Modernizing Eligibility Systems for Better Health Care Access in Colorado

1. June 25, 2009 Colorado Perspective – Updates and OpportunitiesSue Williamson, Deputy DirectorColorado Department of Health Care Policy and Financing

2. Where to Start ??? 2

3. Something’s Working • Largest Medicaid caseload in history of program • 13% increase from January 2008 • 457,699 Medicaid clients • 63,039 children on CHP+; 1,659 pregnant women on Pre-Natal CHP+ (Source:  April 2009 Caseload Report to JBC) 3

4. Eligibility and Health Care Reform • Goal of the Department: To enroll all eligible, but not enrolled children into Medicaid and CHP+ (85,000 – 110,000 children eligible for Medicaid and CHP+ are not enrolled) • The State is making significant investments in outreach only to lose a great many clients at re-determination • On average, the first two months of a client’s eligibility is the most expensive (care is not received in appropriate settings and care is not managed) 4

5. Eligibility and Health Care Reform • The Deloitte CBMS study (2005) and Deloitte County Workload study (2007) both suggest that we can and must do a better job with both the systems side of eligibility and the administrative side of the eligibility determination process • 208 Blue Ribbon Commission on Health Care Reform included a recommendation for centralized eligibility (Recommendation 5) – January 2008 • Increased focus by state and federal auditors on state’s oversight of eligibility process (single state audit; PERM) 5

6. What is Eligibility Modernization?National Perspective • No single definition – many states have modernization efforts underway • Focused on all public benefit programs (Food Assistance, TANF, Medicaid) • Change in the way states do business to expand access to benefits and improve efficiency • States using new technologies and procedures such as online applications, call centers, document imaging • Increased efficiencies – economies of scale 6

7. Colorado: Goals of Eligibility Modernization • Return on Investment • Without these changes, the State will not be able to handle the growing caseload (economic downturn, health care expansions) • Need better tools to support workers so they can focus on the clients as opposed to administrative tasks • Need statewide solution to be efficient • Achieve Goals • Client Centered Approach • Enroll and Retain Eligible Children & Families • Provide Good Customer Service with Low Application Processing Times • Leverage Existing Technology • Design and Implement Effective Policies • Incorporate Partners & Stakeholders Input into the Vision 7

8. Colorado: Eligibility System v. Business Side • Colorado Benefits Management System (CBMS) • System that determines eligibility for medical and financial programs • Implemented in September 2004 developed and operated by EDS (April 14, 2009) • Deloitte Consulting LLP – new CBMS operations and maintenance vendor • CBMS Realignment Project • Business Side: Application Process • 64 counties, 3 medical assistance sites (Denver Health, Peak Vista, CHP+ vendor, ACS), 3 school pilot sites • Everything that needs to happen before the information gets into CBMS • Eligibility Modernization Project • Nexus Between the Two Projects 8

9. Due Diligence • Public Knowledge – Administrative 2008 • Visited and reviewed selected eligibility sites • Conducted research into best practices • Reviewed responses to Request for Information (RFI) • Identified and documented findings • Identified modernization options • CBMS Realignment Feasibility Study – Systems 2008 • In Collaboration with Dept of Human Services • Extensive Stakeholder and Public Input 2008 - Ongoing • Eligibility Modernization Task Force • CBMS Advisory Committee • HCPF/County Advisory Committee 9

10. Public Knowledge Approach & Recommendations • Report and Summary Now Available • www.colorado.gov/hcpf • Statewide Findings Current Practices • Lessons Learned from Other States • Best Practices • Recommendations • Electronic Document Management System • with Workflow Management • Centrally Managed Customer Service Center • Involvement of Community-Based Organizations (CBOs) • Web-Based Services for Clients and CBOs • Replace Paper Documentation with Electronic Data • CBMS Realignment • Training, Quality Management Plan, Monitoring Performance 10

11. Conditions for Success • Enhance the CBMS to maximize eligibility and enrollment efficiency • Solidify a Quality Management Plan to promote consistency in eligibility and enrollment processes and strengthen program integrity • Develop a comprehensive training program that will provide greater support and deliver a uniform message • Create a detailed communication strategy to encourage collaboration between Departments, county partners, Medical Assistance sites and community based organizations (CBOs) • Realign the redetermination dates among the programs to streamline tasks 11

12. Funding • Eligibility Modernization • Funding to complete RFP for vendor • CHP+ Reprocurement • CBMS Realignment • $10 million for 3 years from state legislature • 3 Primary Projects • Intelligent Data Entry • Web Portal (online application for clients) • Client Correspondence 12

13. Intelligent Data Entry ProjectCBMS Worker • Collect required information only • Minimize cross program contention • Combine multiple screens into a single page • Display summary views of related information • Streamline process flow • Utilize time saving functions • Provide powerful navigation tools 13

14. Web Portal (Online Application) Project – Client Facing • Am I Eligible? • Quick, anonymous self-assessment of potential eligibility • Apply for Benefits • Clients can apply for multiple medical and financial programs via a short series of web pages • Check My Benefits • Allows clients to view their eligibility online • Report My Changes • Clients can report changes to employment, other income, bills, and other household changes such as adding a person, divorce, marriage, pregnancy, disability 14

15. Key Dates • Colorado Eligibility Modernization Project • Summer 2009 Draft RFP (Starting with CHP+) • Fall 2009 RFP Released • Spring 2010 – Pre-implementation Period • July 1, 2010 – Operations Period • CBMS Realignment Project • May 2009 – Requirements Gathering • Intelligent Data Entry (CBMS worker improvements) • Web Portal (online application for applicants/clients) • January 2010 – Online application implementation • May 2010 – December 2010 – Intelligent Data Entry improvements 15

16. HRSA State Health Access Program Grant • $75 million per year for 5 years • Submitted Grant 6-14-09 • Notification 9-15-09 • HCPF asked for over $42M over 5 years • Big emphasis on eligibility modernization 16

17. HRSA SHAP Grant • Outreach • $9M over 5 Years – Outreach to expand Healthy Communities Program (New Outreach Model) • Eligibility Modernization • Automation of Vital Statistics Retrieval • Interface with Department of Revenue, Division of Motor Vehicles • Interface with Social Security Administration • Interface with Income Eligibility Verification System (IEVS) SB 161 17

18. HRSA SHAP Grant • Express Lane Eligibility – Coordination with Free and Reduced Lunch Program and Department of Revenue (Income Tax Records) • Passive Re-enrollment (changes to CBMS) • Web based online application for expansion populations associated with HB 09-1293 18

19. SUCCESS! 19

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