california ’ s experience: designing a streamlined user-friendly enrollment system
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January 19, 2012. California ’ s Experience: Designing a Streamlined User-Friendly Enrollment System. Kristen Golden Testa Health Director The Children ’ s Partnership. Families USA Conference Washington DC. Overview. www.childrenspartnership.org. California Experience - PowerPoint PPT PresentationTRANSCRIPT
January 19, 2012
California’s Experience: Designing a Streamlined
User-Friendly Enrollment System
Kristen Golden TestaHealth DirectorThe Children’s Partnership
Families USA ConferenceWashington DC
Overview
California Experience What we have to work from Partnering agencies/governance State legislation Draft design Stakeholder input RFP
TCP’s Enrollment roadmap Lessons Learnedwww.childrenspartnership.org
What California Has Now
58 counties determine Medicaid eligibility 3 county Medicaid IT systems 1 private vendor for centralized CHIP eligibility A “single point of entry” for joint applications Health e app Express Lane for pilot school lunch programs Separate Exchange board up and running
www.childrenspartnership.org
What California Has Now Negative: Previous attempts to
consolidate/privatize/centralize left mistrust Negative: Enormous structural budget deficit Positive: ACA requirements and new federal
funding in the short term Positive: Strong political energy and talent
behind the California Health Benefit Exchange (HBEX)
www.childrenspartnership.org
California Experience: Governance
DHCS and counties for Medicaid (Medi-Cal) CHHSA (overseeing Medicaid and CHIP) MRMIB for CHIP (Healthy Families) New California Health Benefits Exchange
(HBEX) ??? Who is ultimately responsible for the
California Health Eligibility, Enrollment and Retention System (CalHEERS)
www.childrenspartnership.org
California Experience: State Legislation
AB 1296 (2011) creates CalHEERS to: Streamline eligibility rules among Medi-Cal, premium
subsidies in the Exchange, and Healthy Families; Coordinate and simplify citizenship and identity verification at
application and renewal; Require a single statewide application used at all entry points; Adopt rules for “no wrong door” to ensure consistent
determinations from one system Require real-time determination Establish consumer protections and transparency
requirements Establishes stakeholder planning and design process
www.childrenspartnership.org
Enrollment IT Design
California Experience: Stakeholder Process
Advocates’ own coalition Slow agency coordination HBEX stakeholder workgroups HBEX state tour: input on marketing,
enrollment and retention Joint agency process
www.childrenspartnership.org
California IT RFP Goals
“No Wrong Door” service system with consistent consumer experience through all entry points
Culturally and linguistically appropriate oral and written communications , access for persons with disabilities
Seamless and timely transition among health programs Minimal eligibility burden for consumers Security and privacy of consumer information Real-time eligibility determination Transparency and accountability No gaps in coverage Consumers to make informed choices
California RFP Functionality
Single rules engine for MAGI‐related eligibility determination Coordination with county systems for non‐MAGI eligibility Single application On‐line verification Support for selecting among offered health plans, such as qualified health
plans levels, premium/cost sharing ,enrollee satisfaction survey, quality ratings, medical loss ratio information, and provider directories
Plan management, including certification of issuers � Financial management,� Consumer assistance online, over the phone, and by mail� On‐line support and financial transactions for navigators�
Our Enrollment Roadmap
1. Smart connections through multiple doorways
and accessible consumer assistance.
2. Integrated eligibility criteria and processes
across programs.
3. Real-time, immediate, and ongoing
enrollment.
4. Easy navigation of coverage
www.childrenspartnership.org
Roadmap: Multiple doorways
Target harder-to-reach populations who need live connections and assistance
Consumer assistance and call center provide real-time (either automated and live human) assistance
Web portal to support the full coverage experience Use express lane strategies and technology to
prepare for large-scale pre-enrollment. Leverage enrollment gateways to reach more
uninsured consumers
www.childrenspartnership.org
Roadmap: Integrated Process
Single shared eligibility system for all insurance programs, regardless of program entry point
Conform income and other eligibility criteria Continue essential health services and coverage
pathways with insurance program Integrate eligibility and enrollment for other human
service programs
www.childrenspartnership.org
Roadmap: Real-time Enrollment
Modernized IT system and state verification hub Data hierarchy to resolve inconsistencies in
eligibility data to reduces need for follow-up When real-time not possible, provide immediate
coverage to eligible consumers Establish consumer-protection policies to govern
the use of data
www.childrenspartnership.org
Roadmap: Easy Navigation
Enrollment UX project Integrated health plan enrollment with eligibility process and
real-time Coordinated premium payment across programs Consumer-friendly procedures for those facing changing
circumstances Easy navigation through multiple programs for mixed-
coverage families Connecting employees/dependents of SHOP employers
with Exchange subsidies, if eligible
www.childrenspartnership.org
California Lessons Learned
Stakeholder input and coordination Clear governance Thinking through the details Don’t forget SHOP as linkage opportunity Best practices from other states (and UX
project) Federally funding essential
www.childrenspartnership.org
Contact
Kristen Golden Testa
(415) 505 1332
www.childrenspartnership.org
For CA HBEX information:
www.hbex.ca.gov