RE-ENGINEERING THE ENROLLMENT PATHWAY FOR NEW YORK STATE PUBLIC HEALTH PROGRAMS

1. RE-ENGINEERING THE ENROLLMENT PATHWAY FOR NEW YORK STATE PUBLIC HEALTH PROGRAMS Patricia Boozang, MPHKinda Serafi, JDElisabeth Benjamin, JD, MSPH October 14, 2009 United Hospital Fund Roundtable

2. Project Overview • Policy Issue/Imperative • Streamlining initiatives provide new options for application and enrollment • Challenges remain in current application and enrollment process • Goal: Re-evaluate and re-engineer application to improve consumer access to coverage through every available doorway: • LDSS • Facilitated enrollment • Consumer mail-in application (with elimination of F2F) • Enrollment center (future)

3. Project Overview • Project Funders • United Hospital Fund, New York Community Trust • Project Partners • CDF-NY, CSS, PHP Coalition • Project Components • Phase 1 • Identify barriers and challenges in current enrollment process • Provide initial recommendations to SDOH for April 2010 application • Phase 2 • Develop and field test model application and consumer tools • Provide final recommendations to SDOH for consumer-friendly, re-engineered enrollment pathway

4. Phase 1: Project Activities • Facilitated Enroller Feedback Sessions • Legal and Regulatory Analysis • Feedback and Work Sessions with New York State Department of Health • Recommendations for April 1, 2010 ANY Revision • Consumer Application Pilot

5. Facilitated Enroller Sessions • Asking the on-the-ground experts about the pitfalls of the current Access NY application • 4 roundtables with facilitated enrollers: • 2 health plan sessions • 2 CBO sessions • Participation of over 50 upstate and NYC FEs • Yielded valuable insights driving partner recommendations: • High level – Citizenship, application format • Nitty-gritty – Email address, legal name, language

6. “Additional Application Forms” • Investigating the lore of “other forms” • The facts behind the lore: • 58 forms identified • One-third “county specific” versions of the same form • 34 “unique” forms • 25 collect information already in Access NY • 18 reflect more stringent eligibility requirements of counties • 7 reflect information not needed for eligibility

7. “Additional Application Forms” • Partner Recommendations: • Eliminate • Incorporate • Standardize

8. Consumer Pilot Project FEs conducted consumer pilot to assess barriers to navigating current application independently. • Process • Consumer completes application and submits documents • FE and consumer complete survey together to discuss application • FE correctly completes application and completes survey • Participants • 143 consumer surveys submitted by health plans and CBOs • NYC, Long Island, Binghamton, Rochester, Albany, Syracuse

9. Ease of Completing Application • 62% (89) reported they were able to complete application on their own. • Just 1 application was successfully completed • 38% (54) reported they were not able to complete the application alone • Over one-half indicated confusing language or format • One-third pointed to unclear or inadequate instructions • 84% (118) reported it took them less than an hour to complete

10. Initial Key Findings • Section K: Health Plan Selection • 28% of consumers found Hard/Very Hard • 41% of applications needed this section corrected • Did not understand what “health plan” meant • Did not know how to choose a plan • Section E: Household Income • 25% of consumers found Hard/Very Hard • 50% of applications needed this section corrected • Unsure what and whose income to include • Unclear how to calculate income • Section C: Health Insurance • 20% of consumers found Hard/Very Hard • 41% of applications needed this section corrected • Skipped this section altogether • Didn’t understand term “policy holder” and CIN #

11. Immigrants • Recommendations: • Change “Citizenship” title to “Citizenship/Immigration” • Eliminate A/B/C categories, gather documents instead • Clarify that pregnant women & children are eligible, regardless of status • Justification: • Clarifies eligibility & documentation requirements • Resolution: • New title “Citizenship/Immigration Status” • Clarify immigrant women/children’s eligibility • Clarify documents needed, eliminate categories

12. Veterans • Recommendation: • Eliminate veteran’s question as redundant • Justification: • Household Income section lists veteran’s benefits • Health Insurance section could add veteran’s benefits • Resolution: • LDSSs maintain referrals to VA are made pursuant to this question • Advocates would like to continue to discuss this issue

13. Maintenance of Income • Recommendation: • Use 70% standard, not 50% standard • Justification: • Statewide: median rental burden is 57% for low-income renters. • 28 out of 52 counties have median gross rental income over 50% (82% in Putnam and Nassau) • Provided sample low-income person budget • Resolution: • SDOH adopted 60% standard & continue to discuss

14. Maximize Efficient Collection of Individual Information

15. Next Steps • Consumer Pilot recommendations • “Additional Application Forms” work • Phase 2 Activities • Identify Best Practice from Other States • Interview Key Stakeholders • Develop Model Application and Field Test with Consumers • Develop Consumer Tools • Final Recommendations for a Consumer Friendly, Re-Engineered Enrollment Process

16. Questions Project Partner Contact Information Elisabeth Benjamin – ebenjamin@cssny.org Patricia Boozang – pboozang@manatt.com Kinda Serafi – kserafi@cdfny.org