Define and manage rules to determine eligibility and calculate benefits.

The Social Benefits Playbook uses an Eligibility Rules Engine, a series of pre-defined policies that are associated to a specific benefit, to determine whether they are eligible to apply for one or more social benefit programs that your agency offers. These policies are a set of pre-defined rules and logic that determines whether a constituent will receive benefits or not. Using a set eligibility rules criteria for Social Benefits Playbook may aid in deflecting applications for which the applicant is not eligible for a specific social benefit program. These policies can be updated as rules and regulations surrounding these social benefit programs change. The policies in Social Benefits Playbook Eligibility Rules Engine are powered by Policy as Code Engine (PaCE).

A PaCE policy is  a set of pre-defined rules and logic that determines the desired behavior of an application or a service. When invoked, the rules in the policy are applied on the provided input, and a decision is reached. In PSDS, a PaCE policy represents a set of eligibility criteria that must be satisfied for a constituent to receive benefits. When invoked, the rules in the policy are applied to the case, and an auto-calculated eligibility recommendation is provided to the agent. For more information on understanding PaCE within the Social Benefits Playbook, see Understanding Policy as Code Engine (PaCE) and the Social Benefits Playbook.

You can use the eligibility rules engine to manage the life cycle of a policy and create, update, review, and execute policies. With the eligibility rules engine, you can:

• Evaluate any changes to ensure they meet your organization's policy management requirements.
• Create a policy, modify policy information, or copy a policy and its version to a new policy.
• Create a new policy version by copying an existing policy version and modifying it.
• View and define mapping information for any policy.
• Review executed policy activity and execution history for policies and policy versions.
• Use tags and categories to manage your policies more efficiently.

If the applicant fulfills all the criteria set forth by the eligibility rules engine policies, then the applicant can proceed with their application, or the agent can proceed in creating a case for the applicant.​ Case information must satisfy the conditions of each pre-defined policy for a constituent’s request to be deemed ‘eligible.’ If the information from the case is found to be non-compliant with one or more policies, and the applicant does not fulfill at least one of the eligibility criteria, neither an agent nor an applicant can proceed in creating a case for the social benefit program, and their request will be labeled as "not eligible."

Workflow