States taking steps to facilitate Medicaid application process
If individuals "churn" in and out of the Medicaid program, they may end up with a different primary care provider and disruption in preventive services or care of chronic health conditions. To prevent this from happening, a growing number of states are trying to make the application and renewal processes for Medicaid easier and more efficient.
Washington state, for example, now allows the renewal process to be done by phone or online. "It is hoped that families can maintain their benefits by easing the renewal obstacles," says Patty Hayes, RN, MN, executive director of WithinReach in Seattle, a nonprofit organization working to improve maternal, child, and family health. "We hope this will not only prevent families from losing their benefits but will also help prevent the loss of the primary care provider. Being able to maintain coverage, and thus the provider, can be a critical element to maintaining health."
To facilitate online enrollment, Washington's Department of Social and Health Services just completed an upgrade to the agency's system for benefit application. "There is now the ability for an individual or family to apply for specific programs online. The information goes directly into the system for quicker service," says Ms. Hayes.
The Virginia Department of Medical Assistance Services (DMAS) implemented an online application process for the adult population. Individuals can now apply for Adult Medical Assistance electronically. Additionally, counselors from the State Health Insurance Counseling and Assistance Program and the Virginia Insurance and Counseling Assistance Program have been trained to assist individuals in using the online process to file applications.
At this time, DMAS does not have an online application process that allows individuals to apply for multiple programs at once, such as Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, and Medicaid using one electronic application. However, the state's S-CHIP program, called Family Access to Medical Insurance Security (FAMIS), has an online process to apply for coverage for children and pregnant women. "This option is very popular with applicants," says Cindi Jones, chief deputy director of Virginia's DMAS.
Legislation was recently passed to authorize e-signatures for state benefit programs in the state of Washington. This allows families to submit applications online, without sending in a hard copy of the application with their signature. "I expect this statutory change to be a great help to families who want to apply online, and for organizations helping families apply for benefits," says Ms. Hayes.
Online enrollment will make it easier for families to find out about benefit programs, and allow them to apply at any time of the day or night. "We recently had a young dad e-mail us with his thanks at being able to use our web site to gain information on state benefit programs and fill out an application," says Ms. Hayes. "This improvement alone saved this father the time and stress of the application process of the past. He had applied late in the evening after his wife and new baby were resting. He was grateful that there was a new option for him."
WithinReach's outreach staff have provided training to libraries throughout the state on the use of online systems. "We know that libraries serve a critical role for computer access. The idea of an easy online application process used in libraries is a natural outgrowth of the rise of interest in technology," says Ms. Hayes.
In California, individuals can simultaneously apply to multiple public health insurance programs including Medi-Cal, the state's Medicaid program, due to the implementation of One-e-App, a web-based program. As a result, the application process has become faster and easier, according to a June 2009 analysis done by the Falls Church, VA-based The Lewin Group, "Using Web Technology for Public Program Enrollment: Assessing One-e-App in Three California Counties."
To date, One-e-App is used in four states and has screened 2.3 million people for coverage, including eligibility for Medicaid. Many of those people qualified for more than one program and were able to submit their applications electronically in real-time via One-e-App.
The Lewin Group's analysis revealed, however, that there are still some challenges with the application process for Medi-Cal enrollees. This is primarily due to the complexity of the program's eligibility rules and the challenge of navigating the different IT systems responsible for final eligibility determination, according to The Lewin Group's senior vice president, Lisa Chimento.
"Given the proposed cuts to health and social services in California due to the state budget crisis, tools like One-e-App can be very helpful to families having to navigate the myriad of public assistance programs available," says Ms. Chimento. Counties also benefit, since One-e-App screens people for federally funded programs like Medi-Cal first, before enrolling them in locally-funded programs.
According to Claudia Page, co-director of The Center to Promote Health Care Access in Oakland, CA, and manager of One-e-App, "In an environment where state budgets are being cut, unemployment rates are rising and people are losing benefits, a tool like One-e-App that streamlines and improves the efficiency of the eligibility and enrollment process is more important than ever."
