Oklahoma: Online Enrollment is Grand!

When states working on health reform think “Oklahoma,” they are thinking about a state pioneering eligibility and enrollment innovations and not the award-winning musical. In September 2010, Oklahoma launched the first real-time Medicaid eligibility and enrollment system in the nation, making the days of paper applications and long, cumbersome verification processes a thing of the past. Today, Oklahoma handles about 30,000-35,000 applications a month through an automated central rules engine and data exchange. It takes an applicant 20-30 minutes from the time they begin filling out the application until they are enrolled, greatly minimizing the burden for individuals and families seeking health coverage.
How Does it Work?
An applicant can apply online anytime, instead of being limited to regular weekday business hours. The applicant enters some basic information—name, address, income, and members of the household—into an online portal. If the “rules engine” behind the screen deems the applicant eligible, he or she receives an ID number and welcome packet and is able to access services immediately. At this time, the applicant also learns about other social service programs for which he may be eligible based on the information provided, and has the opportunity to select a medical home and provider. The state then verifies the applicant’s income using electronic sources such as the Social Security Administration, child support services, and the state employment security commission. If any of these sources indicate income data provided by the applicant at the time of application is incorrect, the applicant receives a notification.
As a trailblazer in real-time eligibility determinations, Oklahoma faces challenges, but its lessons learned along the way can guide other states as they venture into this exciting new territory. Here are some key recommendations from the state:

• Develop policies and systems that support quick decision-making. Income verification is complex. States should develop specific policies and systems to support quick decision-making to resolve discrepancies, as Oklahoma did. There is even less certainty about current income when the verification takes place in real time, for income often changes and income data source reporting can lag three to four months behind when the income was earned.

• Frame the issue to improve buy-in. It can be hard for states to prioritize making financial investments in revamping eligibility systems. Framing the changes as an “innovation” or to “improve efficiency” can help garner legislative and political support. Taking advantage of the 90/10 Medicaid match to upgrade eligibility systems can also be a selling point for states.

• Keep the technology flexible. Like many other states, Oklahoma is uncertain of the design of its exchange. As Oklahoma continues to refine its real-time eligibility system, the state is focusing on keeping the technology flexible so it will be able to interface with either a federal- or state-based exchange.

• Prepare for the flood. Oklahoma wasn’t sure how many people would apply online for Medicaid and the state was surprised by how quickly the enrollee community embraced applying online without assistance. Within two months of implementation, Oklahoma was receiving nearly half of all applications from the consumer-facing “home view” online application. More than a year into implementation, only about one in 10 of all applications are submitted on paper. Although no state can predict exactly how many applicants will take advantage of the online enrollment system, it will be important for states to prepare for potentially high numbers of people.

• In-person interaction is still valuable. Ensuring applicants have access to eligibility workers will remain important as states move forward with implementing new application systems and policies. While the online process may be easier for some individuals, others will continue to prefer to interact face-to-face with eligibility workers.

The Maximizing Enrollment program will be highlighting these and other innovations from Oklahoma in an upcoming brief. What do you want to learn from Oklahoma’s experience? What questions do you have for Oklahoma? Post your thoughts by clicking the “post new comment” button below. Oklahoma will share quick responses here and more details in the upcoming MaxEnroll brief.