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NASHP Conference October 4, 2011 Ruchika Bajaj

NASHP Conference October 4, 2011 Ruchika Bajaj Division of Health Reform and Health Insurance Exchange Integration Office of Health Insurance Programs. Gearing Up for Enrollment in the Digital Age. New York Health Coverage and Enrollment: 2011. Public programs: 5 million

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NASHP Conference October 4, 2011 Ruchika Bajaj

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  1. NASHP Conference October 4, 2011 Ruchika Bajaj Division of Health Reform and Health Insurance Exchange Integration Office of Health Insurance Programs Gearing Up for Enrollment in the Digital Age

  2. New York Health Coverage and Enrollment: 2011 • Public programs: 5 million • Employer-based: 10.5 million • Uninsured: 2.7 million

  3. Increase Medicaid enrollment by about 25% Add Exchange coverage for over one million more New Yorkers (700,000 subsidized) New York Health Coverage and Enrollment: 2014

  4. How will we get there? Planning Grant Early Innovator Grant Business Process Redesign Simplify Align Rules Funding for Exchange Build and Rollout MA Eligibility 90/10 funding NY-HX Establishment Grant 2014 and beyond

  5. NY-HX System Solution: What is It? • New York is committed to integrating eligibility and enrollment for all public, subsidized and individual/employee Exchange health coverage through the NY-HX (Medicaid, CHP, Exchange, Basic Health Program, if offered) • Working with funders/consortia to design “customer experience” (web portal)- IDEO

  6. NY-HX System Solution: What is It? • Simplify, align and integrate HX eligibility and enrollment determination process • Procurement pending-Systems Integrator • Technical infrastructure to support a more uniform, automated, consumer-friendly administration of health coverage programs by 2014

  7. NY-HX System Solution: What does it Require? • To design and develop a “best in class” Exchange system solution, NY has to first specify what the NY-HX will do, and how it will do it (business requirements, business processes). • NY has a number of key policy decisions to make, and design options to choose from, to establish the needed framework and simplify and align the rules governing NY-HX implementation and business operations.

  8. Project Management Approach • NY-DOH formed NY-HX EI Project Management Office (PMO) upon Feb 2011 EI Grant Award • Adapt NY-HX EI PMO to evolving governance structure • Role of PMO • Establish framework to manage project, meet grant requirements, and oversee Systems Integrator work • Develop strategy and schedule to manage external project dependencies, e.g. User Experience Project, Federal Hub Development Project, Medicaid Eligibility and Enrollment System Project

  9. NY-HX System Solution: How is NY Getting There • Joint efforts - Insurance, Health, other agencies under leadership of Governor’s Office Insurance Department Planning Grant Team DOH Medicaid CHP DOH EI PMO Governor’s Office

  10. New York : Key Challenges to Bridging the Gap • Multiple, 30+ year old, “horizontal” legacy eligibility and enrollment systems • Shared State/local responsibility for administering Medicaid • Budget and staffing constraints; procurement rules and timelines • Legislative timeline

  11. Self declaration of income/ residency at renewal 12 month continuous enrollment for children and most adults No resource test for most Medicaid beneficiaries No finger imaging requirement No face-to-face interview Elimination of Enrollment Barriers Helps Pave the Way : Key Challenge is Automated Eligibility System Automated Eligibility

  12. New York : Accomplishments to Help Bridge the Gap • Statewide Call Center • Telephone Renewal supported by automated tool/rules • Medicaid Redesign Team (MRT) workgroup developing recommendations to align state/local responsibilities- late 2011

  13. Conduct joint application design sessions on business requirements Exploring other state, national potential solutions (e.g. SERFF (NAIC/50 state) system for plan management functionality, IDEO user interface project) New York : Strategies to Help Bridge the Gap

  14. Proposed MAGI rules simplify and address much, but not all – work in progress Robust federal hub, with easy, automated processes for eligibility and verification (e.g. PARIS, death matches, in addition to SSA, HSA and IRS) Federal support for Exchange systems and tools - (e.g. plan management- use of SERFF? Plan comparison tool? Well designed user experience (IDEO)) Align federal audit standards with ACA Federal Role In Support of State Exchanges Critical

  15. Federal funding, guidance critical State/ Exchange must be able to quickly make decisions and expend funds -- hire, procure, plan and implement new processes and systems Learn from and involve stakeholders New York : Lessons Learned

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