Ms. Page says the One-e-App approach has these benefits for potential Medicaid clients:
-The process is made more efficient, both for states and eligibility workers.
One-e-App reduces the need for follow-up with families, in order to complete missing information and correct errors, by about 78%. "Electronic application submission eliminates the need for duplicate data entry," says Ms. Page. "It delivers to the state a high-quality, error-checked application for final eligibility determination."
-Applicants are screened in real time across a wide range of health and social services programs with a single application.
"In an environment where eligibility rules, provider rates, and benefits are being tightened for many programs including Medicaid, a comprehensive screening process that considers eligibility for a range of programs is critical," says Ms. Page.
WithinReach developed an online eligibility and enrollment tool for the state of Washington (www.parenthelp123.org) for families to apply for multiple state benefit programs. "We are working with state agency partners and interested policy-makers to create an online link with our system as well," says Ms. Hayes. "We recently met with the One-E-App staff from California, to learn about their expanding work in other states. There is interest in Washington to expand the number of programs that families can access online for federal, state, and local benefit programs."
-Applicants can apply from anywhere.
In Fresno, CA, applicants can use the One-e-App tool from home, work, and other public locations. In Los Angeles, One-e-App kiosks are available for public use at some school district sites. In both cases, though, applicants can receive assistance from a trained application assistant if they prefer.
"This lets them apply at a time and location convenient to them, and avoids the need to miss work, travel long distances, and find child care," says Ms. Page. "We have seen an exponential increase of 90% per month in the number of high-quality applications submitted without assistance in Arizona."
Drastic new approach
With its "No Wrong Door" program, Oklahoma is planning a "drastic new approach to facilitating the enrollment process," according to Richard Evans, eligibility automation and data integrity manager at the Oklahoma Health Care Authority. The March 2010 implementation not only will allow individuals to apply online anywhere for multiple medical programs, but also will actually enroll them in real-time.
After creating a username and password, an individual will be able to find out immediately if he or she is eligible for a program. Currently, the process of determining eligibility and enrollment can take up to 30 days.
If a member logs on to use the "Manage Your Account" feature to update an address or phone number, the application will encourage the member to answer some additional questions. This constitutes a review of the member's eligibility, regardless of how long he or she has been enrolled, and the individual can be recertified for an additional 12 months.
The system will rely on real-time and batch data exchanges with numerous state and national sources to verify a person's citizenship, Social Security number, and income. Oklahomans can apply from home, their library, county health departments, Indian Health and Tribal facilities, the Oklahoma Department of Human Services offices, and other community and state partner locations.
"Of course, the web application will be available around the clock. So an individual can apply at any time, day or night, and from the privacy of their own home," says Mr. Evans.
Policy changes that affect eligibility can be easily implemented into the rules engine, whereas in the past, changes in eligibility policy took up to a year to implement. "'No Wrong Door' also standardizes policy interpretation," he says. "The rules engine will interpret policy consistently throughout the state."
"No Wrong Door" will be able to determine eligibility and enroll applicants in SoonerCare, Oklahoma's Medicaid program, and SoonerPlan, the state's family planning program, as well as services administered by the Oklahoma Department of Mental Health and Substance Abuse Services.
The "No Wrong Door" program had two predecessors, both administered through the Oklahoma Health Care Authority. "Insure Oklahoma" created a web application for the state's premium assistance program, and an electronic version of the paper form added newborns to Sooner Care coverage in real-time with a web application. All of these applications allow applicants to select a primary care provider from an online directory. "'No Wrong Door' was able to glean this feature, as well as other valuable lessons learned, from these two earlier web developments," says Mr. Evans.
Contact Ms. Chimento at (703) 269-5500 or [email protected], Mr. Evans at (405) 522-7101, or [email protected], Ms. Hayes at (206) 830-5161 or [email protected], and Ms. Page at (510) 273-4641 or [email protected].
If individuals "churn" in and out of the Medicaid program, they may end up with a different primary care provider and disruption in preventive services or care of chronic health conditions. To prevent this from happening, a growing number of states are trying to make the application and renewal processes for Medicaid easier and more efficient.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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