Welcome to the Aligned Certification Period Webinar

1. Welcome to the Aligned Certification Period Webinar Thanks for joining! We’ll be getting started in just a minute. To join the audio portion, you can select from the drop down menu to either: • Enter your phone number to receive a call back • Dial in yourself, by calling the 866 number and entering the access codes displayed under the call-in number

2. Aligned Certification Period Policy January 23, 2013 2:00 – 3:30 PM Best practices, lessons learned, and implementation strategies for cross program certification period alignment. www.pcghumanservices.com

3. About WebEx • All participants are in listen only mode • Please put your phones on mute • To ask a question, please submit it through the chat function

4. Agenda • Introductions • Background (5 minutes) • Pilot and Lessons Learned (10 minutes) • Pilot County Experiences (30 minutes) • State Policy and Procedures (10 minutes) • Questions & Answers (35 minutes)

5. Presenters Dean Simpson Susan Ryan Policy Project Manager Division of Medical Assistance Susan.Ryan@dhhs.nc.gov (919) 855-4016  Lindsey Shewmaker Donna Grady Medicaid and FNS Program Manager Lenoir County DSS dgrady@dss.co.lenoir.nc.us (252) 559-6329 Chief, Economic and Family Services Division of Family Services dean.simpson@dhhs.nc.gov (919) 527-6330 Human Services Manager Orange County DSS lshewmaker@co.orange.nc.us (919) 245-2817 Erin Henderlight PCG Project Manager ehenderlight@pcgus.com (828) 214-3614

6. Background • Many families receiving multiple benefits, within and across programs • Recertification process was cumbersome for customers • There is often little information sharing between FNS and Family & Children’s Medicaid • Aligning certification periods was commonly cited as the most needed policy improvement

7. Pilot • February – May, 2012 • Two Pilot Counties: Orange and Lenoir • Began with walk in customers, then was expanded to mail in applications and recertifications • The primary goals were to: • Reduce the likelihood of customer churning • Increase information sharing within the agency • Enhance the customer experience and reduce the number of repetitive interactions with the agency • Reduce workload for county staff www.ncwss.com

8. Pilot, continued. When a household receiving Family and Children’s Medicaid (including MIC/MAF) applies or reapplies for FNS in person, the information provided should be used to recertify both their FNS and Medicaid case. All of the information required to recertify the Medicaid case will be collected during the FNS interview, and will be stored in the customer’s case file. The Medicaid or FNS case worker should leverage that information to complete a recertification, and should only contact the customer in the event of missing or incorrect information. Failure to recertify one program will not result in automatic termination of the other.

9. Pilot, continued. • Key considerations in pilot policy development: • Communicating information between programs • Processing Medicaid recertifications • Changes to FNS recertification form • Quality control • Implementation Plan: • Business process redesign • Form revision • Staff training • Customer communication • Data collection and evaluation

10. Pilot Outcomes • Staff satisfaction • Time savings (staff and customers) • Better customer experience If the pilot had continued for the next nine months, 97% of certification periods would have been aligned.

11. Lessons Learned from Implementation Start small. Counties already have the ability to align certification periods across Medicaid programs. Start by: • Getting the biggest bang for your buck. If your county doesn’t have the resources to do a full scale alignment, start with the biggest programs first. This can be done as part of the Medicaid preparation for NC FAST. • Develop alignment processes and procedures within Medicaid. Establish a process for staff to align certification periods within the medical assistance programs, which can be utilized by all MA staff regardless of specialization. • Start with walk-in customers.

12. Lessons Learned from Implementation Plan the information sharing. Managing the cross-program communication is the beginning to successful implementation. • Consider key questions. What will result in the best experience for the customer? How should information be shared across programs? How can we ensure nothing gets lost in the shuffle? • Sketch out your new business process. Counties will need to map out a new process, asking, “What additional information should be collected from the customer? When should that happen? How should that be shared and what should be the follow-up?” • Collect all the customer’s information up front. While NC FAST will eventually do this for us, counties should start this practice as soon as possible. The DMA-5065 can be repurposed to collect Medicaid information through other programs. • Decide how to message the alignment to customers. It is important to let customers know this means fewer visits to the office, less paperwork, and fewer dates to remember.

13. Lessons Learned from Implementation Develop new process and training. Once key planning decisions have been made, the new process and training should: • Allow for trial and error. • Provide clear procedures in writing for staff.

14. County Experiences Lenoir County Challenges and Learning Opportunities Time consuming to align MAF cases due to reserve requirements Need for access to partner program’s certification periods in order to determine if already aligned

15. County Experiences Lenoir County Benefits Supports #1 Tenet of WSS – Families only tell their personal story one time, to one person, and they receive benefits in multiple programs View the family as one unit and decreasing the number of contacts that family must have with DSS to maintain benefits

16. County Experiences Orange County Overview of Intake Process – Chapel Hill Clients coming in the door to apply for FNS or a mail-in FNS application are assigned to an FNS Intake worker. The worker checks EIS for open F&C Medicaid cases that meet alignment criteria. Any needed verifications are requested by the Intake Worker on a 5097 and client reserve is documented on a 5065 (MAF Supplement). Once the FNS case has been approved it is forwarded to the ongoing Medicaid worker in the F&C’s Unit. The cases are aligned and the aligned Medicaid and FNS cases are kept in one district.

