how we transformed the medicaid eligibility process in louisiana (and lived to tell about it!) churn...
TRANSCRIPT
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How We Transformed the Medicaid Eligibility Process in Louisiana (and Lived to Tell About It!)
Churn in Public Programs
Washington, DC
May 20, 2011
Don Gregory, Medicaid Director
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Children’s Health Coverage in Louisiana in 1998
• High rate of poverty and poor health outcomes
• Absolute minimum levels of coverage for children
• Onerous application and verification requirements
• Nation’s third highest percentage of uninsured kids
• Almost 1 in 3 low income children had no health coverage
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A “Hole in the Bucket”–Our Renewal Woes Circa Early 2000
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Net loss of more than 6000 kids in a single month
Thousands of closures each month for “procedural”/paperwork reasons
Failure to return renewal formFailure to submit verificationUnable to locate
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Dramatically Reducing Closures at Annual Renewal for Paperwork Reasons
• Ex Parte renewals when possible
• Telephone renewal processes
• “Administrative” renewals
• Express Lane Eligibility renewals NEW in 2010
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Ex Parte Renewal Defined• “Action by one party without
the involvement of the other”
• Described in 4/7/00 State Medicaid Director’s Letter
• Fully embraced since 2000• Heavy reliance on other
computer systems for verification– SNAP (Food Stamps)– TANF– Child Support
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Maximizing Alexander Graham Bell’s Great Invention
• Aggressive follow up phone calls when paperwork is not received
• AVR--Automated Voice Response Renewals
• Telephone renewals
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Telephone Renewals Benefit Families and the Agency
• Federal regulations require annual review but not signed form
• Implemented 11/03 as option when ex parte can’t be done
• Reduces administrative cost—postage, paper, staff time
• Key to our getting procedural closure rate from above 22% to below 1%
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“Paths” to Renewal for Children in August, 2010
Medicaid CHIP
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What Difference Does “Fixing” Renewals Make?
45,809 Total Kids—Couldn’t renew 327 of them
327
<1% (2010 Rate) August 2010
22%(2001 Rate)
10,078
CHURNERS
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Administrative Savings from Paperless Renewals
• Ex Parte, Telephone & Web Renewals – No renewal form
Cost of printingPostageManpower necessary to process outgoing and
incoming forms– Annual savings: $10.7 M
• Targeted Administrative Renewals– If no reported changes, totally automated process– Annual savings: $8.25 M – 288,000 annual renewals
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Improving Work Processes Through Technology
• Paperless eligibility case records
• Web–based application,renewal, & change reporting
• Real time verification through other data bases
• SSA citizenship verification• Electronic newborn
enrollment• Web-based nursing facility
admission & change reporting
Remote wireless access to all eligibility systems
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Reasons We Pursued “Paperless” Eligibility Records in 2002
• Interminable problem of “lost” and “misplaced” records
• Labor issues associated with paper records and file rooms
• Other administrative costs • Bottleneck in business process while
waiting for records• Multiple processing locations -
postage costs• Vision of greater simplicity by reducing
“paper”
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Louisiana Medicaid/CHIP Enrollees
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Workload / Case Worker Ratio
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“Organizational Change” A Major Factor in Simplification
• Even more important than technology
• Caseworkers “open” and “close” the door
• Major changes in expectations of caseworkers– From passive– To proactive
• It’s about winning hearts & minds
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Our Internal Marketing Messages to Eligibility Employees
• Why health coverage for kids is important– to child– to family– to State– to society
• Barriers to getting and staying enrolled– Misinformation/lack of knowledge– Literacy
• Parental apathy is not the child’s fault18
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Are They REALLY Eligible?
• PERM Medicaid eligibility error rate of
1.54%-one of lowest of any state!
• Greatest vulnerability is overestimating income & placing Medicaid child in CHIP
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Children’s Health Coverage in Louisiana in 2011
• High rate of poverty and poor health outcomes – still a challenge to be met
• Absolute minimum levels of coverage for children – now offer coverage to 250% FPL
• Onerous application and verification requirements – much improved
• Nation’s third highest percentage of uninsured kids – now less than 5%; lowest quintile per 8/10/10 Urban Institute report
• Almost 1 in 3 low income children had no health coverage – now fewer than 1 in 20
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Our Secrets Revealed
Commitment to Simplification
Improving Retention
Integration of Technology
Organizational Change
Continuous Process Improvement
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Don GregoryMedicaid DirectorLouisiana Department of Health & HospitalsP.O. Box 91030 Baton Rouge, LA 70821-9030Telephone: 225.342.3891Fax: 225.342.9508E-Mail: [email protected] www.lachip.org
Never doubt that a small group of thoughtful, caring people can change the world. Indeed, it is the only thing that ever has!
— Dr. Margaret Mead