By Alice Weiss
While open enrollment for health insurance exchanges is well underway, major changes to enrollment processes won’t begin for all states until January 1, 2014, when the Affordable Care Act’s Medicaid and Children’s Health Insurance Program (CHIP) eligibility requirements go into effect. These new requirements, like the “no wrong door” enrollment process, standard income determination rules, and electronic verification, apply to all states, regardless of their decision to host an exchange or expand Medicaid. To prepare, state officials have been working around the clock.
Successful coordination between Medicaid and Ryan White HIV/AIDS programs is one key to improving care and services for persons living with HIV/AIDS. As more people living with HIV/AIDS gain health insurance coverage, effective coordination between programs remains critical. During this webinar, state officials will discuss promising practices for coordination in the areas of inter-agency communication, program eligibility, access to care, benefits, and prescription drugs. This webinar is supported through a cooperative agreement with the Health Resources and Services Administration.
- Kathy Witgert, Program Director, NASHP
- Dr. Karen Mark, Chief, Office of AIDS, Center for Infectious Diseases,Department of Public Health, California
- Dr. David Collier, Associate Medical Director, Bureau of TennCare, Tennessee
- H. Dawn Fukuda, Director, Office of HIV/AIDS, Bureau of Infectious Disease, Department of Public Health, Massachusetts
- Barbara Lantz, Manager, Quality and Care Management, Washington State Health Care Authority
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There are several additional simplifications states can implement to improve enrollment and renewals now that will also make it easier down the road. Maximizing Enrollment grantee states have had success with two such strategies. Automated or administrative renewals reduce documentation burdens on those eligible for coverage and allow workers to focus on complicated cases. Express Lane Eligibility (ELE) allows Medicaid and CHIP to leverage data housed in sister agencies’ systems to streamline enrollment and renewal for families and eligibility workers. Learn about the fundamentals from experts and discuss rewards and pitfalls from state colleagues with experience in each.
Alice Weiss, Co-Director, Maximizing Enrollment; Program Director, NASHP
Maureen Hensley-Quinn, Deputy Director, Maximizing Enrollment; Program Manager, NASHP
Gretel Felton, Director, Technical Support Division, Alabama Medicaid Agency
Amy Andrade, Director, Member and Provider Services, Massachusetts Office of Medicaid
By Nicole Dunifon
This blog post was originally published on State Refor(u)m’s Sate of Implementation Blog
Many states are seizing the opportunity to draw down a 90 percent federal matching rate to design and develop new and upgraded Medicaid eligibility systems to support seamless enrollment. To secure the 90 percent match, states must submit an advanced planning document (APD) to the Centers for Medicare and Medicaid Services (CMS) that demonstrates their systems will meet seven standards and conditions. As many states are considering their eligibility system enhancements and writing their APDs, we wanted to share exciting information technology (IT) innovations from Utah that have improved enrollment and retention in Medicaid, CHIP, and other human service programs.
In May, Utah hosted eight Maximizing Enrollment state teams and provided an in-depth look at Utah’s systems enhancements. During this meeting, representatives from Utah’s Departments of Workforce Services (DWS) and Health (DOH) explained how multiple system components work together to streamline processes for eligibility workers and offer a more customer-friendly experience for applicants.
- eRep – A rules-based eligibility system that is used for multiple human service programs, including the Supplemental Nutrition Assistance Program (SNAP), Medicaid and CHIP. Using the information provided by the applicant, the system can generate an automated determination of an applicant’s eligibility for multiple human service programs.
- eFind – A web-interfacing data warehouse that collects, compiles and standardizes information from different state and federal data sources (such as quarterly wage, unemployment insurance, Social Security, and many more) into a single screen or portal for the purpose of verifying eligibility criteria for various public assistance programs. This eliminates the need for workers to log into multiple different systems with different passwords and protocols, making the process of verifying electronic eligibility data streamlined and efficient.
- MyCase – A customer-facing online account page where Medicaid or other human services program enrollees can access and report changes to basic personal case information, such as an address change or a pregnancy. Enrollees can also complete a coverage recertification and opt to receive electronic notices.
- eNotices and eAlerts – Paperless notifications through email or text message that prompt an enrollee to log into their MyCase page with pin number protection, to access updated information on their case. Utah is the first state to receive CMS approval to transmit notices electronically rather than via US mail. An enrollee can opt in to receive all of their notices.
- Online Chat – As an alternative to calling, clients can use the online chat function to reach an eligibility specialist to ask questions about MyCase, online application and renewal, and more. Communication with a specialist happens through an instant messaging-type conversation on the client’s computer. To ensure the online chat staff is able to communicate professionally and concisely, DWS interviewed candidates solely via chat to test their ability to communicate clearly and succinctly.
- Call Centers – An integrated call center with one phone number that people can call to inquire about all public assistance programs. Call center staff can conduct interviews; process change requests; answer case status questions; and make coverage determinations while the customer is on the phone.
