Nicole Ravenell Edwards, MPP President and CEO Southern Institute on Children and Families

1. Simplification: The Make or Break Issue May 17, 2011 National Covering Kids and Families Network Webinar Nicole Ravenell Edwards, MPPPresident and CEOSouthern Institute on Children and Families

2. About Founded in 1990, the Southern Institute on Children and Families is an independent non-profit organization dedicated to improving the well-being of children and families, especially those who are economically disadvantaged. We take an intense look at public benefit programs for low income children and families and finds ways to make them better through…

3. How We Work • Research and Public Policy Analysis • Quality Improvement Strategies • Coalition Building/Strengthening

4. Enrollment and Renewal Challenges • Lack of awareness • Completing applications accurately • Inability to obtain verifications • Confusing correspondence • Complicated requirements • Language barriers • Varying program eligibility and criteria for family members • Collection of premium/enrollment fees

5. Enrollment and Renewal Challenges • Transitions between Medicaid and CHIP • Role of MCO in the renewal process • Maintaining up-to-date client information • Inappropriate closures, i.e., family connected with another benefit program • Staff turn-over and understaffing • Training – new employees, policy and process changes, inconsistencies in interpretation and implementation

6. Do you know the top 2 or 3 reasons families either fail to complete the application or the renewal process? Understand your eligibility process

7. Enrollment and Renewal Challenges: Understand Your Eligibility System • Knowing why families do not complete the application or renew • Measuring the effectiveness of policies • Improving process efficiency and customer service • Limitations of eligibility systems • Role and relationship with external partners

8. Children’s Medicaid and CHIP Policy2000 vs 2011 Martha Heberlein, Tricia Brooks, and Jocelyn Guyer. Georgetown University Center for Children and Families and Samantha Artiga and Jessica Stephens. Kaiser Commissioner on Medicaid and the Uninsured. Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost Sharing Practices in Medicaid and CHIP, 2010-2011

9. Simplification Strategies • Educate the public about Medicaid and CHIP eligibility, including the renewal process • Simplify and streamline applications and renewals forms and documents • Use innovative modes of submitting applications and renewals • Provide appropriate language assistance to limited English proficient (LEP) individuals

10. Simplification Strategies • Maximize opportunities for applying outside of the eligibility office • Coordinate outreach with other programs • Accept other programs’ eligibility determinations data • Auto referral between Medicaid and CHIP • Utilize MCOs and providers for renewals • Use technology to update client contact information

11. Simplification Strategies • Improve communications – written, phone messages and Web based • Extend the auto-closure time period • Convenient submission of cost-sharing • Deliver reminders - auto-dialer or paper • Align redetermination periods with those of other programs • Perform rolling redeterminations

12. Do you know which simplification strategy your state has implemented that has led to steady increases in enrollment? Understand your eligibility process

13. Simplification Strategies:Understand Your Eligibility System • Survey or conduct focus groups with applicants • Follow-up with families that fail to complete the process • Monitor and study enrollment and renewal data

14. For more detailed information contact: Nicole Ravenell Edwards President and CEO (803) 779-2607 x6 nravenell@thesoutherninstitute.org Judi F. Cramer Senior Consultant (803) 779-2607 x2 jcramer@thesoutherninstitute.org www.thesoutherninstitute.org

15. Alabama Medicaid Eligibility Simplifications Presented by Gretel Felton May 17, 2011

16. Current Simplification Implementations • Elimination of face-to face interview and assets test • Joint application and renewal process with CHIP • 12 months continuous eligibility for children • Administrative renewal process • Self declaration of income • Online application with use of electronic signature • Verification of Citizenship through SSA • Expedited newborn certification • Use of “The work number “ to verify income

17. Benefits of ELE • Express-lane eligibility allows the Medicaid agency and/or CHIP agency to choose to use the Findings of another federal program such as SNAP, TANF, WIC, School lunch, etc. to make an eligibility determination for Medicaid or CHIP. • ELE can prevent duplication of verification requirements for applicants and/or recipients • ELE allows options such as income methodologies, screen and enroll income limits and whether ELE applies to applications or renewals or both

18. Our ELE Approach • The Alabama Medicaid Agency is phasing in the express lane option for children under age 19 and has selected the Alabama Department of Human Resources (ADHR), the agency that administers the SNAP and TANF programs, as the express lane agency in the initial phases of the process

19. Lots of Parts…where does Express-lane Fit in ? Three agencies: Many systems

20. How did we get started? • Alabama began considering ELE as early as 2001 with the Governor’s Task force on Children’s Health Insurance • Upon CHIPRA passage we completed a match with ALL Kids and ADHR to determine how many children might be impacted by ELE

