and to deliver the best services possible. When administrations fail to deliver on either expectation, voters aren’t shy about voicing their discontent at the ballot box.

Process Intelligence enables public institutions to take their operations from “that’s the way it’s always been done” to “we do it this way because it’s the most efficient and effective” — thereby delivering better social services.

Get started: Discover why top public sector organizations trust Celonis Process Intelligence.