Alaska's small, isolated population centers pose unique enrollment challenges
Alaska Medicaid now has a simplified application process, with a relatively short application and no interview requirement. However, according to William Streur, deputy commissioner of the Alaska Department of Health and Social Services (DHSS), the impact of these recent changes is not yet clear.
"Alaska is a unique state with mostly small and isolated population centers with limited technology options," notes Mr. Streur. "The value and effect of these and other efforts to affect enrollment will remain unknowns for some time to come."
Applications are widely available in the community at public assistance field offices, medical providers, Native regional organizations, and community-based organizations. Alaska's smallest and most remote communities access the program through a network of more than 300 fee agents serving close to 200 rural communities. A printer-friendly version of the application is also available online.
"The state of Alaska works closely with large regional health organizations, largely operated by Native nonprofits, to help ensure access and enrollment of eligible individuals," says Mr. Streur. These organizations are allowed limited, read-only access to the department's Division of Public Assistance (DPA) eligibility information system. This is done to ascertain the status of patients in order to confirm eligibility or to facilitate program access.
DPA also has outstationed eligibility staff at one large, urban Native health facility to help expedite processing of applications. "Whenever possible, DPA staff participate in outreach activities to help raise community awareness and understanding about Medicaid and other public assistance programs," says Mr. Streur. Recently, staff had a booth at the Alaska Federation of Natives conference and were featured in a talk show about Denali KidCare on public radio.
The department is using "Lean" business practices to improve core processes that drive program access and service quality across the organization. "We anticipate that these efforts will result in further improvements in business processes that support enrollment efforts," says Mr. Streur.
Technology is issue
The department is still exploring the range of opportunities offered by initiatives such as Express Lane Eligibility and the operational impacts of health care reform. Meanwhile, the efforts to streamline basic business practices and processes already have had a positive impact.
"For 2009, DHSS received almost $800,000 in Medicaid bonus funds for its successful efforts to increase enrollment and participation in Medicaid programs," says Mr. Streur. "These gains have been made while maintaining high levels of accuracy as measured by [Payment Error Rate Measurement] PERM reviews."
Any enrollment system that relies heavily on technology is going to be problematic in Alaska. "The state's enormous size makes direct service delivery a challenge. It is no different with distance delivery," says Mr. Streur. "The state's digital infrastructure is still developing. Especially in rural communities, it often does not adequately support technologies that rely on high-speed Internet transmissions."
Without a better infrastructure, technologies such as service kiosks and online applications would be ineffective and difficult to sustain.
"DHSS did support a grant application by the State of Alaska Library System to provide high-speed Internet access in public libraries in rural Alaska," says Mr. Streur. "It is hoped that this might serve as a portal for better access for people in a limited number of smaller communities."
Contact Mr. Streur at [email protected] or (907) 334-2520.
Alaska Medicaid now has a simplified application process, with a relatively short application and no interview requirement. However, according to William Streur, deputy commissioner of the Alaska Department of Health and Social Services (DHSS), the impact of these recent changes is not yet clear.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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