21. Phase One • Phase One was effective 10/1/2009 SPA was approved 11/02/2009 • The Express Lane option was only applied to redeterminations • SNAP or TANF household net income is used to determined financial eligibility for Medicaid

22. Phase Two • Phase two was effective 4/1/2010 Phase two SPA was approved 6/07/10 • The Express Lane option is now applied to applications and redeterminations • SNAP or TANF household net income is used to determined financial eligibility for Medicaid

23. ELE Components • Access to ELE Program data • Approved SPA &Policy Manual Changes • Procedural Changes • Training • Tracking mechanism for ELE children

24. Barriers … Workers reluctance to use the data and disregard the differences in household composition Tracking Codes did not work right away as expected …

25. How well are we doing? • Over 134,000 children have had eligibility determinations using ELE in Alabama

26. What next ? • Phase Three: Automation of re-enrollment using SNAP income determination along with renewal information provided by household • Phase Four: Automated use of ELE findings for enrollment of new applicants based on SNAP or TANF eligibility via automated data matching • Phase Five: Same as Phase Four but will involve adding other agencies such as subsidized child care or WIC.

27. Questions? 242-1720 gretel.felton@medicaid.alabama.gov

28. Presumptive Eligibility Iowa Medicaid Enterprise – Presumptive Eligibility for Infants and Children

29. In Iowa, there are primarily two programs for children who are uninsured or cannot afford health insurance: Uninsured? • hawk-i (CHIP) for uninsured children • Medicaid (Title 19) medical assistance

30. Free or Low Cost Health Care Coverage for Uninsured Children (CHIP Program)

31. Iowa Department of Public Health • Iowa Department of Human Services (DHS) contracts with Iowa Department of Public Health (IDPH) to provide localized hawk-i outreach • 22 hawk-i coordinators • Distribute information to healthcare providers, faith community & schools • Display at community events and business • Assist families with completing applications Inside the hawk-i Program

32. Outreach Coordinators Inside the hawk-i Program

33. Presumptive Eligibility for Children 33

34. What is Presumptive Eligibility (PE) for Children? • Allows children to obtain Medicaid covered services while a formal Medicaid eligibility is being determined by the Department of Human Services (DHS). • Presumptive eligibility is based on the family’s statements on the application regarding circumstances and income. • DHS may request additional information or documentation to determine ongoing Iowa Medicaid coverage. 34

35. What is a Qualified Entity (QE)? A Qualified Entity (QE) is an individual who is certified by DHS and authorized to make presumptive eligibility determinations. • QE’s must be Medicaid Providers or employees of Medicaid Providers

36. Who can become a QE? • Iowa Medicaid Hospitals and Physicians • ARNP’s • Rural Health Clinics • Local Education Agencies (School Nurses) • Maternal Health Centers • FQHC’s • Family Planning Centers • Child Health Screening Centers • Area Education Agencies • Early Access Service Coordinators • Indian Health Service Providers

37. What are the General Eligibility Requirements for PE? • Child must be under age 19 • Be an Iowa resident • Be a citizen or qualified alien • Have gross family income less than 300% of the Federal Poverty Level (FPL) based on the size of the family • Not have received presumptive eligibility in past 12 months from the month the application is received by the QE  • The presumptive application will be denied if the child has received presumptive eligibility in the past 12 months 37

38. The PE Process • A family requesting presumptive eligibility for a child must complete a Presumptive Health Care Coverage for Children Application. • Information must be entered into the online application exactly as documented on the application provided by the family within 2 days of receipt of the application. • All information on the application is self-declared by the family; therefore, not verified. • NOTE: All presumptive applications are referred to DHS for an ongoing Medicaid eligibility determination for the child. During the formal Medicaid eligibility determination, DHS will verify income, citizenship, alien status, identity, and other information as necessary.

39. What else should a QE know? What are the QE duties? • Provide a Notice of Decision (NOD) to the family that reflects the information entered from the application within 2 business days of the date stamped on the application. • Maintain documentation to support the presumptive eligibility decision. This may include, but is not limited to, the application, clarification of any information provided by the family, and a copy of the NOD. • Date stamp the application when received. • Clarify information on the application, if necessary. • Inform the family that all applications are referred to DHS for an ongoing Medicaid eligibility determination. • Enter information from the application into the presumptive eligibility system.

40. The Notice of Decision (NOD)

41. How it works…. Notice of Decision http://www.insurekidsnow.gov/professionals/campaigns/connectingkids/organizations.html

42. Number of Requests for PE for children • 1,064 • 986 Approved • 75 Denied • 3 Cancelled • Denial Reasons • Families not following through with submission of required documentation Iowa Statistics Number of QE’s 159

43. Contact Information Melissa Ellis (IDPH)State hawk-i Outreach Coordinator515-242-5980melissa.ellis@idph.iowa.gov