Now We Know! Lessons from a Decade of Health Coverage Simplification and Outreach

1. Now We Know! Lessons from a Decade of Health Coverage Simplification and Outreach Tricia Brooks Georgetown Center for Children and Families Public Benefit Modernization: What Are the Advocacy Issues? CBPP Conference 9-24-08

2. Key Lessons Learned • Communication matters • Methods, messages, messengers • Informational materials, forms, notices, letters • Multiple doors • In person, via mail, online, over the phone • Need for outreach; follow-up never go away

3. Community Application Assistors*: Overcoming Barriers Trusted community members In touch with eligible families Accessible; close to home Exemplify a culture of helping Help overcome stigma *Federal requirement for states to outstation Medicaid eligibility workers or provide a plan for offering application assistance at places other than government offices

4. Community Application Assistors: Helping Families Create program awareness Able to reach low-income families Identify eligible but unenrolled children Provide application assistance Clarify requirements for families

5. Community Application Assistors: Adding Value Focus on outcome, not procedure Reduce administrative load on state eligibility workers Provide feedback mechanism Program improvement Quality assurance Can be great advocates Source for story-banking *Federal requirement for states to outstation Medicaid eligibility workers or provide a plan for offering application assistance at places other than government offices

6. NH – CAA Applications Source: NH Healthy Kids

7. Technology: Benefits www.childrenspartnership.org e-health snapshot: Harnessing Technology to Improve Medicaid and SCHIP Enrollment and Retention Practices • Enhances awareness and access to programs • Improves effectiveness and ease of verification • Creates administrative cost-savings, freeing up funds to provide better services to more children and families • Improves data collection and quality control

8. Technology: Reaching More Families Using Web to reach and educate families Families apply and renew coverage online • PA Compass – • online screening • application tool • renewals • multiple programs • multiple languages • multiple locations • 24/7 • www.compass.state.pa.us

9. Technology: Finding Eligible Children Data Mining: using other programs for targeting outreach to likely eligible families Food Stamps School Lunch (Ex: WA) Child Care Earned Income Tax Credit Provider Partnerships Ex: (AL) (MA)

10. Technology: Verifying Eligibility Sharing information between systems and agencies to reduce verification documents required State examples: Utah e-FIND – 18 federal, state and local data sources Spent $2 million saved $2.1 million in first year WA

11. Methods to Verify Citizenship For Children in Washington’s Public Insurance ProgramsJuly 2006-June 2007 N = 449,265 verifications for applications and renewals. Note: CMS has defined four levels or tiers of documents that can be used to prove citizenship, with preference given to the first two. Tier one is a U.S. passport, a Certificate of Naturalization, or a Certificate of U.S. Citizenship. Tier two is a birth certificate or a specified other record. Tier three includes hospital, insurance, religious or school records, and tier four specifies documents, including, as a last resort and subject to rigorous conditions, written affidavits. Documents to prove identity are also required for all but the first tier. Batch matches of birth certificates are considered the equivalent of tier two. Source: Washington State Department of Social and Health Services, 2007

12. Technology: Enhancing Older Systems Utility programs Integrate applications Exchange data Ex: WI – enterprise service bus OK – auto-eligible babies New front-end applications Enhance productivity Extend life of older eligibility systems

13. Technology: Planning for the Future Long Term Vision Create a system-wide vision for technology Need collaboration among and between public programs upfront Ex: FL Investment in technology needs advocacy

14. Systems Good to Go?Time to Re-launch, Re-brand

15. Finding, Informing & Assisting • Many eligible families have touched the system • Need to know that barriers and issues have been addressed • Community application assistors and outreach partners can play a key role

17. “Welcome Mat” Effect: What Happens When States Cover All Kids Source: Presentation given by Anne Marie Murphy, Director, Division of Medical Programs, Illinois Department of Heatlhcare and Family Services, to NASHP (May 21, 2008); Massachusetts Office of Health and Human Services (April 28, 2008); Email communication with George Hoover, Deputy Commissioner, Pennsylvania Department of Insurance (June 5, 2008); and Wisconsin Council on Children and Families analysis of Wisconsin Department of Health and Family Services Data (June 5, 2008).

18. “Even if you’re on the right track, you’ll get run over if you just sit there.” - Will Rogers