getting in the act? the state of state implementation of health care reform virginia’s experiences...
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Getting in the Act? The State of State Implementation of Health Care Reform
Virginia’s Experiences Using Technology to Streamline Enrollment
Rebecca Mendoza, MACHIP Director & Director of Maternal & Child HealthVirginia Department of Medical Assistance Services
October 3, 2011
CHIP’s Role in Encouraging Use of Technology & New Enrollment Strategies
More Flexibility No Requirement for Government Workers Enhanced Federal Match New Focus on Health Insurance Coverage New Marketing & Outreach Focus Opportunity to Experiment
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Contracted Centralized Processing Center – operating since 2001
Web-based Eligibility Determination System with a Rules Engine and Integrated Application Tracking and Customer Service Functionality – since 2001
Fax Server – since 2001 Pre-filled New &Renewal Applications – since 2001 Bar Coded Applications – since 2003
Using Technology to Streamline Processes
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Using Technology to Streamline Processes
Customer Friendly “.org” Website – since 2001
Online Application – since 2005
Paperless Workflow – since 2007
Automated Phone System – since 2007
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Using Technology to Streamline Processes
Full Implementation of Enhancements to CHIP Eligibility System – January 2010
SSA Data Match for Citizenship & Identity Verification in Medicaid & CHIP – March 2010
Automatic Data Transfer – March 2010 One Page Renewal Application – June 2010 New Process for Enrollment of Newborns – July 2010
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Using Technology to Streamline Processes
Pre-populated Online Renewal – July 2010 E-Signature for Online Applications – July 2010 E-Submission of Verification Documents – July 2010 Administrative Renewal – October 2010 Telephonic E-signature – January 2011 Website Redesign with Rolling Feature Box – June 2011 Data Warehouse of Eligibility & Enrollment Data with
Cognos Reporting Tool Integrated into the MMIS Contract – August 2011
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CHIP & Medicaid Enrollment Trends
** Medicaid enrollment includes the CHIP Medicaid Expansion Program
CHIP Children’s Medicaid
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Medicaid Seamless Transfers to SCHIP
0%
10%
20%
30%
40%
2004(Aug)
2005 2006 2007 2008 2009 2010Virginia
*Defined as the proportion of Medicaid disenrollees in a given month (Title XIX and M-CHIP) that transfer to S-CHIP with less than a full month's gap in public coverage
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0%
20%
40%
60%
80%
2004(Aug)
2005 2006 2007 2008 2009 2010Virginia
*Defined as the proportion of S-CHIP disenrollees in a given month that transfer to Medicaid with less than a full month's gap in public coverage
SCHIP Seamless Transfers to Medicaid
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Newborns of CHIP Moms Deemed Eligible
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61% 59% 60%
48%
63% 60%54% 54% 52%
48%53% 53% 51%
31%
24% 22%
21%
10%12%
13% 14%14%
14%
13% 15%16%
7%
16% 18%
31%27% 28%
33% 32% 34%38%
34% 32% 33%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
July August September October November December January February March April May June July
Renewal Applications by Received MethodJuly 2010 - July 2011 Mail Fax Web Phone
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93%84% 82%
69%73% 72%
67% 68% 66%62%
66% 68% 67%
7%16% 18%
31%27% 28%
33% 32% 34%38%
34% 32% 33%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
July August September October November December January February March April May June July
Renewal Applications by Received MethodJuly 2010-July 2011
Paper
Web
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New Online Applications Screened Medicaid Eligible
32%
30%29%
24% 24%26%
25%
33%
29%27%
29% 29%
0.0%
10.0%
20.0%
30.0%
40.0%
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29% 27% 26% 23% 25% 23%
13% 14% 11%
22% 19%14% 11%
23%23%
18% 22%20%
19%
17% 17%19%
17% 21%
16%14%
48% 50%56% 56% 55% 58%
50% 49% 51%
44% 41%
51%57%
20% 20% 19% 17% 18% 18% 18%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
July August September October November December January February March April May June July
New Applications by Received MethodJuly 2010 - July 2011
Mail Fax
Web Phone
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52% 50%44% 44% 45% 42%
30% 31% 30%39% 41%
30%25%
48% 50%56% 56% 55% 58%
50% 49% 51%
44% 41%
51%57%
20% 20% 19% 17% 18% 18% 18%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
New Applications by Recieved MethodJuly 2010-July 2011 Paper Web Phone
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New Applications Denied Never Received
18%
16%
14%16%
18%
14% 15%
13%
8% 7%9%
10% 11%
8%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Jun Jul Aug Sep Oct Nov Dec Jan 2011
Feb Mar Apr May Jun Jul
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Lessons Learned
Designing systems takes more than just money and IT staff
Design contract to control costs as well as quality New technology can have unintended consequences Culture shift from case
management to production work
Out of sight = Out of mind?
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For More information on Virginia’s Experiences Using Technology to Streamline Enrollment
Rebecca Mendoza
804-786-3206
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