Utah’s in-house IT staff played a major role in the design, development, implementation and maintenance of these system enhancements. The state’s investment in their IT staff allows Utah more control over their systems, and the state requires external vendor assistance only for discrete projects.
Whether using a vendor or internal IT expertise, these kinds of systems enhancements can be expensive. However, Utah reports a savings of over $2 million in the first year of using their eFind system. In addition, the state is saving over $500,000 annually by sending electronic notices instead of paper. Aside from the potential return on investment, the time-limited 90 percent federal matching rate makes it a good time for states to invest in and improve their Medicaid eligibility systems.
Is your state considering systems changes to take advantage of the 90 percent federal matching rate? What enhancements is your state seeking to build? Tell us in the blog comments below.
For a complete slide presentation, click here.
With the recent affirmation by the Supreme Court that the Affordable Care Act (ACA) passes constitutional muster, states will want to accelerate their planning efforts to implement eligibility system provisions under the law for Medicaid, CHIP and Exchanges. This webinar will offer detailed analysis of one of these provisions, the standards under which states can find “reasonable compatibility” of income information provided by applicants for Medicaid, CHIP and the exchanges that is not precisely equivalent. Income data is typically neither static nor centralized, and states must be prepared to resolve discrepancies when income data is submitted by applicants or retrieved from state, federal, or other independent sources. In the case of a discrepancy, CMS eligibility rules provide guidelines to help states proceed with an eligibility determination, including some flexibility for states to find data is “reasonably compatible.”
These rules, which will apply to APTC/CSR, Medicaid and CHIP eligibility decisions regardless of whether states implement the Medicaid expansion and to state-based and federally funded exchanges, provide states with critical flexibility to operationalize eligibility decision-making by allowing states to accept small deviations in income data from different sources. What might a “reasonable compatibility” decision-making process look like in practice? How would a reasonable compatibility analysis work with programs where the actual income amount matters, as with a CHIP premium or cost-sharing requirement or the advanceable premium tax credit and cost-sharing benefit for the exchanges?
In this webinar, Deborah Bachrach and Kinda Serafi of Manatt Health Solutions, will walk participants through straw models they have created to help states think through options for reasonable compatibility process flows for Medicaid, CHIP and APTC/CSR income eligibility determinations. Karen Gibson from Minnesota Department of Human Services will share preliminary thinking on planning for implementation of reasonable compatibility standards. In addition, Ben Walker from CMS will be on hand to provide reactions and feedback on the models. Chad E. Shearer, Deputy Director of the State Health Reform Assistance Network will introduce the webinar and Alice Weiss, Co-Director of Maximizing Enrollment, will moderate the panel. [This webinar is rescheduled from its original broadcast date of June 28.]
- Host: Chad E. Shearer, Deputy Director, State Health Reform Assistance Network
- Moderator: Alice Weiss, Program Director, National Academy for State Health Policy
- Speaker: Deborah Bachrach, Special Counsel, Manatt Health Solutions
- Speaker: Kinda Serafi, Counsel, Manatt Health Solutions
- Speaker: Karen Gibson, Director of the Health Care Eligibility and Access Division, Minnesota Department of Human Services
- Speaker: Ben Walker, Health Insurance Specialist, Eligibility and Enrollment Team, Office of Health Insurance Exchanges in the Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services
This report is the final phase of the National Academy for State Health Policy’s contribution to a larger study of Medicaid managed care enrollment and disenrollment, funded by The Pew Charitable Trusts and conducted by Cornell University and Virginia Commonwealth University. It focuses on the enrollment and disenrollment policies and experience of Medicaid managed care programs in four states: Iowa, Minnesota, Rhode Island and Utah. All of these state have had managed care programs in place for a minimum of five years; Minnesota’s program has been operational since 1981.
Get to know three exchange directors from three very different states, and hear about their exchange-related accomplishments, challenges, and policy priorities. Find out how exchanges are taking shape in the states, straight from the source.
Susan Dentzer, editor-in-chief of Health Affairs, will moderate this discussion with three exchange directors:
Richard Fiore of Alabama
Patty Fontneau of Colorado
Peter Lee of California
NASHP, with the support of the John D. and Catherine T. MacArthur Foundation, is working with Models for Change grantee organizations and state policymakers to address the health needs of youth in the juvenile justice system. This new issue brief from NASHP is the second in a series that highlights findings from surveys of juvenile justice and Medicaid agencies in order to determine policies around health care and Medicaid for youth involved in the juvenile justice system. The paper focuses on findings related to Medicaid enrollment and retention policies for juvenile justice-involved youth.
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Many proposals for federal health reform include two key elements: a Medicaid expansion to include all people below a certain income level; and some form of subsidy to make private insurance coverage more affordable for individuals and families. Wisconsin’s BadgerCare Plus program contains many elements of a Medicaid-plus-subsidies model (Medicaid, CHIP, a CHIP buy-in option, and a coverage option for childless adults). An examination of BadgerCare Plus can shed some light on how a state might manage a range