Program (Eligibility and Referral) Rules

SUMMARY: 

Agencies using empowOR can create Program Rules to regulate enrollment eligibility, enhance data quality reporting, and assist with presumptive eligibility determinations. These rules are managed by a local empowOR administrator at the program level.

Key Functions of Program Rules

1. Regulating Enrollment

Once created and activated for a program, rules help ensure only eligible participants can enroll. If a participant does not meet the eligibility criteria:

• A warning message appears when staff attempt to save the enrollment.
• The administrator can configure rules to either:
  • Deny enrollment completely, or
  • Allow an override where staff can proceed despite the warning.

2. Enhancing Data Quality Reports

• If a program has eligibility rules, the Data Quality Report will highlight missing or incomplete information using RED (not complete) or GREEN (complete) indicators.
• This helps agencies ensure all required information is collected for accurate eligibility assessments.

3. Controlling Presumptive Eligibility & Referrals

• Program rules can be included in the Presumptive Eligibility process, allowing empowOR to automatically determine if a household qualifies for a program.
• If enabled, eligible programs will appear in the Presumptive Eligibility Quick Report, which helps staff refer households to services they qualify for.

Planning for Program Rules

Before creating rules, agencies should prepare by identifying:

1. Eligibility Criteria – Define what determines eligibility (e.g., income threshold).
2. Forms & Assessments – Identify the forms/assessments that hold relevant data (e.g., an Income Supplemental Form for an income-based rule).
3. Supplemental Forms & Work Templates – Ensure the necessary forms and assessments are attached to the work template.

Example: If a program requires households to have an income at or below 150% of the federal poverty level, administrators must include:

• The rule condition (income ≤ 150% of poverty level)
• The Income Supplemental Form, which stores this data

Important Consideration:

• Use only necessary rules to avoid unintentionally excluding eligible participants.
• Rules using the same form/assessment can be linked with "OR" connectors, but if multiple forms/assessments are used, participants must meet ALL criteria.

Where to Create Rules

To set up program rules:

1. Navigate to Admin Menu → Program Info → Manage Programs.
2. Select the program where you want to create rules.
3. Open the Eligibility Rules tab.

Note: Eligibility Rules can be added while creating a new program.

Steps to Create an Eligibility Rule

1. Navigate to Admin → Program Info → Manage Programs.
2. Select a program and go to the Eligibility Rules tab.
3. Add a new rule using forms or assessments.
4. Set field names, qualifiers, and values (e.g., income ≤ 150% poverty).
5. Save and apply rules.

To add another rule to the same form (e.g., "Income"), edit the existing rule.

1. Click the AND/OR button to define whether the new rule should be combined with "AND" or "OR".
2. Click the first icon next to the AND/OR button to add a new condition.
3. Configure the new condition similarly (select field, qualifier, and value).
4. Click SAVE QUALIFICATIONS and then CLOSE.

Optional Overrides:

• Agencies can allow enrollment after a warning by enabling "Allow Enrollment after Warning" in program settings.

Data Quality & Reporting

• Rules highlight missing data but do not determine eligibility.
• Presumptive Eligibility settings must be enabled for programs to appear in eligibility checks.

Enabling Presumptive Eligibility

• Ensure eligibility rules exist for the program.
• Check “Check for Presumptive Eligibility” in the program settings.