17. County Experiences Orange County Overview of Intake Process – Hillsborough All walk in FNS applicants or mail-in FNS applications are evaluated by the Intake Supervisor to determine if they are attached to an open, ongoing Medicaid case and if they meet alignment criteria. After these cases are identified by the supervisor they are logged in to the Alignment Log and passed to the Lead Worker to complete the FNS application process. Once the FNS case is approved the LW identifies open F&C Medicaid cases that meet alignment criteria. The LW sends an email to the ongoing IMC. F&C Medicaid cases are then closed and aligned as needed. 8194 sent to ongoing worker in the F&C FNS/Medicaid Ongoing Unit.

18. County Experiences Orange County Overview of FC Medicaid/FNS Unit Semi-Annual Recertification Forms (SR) are received in the agency through the mail, dropped off by clients, or brought in by clients walking in for interviews. The ongoing FNS IMC searches for any existing F&C Medicaid cases attached to that SR that meet the criteria to be aligned. The FNS worker requests any needed verification using the 5065 (MAF Supplement) when needed. The completed FNS Recertification is then forwarded to the F&C Ongoing Medicaid caseworker who then aligns all possible Medicaid programs and assigns the combined cases to one ongoing caseworker to handle both FNS and Medicaid.

19. County Experiences Orange County Challenges and Learning Opportunities For Medicaid, the alignment is a 2-day process because one case has to terminate overnight before cases can be aligned. A lot of Medicaid cases could not be aligned because certification period exceeded 6 months. When FNS and Medicaid cases had different case heads in two-parent families, changed case head on Medicaid case and notified client to keep the cases together. Not including Adult Medicaid made it difficult to align cases for an entire family.

20. County Experiences Orange County Challenges and Learning Opportunities County to county transfers did not meet alignment criteria because of the delay in transferring the Medicaid case. NC FAST implementation has diminished ability to continue project. Communication has to be good both within and across units to assure everything gets processed correctly. Used a script to inform clients about the potential for aligning cases and the expected benefits. Document management system made it easier to see all information about client in a single location. Using paper records would make more difficult to accomplish. Started slowly with walk-in applications first, then expanded to include mail-ins and recertifications. Phased-in process worked well and was less overwhelming.

21. County Experiences Orange County Benefits Families will spend less time in our offices Aligning certification periods across programs can help with retention and reduce churn Decrease long term workload for staff See additional efficiencies with NC FAST

22. State Policy and Procedures Medicaid Policy/Procedures Concerning Aligning Certification Periods Medicaid Policy concerning aligning certification periods DID NOT change for the pilot or since the pilot was completed. You can align certification periods among Medicaid cases NOW when completing an app or redetermination. Current policy supports this. F&C MA-3425 IV and ABD MA-2350 III.A.

23. State Policy and Procedures How to Align CP’s When completing an application or review (for Medicaid or FNS): Determine if other Medicaid cases exist for household. If so, redetermine eligibility for all programs allowed If possible, align Medicaid certification periods among the cases. Document, Document, Document

24. State Policy and Procedures Rules NCHC cases must have 12-month cp, so may not be able to include unless completing the NCHC redetermination and aligning Medicaid with that cp Cannot shorten the cp of an existing case unless required to react to change that affects eligibility (MAF, MAD, MAA). Timely notice required to terminate. You can assign a shorter than usual cp to an applicant to match other active Medicaid cert periods, except for NCHC/MPW. If deductible, the deductible is calculated for the # of months in the ongoing cp

25. State Policy and Procedures Alignment Example – Medicaid Mom applies on 1/2/2013 Worker does query and finds Mom has two children with active Medicaid cases Child 1 (MIC) cp of 10/1/12 – 9/30/13 Child 2 (MIC-1) cp of 6/1/12 – 5/31/13 Mom is approved on 1/20/13 for MAF-C with cp of 1/1/13 – 6/30/13 Redetermination based on Mom’s info at app – children are eligible in the same programs Child 1 and Child 2 are given new cp’s of 2/1/13 – 12/31/13 (covers 2 cert periods of Mom) If Mom completes redetermination in May/June, new cp would be 7/1/13 – 12/31/13.

26. State Policy and Procedures Alignment Example: FNS/Medicaid Family applies for FNS on 1/2/13 FNS worker finds family currently has MIC and MIC-1 cases for children (same as previous example) FNS approved with cert period of 1/1/13 – 6/30/13 Redetermination for Medicaid shows children still eligible under current programs. Children will have new cert periods of 2/1/13 – 12/31/13.

27. State Policy and Procedures Alignment Example – Ineligible Same example as before Mom applies for MAF and is medically needy – deductible met with hospital stay Eligibility redetermination for children shows eligible for NCHC based on current income Cannot take action on MIC and MIC-1 cases as they have continuous eligibility and cannot react to this change that affects eligibility until scheduled redetermination. Cert periods remain the same: Child 1 (MIC) cp of 10/1/12 – 9/30/13 Child 2 (MIC-1) cp of 6/1/12 – 5/31/13

28. Policy Question & Answer Submit questions: • Submit questions via chat • All questions will be consolidated into a Q&A document, which will be shared with all attendees

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