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Hurdles and High Jumps on the Road to Streamlined Enrollment

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By Alice M. Weiss, J.D.
February 2013
As states embark on the final stretch before new Patient Protection and Affordable Care Act (ACA) coverage options begin in 2014, most are finding their sprint has turned into more of an obstacle course, with late-breaking guidance posing new hurdles and surprises around every bend. Given all this, you would think states might be ready to slow their pace, and yet when I spoke with state officials at NASHP’s final Maximizing Enrollment grantee meeting, all reported they are committed to reaching the finish line in their work to streamline eligibility and enrollment systems and processes. There were a bunch of common themes, even though the states were coming from different political tracks and starting blocks. I wanted to share out some key ideas I heard about how state work is progressing, challenges states are facing, and lessons learned to help other states and those working with them as we begin this final lap.
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Consumer Assistance in the Digital Age: New Tools to Help Enroll People in Medicaid, CHIP, and Exchanges

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The Maximizing Enrollment report “Consumer Assistance in the Digital Age: New Tools to Help Enroll People in Medicaid, CHIP, and Exchanges,” focuses on the various ways states can help customers connect to coverage and explores how current consumer assistance will change as new tools are deployed and technology transforms the enrollment process. The paper draws on the experience of states that have advanced children’s coverage and pioneered the IT system improvements that inspired the ACA’s vision for technology-enabled, consumer-friendly enrollment.  Where state use of new technology tools is limited, such as online chat, the paper offers best practices in customer service management from other industries.

consumer.assistance.in_.the_.digitial.age_.pdf 421 KB

 

“Reasonable” Flexibility: Exploring Models to Help States Resolve Inconsistencies in Income for Medicaid, CHIP and Tax Credit Eligibility

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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.]

Participants:

  • 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

Using Data to Drive State Improvement in Enrollment and Retention Performance

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The Maximizing Enrollment program has worked intensively with eight states to help them increase their use of Medicaid and CHIP enrollment and retention data to monitor and improve their performance outcomes. This issue brief presents recommendations from Maximizing Enrollment and Mathematica Policy Research for twelve core measures that states may want to consider implementing as they plan for new eligibility and enrollment rules and systems to monitor and improve their program’s performance; and track the results of eligibility policy changes, including those related to the Affordable Care Act

data.drive_.state_.improvement.enrollment.retention.performance.pdf 248.3 KB

 

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

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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.

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Using Data to Drive State Improvement in Enrollment and Retention Performance

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The Maximizing Enrollment program has worked intensively with eight states to help them increase their use of Medicaid and CHIP enrollment and retention data to monitor and improve their performance outcomes. This issue brief presents recommendations from Maximizing Enrollment and Mathematica Policy Research for twelve core measures that states may want to consider implementing as they plan for new eligibility and enrollment rules and systems to:

  • Monitor and improve their program’s performance
  • Track the results of eligibility policy changes,  including those related to the Affordable Care Act

To read the full report please click here.

To view or download the slides from the webcast click here.

 
Moderator:

Catherine Hess, Managing Director, National Academy for State Health Policy; Co-Director, Maximizing Enrollment

Presenters:

Chris Trenholm, Senior Economist and Associate Director for Heath Research, Mathematica Policy Research, Inc.

Rebecca Mendoza, Director, Division of Maternal and Child Health in the Virginia Department of Medical Assistance Services

 

Sign and Deliver: Using Technology to Speed up Eligibility & Enrollment

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More and more states are seeking opportunities to use technology to simplify and streamline the Medicaid and CHIP application processes. Allowing families to submit and sign coverage applications electronically or via the telephone are a couple of ways to ease the documentation burden on families. States that have implemented electronic and telephonic signatures also report administrative cost savings and fewer procedural denials for a failure to return paperwork.
The Affordable Care Act requires states to accept applications online and by telephone, so using these tools can help states prepare for health reform implementation and increase program efficiency now. This webinar will explore how two Maximizing Enrollment for Kids state grantees, Alabama and Wisconsin, are using technology to reduce incomplete coverage applications and hasten enrollment for eligible individuals. Alabama will discuss how the state’s Medicaid and separate CHIP programs implemented its online application and accompanying e-signature. Wisconsin will share its experience and lessons learned in developing and operating its policy for allowing telephonic signatures for coverage applications.
Speakers:

  • James Jones, Deputy Medicaid Director, Wisconsin
  • Vicki Jessup, Chief, Policy Section, Wisconsin
  • Viki Brant, Director of Program Operations and Professional Services, Alabama
  • Gretel Felton, Director, Certification Support Division, Alabama
  • Donna Cohen Ross, Senior Advisor, Office of External Affairs, CMS

 

Maximizing Enrollment for Kids Self-Assessment Toolkit Launch!

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This interactive Web-based toolkit, developed by NASHP, aims to help states identify strengths and weaknesses in their current systems to enroll and retain eligible children in Medicaid and CHIP and highlight improvement opportunities.
The toolkit includes four parts that states can use, either together or separately, including:

  1. Instructions and tools to help them to map their enrollment and retention processes;
  2. An interactive on-line questionnaire that will provide the state with a tailored report highlighting best practices and strategies states can consider to improve enrollment and retention;
  3. Questionnaires for stakeholders to allow the state to get objective feedback on areas for improvement; and
  4. Instructions on how to harness the information gleaned during the assessment process to develop improvement plans.

Speakers:
Alice Weiss, co-program director
Maureen Hensley-Quinn, deputy director

Medicaid’s Role in the Health Benefit Exchange: A Road Map for States

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State Medicaid programs are well positioned to serve multiple roles in the development and administration of state Health Benefit Exchanges being implemented under the Affordable Care Act (ACA). Looking ahead to 2014, Medicaid will be both an option in the continuum of health insurance coverage and an essential partner in developing, governing, and operating each state’s new health benefit exchange. This paper highlights opportunities for states to support and expand Medicaid’s current role in planning new state Exchanges in eligibility, enrollment and outreach; health plan standards and requirements; benefit package design; and infrastructure: governance, operations and finance.
View Webinar on this Topic!

maxenroll Bachrach 033011.pdf 1.6 MB

 

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