Eligibility Simplification is Far from Simple

Yesterday, more than 500 listeners from 48 states and the District of Columbia tuned in to a webinar on tackling health reform’s eligibility challenges. Oklahoma, New York, andMassachusetts discussed readiness for 2014, how simplification has improved enrollment and retention, and what the federal government can do to support simplification efforts. While still awaiting final federal guidance, these states are rolling up their sleeves and flexing their health reform muscles to begin aligning complex eligibility policies, systems, and processes to prepare for the influx of newly eligible people in 2014.
As promised, we are sharing a few of the webinar Q&A highlights in order to transition the discussion online. We have also organized the questions we did not have time to address, and invite you to contribute your insights, and let us know how your state is confronting these eligibility challenges in the “blog comments” below.
Question: What sources do you use for real-time verification of earned income? Do states plan to rely on state sources of information in addition to a federal hub?

• Oklahoma currently uses information from a number of electronic sources, including the Social Security Administration and the state employment security commission. The IRS data exchange hub will be a key component for getting real time data in the future.
• New York does not expect to get all of the necessary data for determining eligibility from a federal hub. Currently, the state uses a batch system to download information such as wage reporting and unemployment data, but it will be essential to move towards more relevant, real-time databases to consolidate information.
• A memo written by Manatt Health Solutions describes sources of data for income verification. Check out this resource and stay tuned for an upcoming State Refor(u)m blog post on this topic.

Question: States are doing a lot of eligibility planning around MAGI (Modified Adjusted Gross Income) populations. Does any of this work also focus on people who are not MAGI-eligible, such as people with functional disabilities and elderly populations?

• New York, Massachusetts, and Oklahoma are focused on making sure all MAGI rules and policies are in place by the upcoming 2014 deadline. In the years following, the states envision enrollment systems that include non-MAGI populations, but for right now they have prioritized MAGI. New York state activities have been primarily administrative, identifying early wins and simplifications to ease the workload on county workers while simultaneously preparing for the coverage expansions in 2014.

Question: How do you make a transition from county to state-based eligibility determinations?

• In New York, the work to moving from county to state-based eligibility determinations is well underway. Governor Cuomo released a proposal that includes resources to make the transition feasible. In the next few months, vigorous conversations with the legislature and other stakeholders will ensure the transition is smooth with minimal disruptions. Right now, the most pressing concerns are related to workforce.

Question: How has your state’s health reform implementation work influenced the state’s vision of the role of eligibility workers?

• In Oklahoma, caseloads continue to climb due to the difficult economic climate. With the new online enrollment system, eligibility workers will be able to dedicate more time to other resource intensive programs. While the online process may be easier for some individuals, certain people will continue to prefer to interact face-to-face with eligibility workers.
• New York is trying to move towards automation whenever possible, but there is still a great deal of complexity and need for eligibility workers to assist with manual data input.Massachusetts concurred that the paperless systems have made processes more efficient, enabling eligibility workers to focus their energy on other programs, although there still remains more work than eligibility staff.

We invite you to share your expertise and help us answer the following questions:
Financing

• If an exchange is not a government entity (i.e. a non-profit governed by a board), can it receive Medicaid-related funding?

Electronic Verification

• More former-inmates will soon become eligible for Medicaid. How can a state use electronic verification of incarceration status and release dates for eligibility purposes?
• How can a state move to electronic verification and maintain program integrity? What is the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) error rates in states that do this already?

Agencies, Programs, and Plans Working Together

• How are Medicaid and the exchange working together to set up eligibility systems and processes?
• Do any of states include SNAP and TANF in early phases of online eligibility determinations/MAGI?
• Under health reform, will coverage portability across state lines improve?
• Are any states allowing carriers to enroll people online?

Contracting

• Does the IT vendor community have the capacity to do this work? What are states’ experiences with IT vendors so far?
• Do states have any advice on out-sourcing eligibility determinations to non-state workers? What are states’ experiences in this area so far?

Providers

• How are states working with Federally Qualified Health Centers on enrollment?  How are states working with other providers?

Post your ideas, challenges and experiences by clicking the “post new comment” button below to help answer these key remaining questions!