how we transformed the medicaid eligibility process in louisiana (and lived to tell about it!) churn...

How We Transformed the Medicaid Eligibility Process in Louisiana (and Lived to Tell About It!)

Churn in Public Programs

Washington, DC

May 20, 2011

Don Gregory, Medicaid Director

Children’s Health Coverage in Louisiana in 1998

• High rate of poverty and poor health outcomes

• Absolute minimum levels of coverage for children

• Onerous application and verification requirements

• Nation’s third highest percentage of uninsured kids

• Almost 1 in 3 low income children had no health coverage

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A “Hole in the Bucket”–Our Renewal Woes Circa Early 2000

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Net loss of more than 6000 kids in a single month

Thousands of closures each month for “procedural”/paperwork reasons

Failure to return renewal formFailure to submit verificationUnable to locate

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Dramatically Reducing Closures at Annual Renewal for Paperwork Reasons

• Ex Parte renewals when possible

• Telephone renewal processes

• “Administrative” renewals

• Express Lane Eligibility renewals NEW in 2010

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Ex Parte Renewal Defined• “Action by one party without

the involvement of the other”

• Described in 4/7/00 State Medicaid Director’s Letter

• Fully embraced since 2000• Heavy reliance on other

computer systems for verification– SNAP (Food Stamps)– TANF– Child Support

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Maximizing Alexander Graham Bell’s Great Invention

• Aggressive follow up phone calls when paperwork is not received

• AVR--Automated Voice Response Renewals

• Telephone renewals

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Telephone Renewals Benefit Families and the Agency

• Federal regulations require annual review but not signed form

• Implemented 11/03 as option when ex parte can’t be done

• Reduces administrative cost—postage, paper, staff time

• Key to our getting procedural closure rate from above 22% to below 1%

“Paths” to Renewal for Children in August, 2010

Medicaid CHIP

What Difference Does “Fixing” Renewals Make?

45,809 Total Kids—Couldn’t renew 327 of them

327

<1% (2010 Rate) August 2010

22%(2001 Rate)

10,078

CHURNERS

Administrative Savings from Paperless Renewals

• Ex Parte, Telephone & Web Renewals – No renewal form

Cost of printingPostageManpower necessary to process outgoing and

incoming forms– Annual savings: $10.7 M

• Targeted Administrative Renewals– If no reported changes, totally automated process– Annual savings: $8.25 M – 288,000 annual renewals

Improving Work Processes Through Technology

• Paperless eligibility case records

• Web–based application,renewal, & change reporting

• Real time verification through other data bases

• SSA citizenship verification• Electronic newborn

enrollment• Web-based nursing facility

admission & change reporting

Remote wireless access to all eligibility systems

Reasons We Pursued “Paperless” Eligibility Records in 2002

• Interminable problem of “lost” and “misplaced” records

• Labor issues associated with paper records and file rooms

• Other administrative costs • Bottleneck in business process while

waiting for records• Multiple processing locations -

postage costs• Vision of greater simplicity by reducing

“paper”

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Louisiana Medicaid/CHIP Enrollees

Workload / Case Worker Ratio

“Organizational Change” A Major Factor in Simplification

• Even more important than technology

• Caseworkers “open” and “close” the door

• Major changes in expectations of caseworkers– From passive– To proactive

• It’s about winning hearts & minds

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Our Internal Marketing Messages to Eligibility Employees

• Why health coverage for kids is important– to child– to family– to State– to society

• Barriers to getting and staying enrolled– Misinformation/lack of knowledge– Literacy

• Parental apathy is not the child’s fault18

Are They REALLY Eligible?

• PERM Medicaid eligibility error rate of

1.54%-one of lowest of any state!

• Greatest vulnerability is overestimating income & placing Medicaid child in CHIP

Children’s Health Coverage in Louisiana in 2011

• High rate of poverty and poor health outcomes – still a challenge to be met

• Absolute minimum levels of coverage for children – now offer coverage to 250% FPL

• Onerous application and verification requirements – much improved

• Nation’s third highest percentage of uninsured kids – now less than 5%; lowest quintile per 8/10/10 Urban Institute report

• Almost 1 in 3 low income children had no health coverage – now fewer than 1 in 20

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Our Secrets Revealed

Commitment to Simplification

Improving Retention

Integration of Technology

Organizational Change

Continuous Process Improvement

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Don GregoryMedicaid DirectorLouisiana Department of Health & HospitalsP.O. Box 91030 Baton Rouge, LA 70821-9030Telephone: 225.342.3891Fax: 225.342.9508E-Mail: Don.Gregory@la.gov www.lachip.org

Never doubt that a small group of thoughtful, caring people can change the world. Indeed, it is the only thing that ever has!

— Dr. Margaret Mead