Computers are the New Paper: Simplifying Eligibility and Enrollment Systems

As states anticipate increased enrollment in health coverage programs and the establishment of health insurance exchanges by 2014, a common goal has emerged – make enrollment systems as streamlined as possible to handle the increase in eligible individuals.

During NASHP’s 24th Annual State Health Policy Conference held in early October, state leaders came together to share best practices and brainstorm ideas about this among other topics related to implementation of health care reform.

Part of the solution to avoid cumbersome application forms lies in creating state data warehouses or data hubs that draw information needed to verify Modified Adjusted Gross Income (MAGI) from eligibility data systems maintained by WIC, SNAP, and TANF, and state wage databases, as well as the WorkNumber or TALX to determine Medicaid, CHIP, and exchange eligibility. Using this strategy, states can simplify the process of getting eligible clients enrolled in the appropriate coverage system, while also saving money.

A big challenge, of course, is figuring out how Medicaid, CHIP and exchanges will work together. Every state is different, but they all share the key need for collaboration among these programs. Over and over, presenters at the NASHP conference also came back to the theme of bringing in multiple stakeholders (consumers, advocates, businesses, community partners and funders) early, building personal relationships, and establishing regular communication. “It’s the trust you build with your stakeholders that gets you through,” said Robin Callahan, deputy Medicaid director for policy and programs for the Massachusetts Office of Medicaid.

Some states participating in the Robert Wood Johnson Foundation supported Maximizing Enrollment initiative are already seeing successes from streamlining their systems:

• Utah has an online customer facing account management tool called MyCase, which allows Medicaid and CHIP enrollees to access all their information online, as well as complete updates and notice reviews. The state has used SNAP grants to update computers in community-based advocacy organizations and taps into assisters at those sites and at other state agencies to help walk clients through the process of enrollment. Utah is now receiving 90% of enrollment applications online, significantly decreasing workload.
• Virginia is using its grant to make a number of improvements to its enrollment system. These include streamlining the renewal process by sending out pre-populated forms with bar-codes that can be easily uploaded to an electronic case record and implementing an online renewal option as a part of their customer-friendly website. They’ve also implemented telephonic signatures allowing applicants to complete initial applications and renewals by telephone. These changes reduced paper applications and renewals by half in one year.
• Alabama is gearing up for an expected 500,000 more Medicaid eligible clients. In its work as a Maximizing Enrollment grantee, the state has implemented express lane eligibility, simplifying eligibility determinations for 190,000 people since Oct 2009. Alabama also adopted 12-month continuous eligibility for children and uses administrative renewal to ease the documentation burden on families at renewal. Based on these successes, the state has received a $93 million CHIPRA performance bonus over the last two years.

One important element of enrollment systems is being designed for voluntary state adoption.  Enroll UX 2014 is a public-private partnership project aimed at creating a streamlined online health insurance portal that can support all insurance affordability programs. Eleven states are participating in the project.

Improving enrollment and eligibility systems is a heavy lift for states but many are working towards a single streamlined application, a data-driven eligibility verification process, and training assisters to help people through the enrollment process. By fostering agency and community collaboration and maximizing data matching, states can minimize the burden.

To see what states are doing to simplify eligibility and enrollment systems, visit State Refor(u)m’sdiscussion page and add information about your state’s initiatives.