December 1, 2009 Alliance for Health Reform Briefing Tricia Brooks

1. Getting the Most Bang from our Post-Health Reform Buck:Enrolling and Retaining Everyone Who’s Eligible December 1, 2009 Alliance for Health Reform Briefing Tricia Brooks

2. How are we doing in Medicaid & CHIP?How can we do better post-health reform? In 2008, the number of uninsured children dropped to it’s lowest rate in more than 2 decades largely due to the success of Medicaid and CHIP but… 5 million of the 8 million uninsured children are currently eligible for Medicaid or CHIP… As many of 40% of uninsured children were enrolled in Medicaid or CHIP in the prior year…

3. Lessons Learned from Medicaid and CHIP

4. Barriers to Enrollment & Retention • Unnecessarily excessive paperwork and red tape • Lack of clarity in communication • Affordability; payment policies • Past experiences with “the system” • Cultural orientation to coverage and access to healthcare • Outdated, inflexible technology

5. Coordination Issues • Lack of alignment between programs: • Policies • Procedures • Requirements • Separate eligibility systems with limited ability to exchange data • Incomplete, unsuccessful hand-offs between programs

6. It’s Not Rocket Science • Harness technology to enhance productivity and accuracy • Engineer the business policies and processes to be: • Efficient • Client-focused • Performance-based • Seamless to families and individuals

7. But There Are Challenges • Resistance to change • Political will and State resources • Technology costs • Data collection and analysis capacity • Effort required to map processes, test new ideas, identify best practices, spread change • Subsidies through tax code would add new element to coordinate

8. Effective Strategies Moving Forward

9. Maximize the Use of Technology • Program information • Self-service options • Screen, apply, renew and manage account • Centralized eligibility or highly functional data exchanges • Administrative verifications • Express lane eligibility • Better data; quality control

10. Make the System Simple and Consistent • Requirements, processes, and procedures • Income, in particular • Materials, forms, letters, all communications • Multiple points of entry • Via mail, phone, web, in-person • Attention to consistency across venues • Screen and enroll for all programs regardless of access point

11. Support Community-Based Assistance Help overcome stigma, cultural and language barriers Offer breadth of services from outreach to screening eligibility to app assistance Clarify requirements for families • Reduce administrative load on eligibility offices • Provide excellent feedback mechanism

12. Offer Affordable Premiums with Flexible Payment Policies • No rule of thumb on affordability but must take into account all cost-sharing • Premiums impact enrollment • Co-payments impact access • Need multiple payment options • Generous grace periods and premium rescues can help

13. Focus on Outcomes • Establish clear program goals and outcomes measures • Collect, analyze and act on enrollment and retention data • Adopt a continuous improvement approach to program administration • Report data publicly to enhance accountability and transparency

14. Put Out the Welcome Mat • Reform offers opportunity to create renewed interest in and enthusiasm for all coverage programs • Care should be taken to create and refine a system of coverage that is seamless and easy to maneuver for families and individuals

15. Contact Information Tricia Brooks Senior Fellow Georgetown University Center for Children and Families pab62@georgetown.edu http://ccf.georgetown.edu/ http://www.theccfblog.org/ 202-365-9148