Taking it to the Max: Eight States Improving Enrollment and Retention in Medicaid and CHIP

Sarabeth Zemel
December 2011

This blog post was originally published on State Refor(u)m’s State of Implementation Blog.
Earlier this month, eight states gathered in Washington, DC for an annual meeting of grantees of the Maximizing Enrollment program, a Robert Wood Johnson Foundation initiative directed by NASHP that aims to help states improve enrollment and retention of eligible children and prepare enrollment systems for individuals eligible for public and publicly-subsidized coverage programs in 2014.

In 2009, the program awarded four-year grants to eight states committed to improving enrollment: Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia, and Wisconsin. At the annual meeting, the program’s grantees came together to share their accomplishments, as well as learn from each other and experts on enrollment and retention issues. The work these states have done may highlight some good ideas for other states as they embark on eligibility and enrollment work to implement health care reform. Here’s what the busy “MaxEnroll” grantees were up to in 2011:
Online Application Systems – New York updated its online assistance tool and developed a Spanish language version of the screening tool. Alabama contracted with a vendor to create an entirely online application process for Medicaid and other public benefits. Wisconsin already had an online screening and application tool in place before starting Maximizing Enrollment work.
Express Lane Eligibility – Louisiana, having implemented Express Lane Eligibility (ELE) in January 2010, started using the system in 2011 to conduct automatic renewals. It also began interfacing with the SNAP program on a daily basis, rather than monthly, in order to find new eligibles for Medicaid/CHIP coverage. Alabama is already using ELE for renewals and New York is about to implement ELE for renewals and changes in eligibility status.
Workflow System Improvements/Culture Change – Illinois spent 2011 working to change how applications are processed to address a backlog and improve response times at its All Kids Central Processing Unit. Representatives reported dramatic improvements; by implementing a triage system and giving workers more control over which types of cases they process, they were able to eliminate their application backlog entirely and reduce average processing time from 35 days in December 2010 to a low of 4 days per application in December 2011.
Electronic Document Management – The move to digital recordkeeping is a huge improvement for many states. Alabama worked on implementing a document imaging system, allowing them to move from paper-based records to an electronic system. Illinois is beginning to embark on a similar venture and just chose a vendor for this work. Massachusetts also made a switch to a digital record management system, reporting successful implementation in all of its four regional offices and the central processing unit in 2011.
Renewals – In addition to the progress on online applications, Alabama pilot-tested a telephone renewal option for families, while New York began to phase in mail-in and telephone renewals through its centralized Enrollment Center. Massachusetts and Wisconsin began a form of administrative renewal Maximizing Enrollment refers to as “continuous renewal,” which uses program data to determine types of individuals who will likely be continuously eligible for public coverage and relies on administrative data to continue program eligibility. Under continuous renewal, the state sends an initial notice and only requires enrollees to submit information to the agency if their status has changed.
Online Accounts – Utah began using MyCase, an online account system accessible to Medicaid and CHIP enrollees that allows individuals to check benefit status, update information, and receive notices electronically. MyCase allowed 41,000 of the state’s 130,000 Medicaid and CHIP enrollees to go paperless. Since May 2011, 45,000 enrollees have reported changes to the state through this system. In the future, individuals will be able to apply for benefits and renew coverage using their MyCase account.
Data Collection and Analysis – This year, Virginia launched its data warehouse, which combines three systems: MMIS, CHIP, and Medicaid eligibility, and enables the state to analyze eligibility and enrollment data in a variety of ways.
Electronic Data Exchange – Wisconsin began automatic updates from data exchanges with its unemployment agency and the Social Security Administration (SSA), and is exploring implementation of real-time SSA data matching under SOLQ-I. Massachusetts implemented electronic data matching with SSA to meet the requirement to verify citizenship for enrollees and applicants.
Engaging Frontline Workers – Virginia convened a meeting for frontline eligibility workers, who are not usually part of policy discussions, to engage them in the conversation about the development of a new online web portal and eligibility system overhaul. Virginia also conducted focus group interviews with frontline eligibility division managers to get input on policy and program changes needed to reduce barriers to enrollment and streamline processes.
These are great accomplishments, but we know other states have also made progress in 2011. Has your state made improvements around eligibility and enrollment? We want to know! Share with us in the comments below or contribute to State Refor(u)m’s eligibility area.



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