Getting & Keeping KidsCovered

Washington StateCKF CollaborativeLearning Session 2

Chattanooga, TN March 30 – April 1

Team MembersTeam Members• Penny Reid, CKF Manager,

Washington Health Foundation• Annette Rodriquez, Outreach

Coordinator, Yakima Neighborhood Health Services

• Judy Cook, Medical Programs Manager, DSHS Medical Assistance Administration

• Vicki Hobbs, CSO Administrator, DSHS Economic Services Administration

Goal : Improve renewals for Medicaid kids in CSO 128 (Yakima region)

Impact of Eligibility Changes on Statewide Caseload

Children's Medical - Actual and Forecasted Caseload

270,000

290,000

310,000

330,000

350,000

370,000

390,000

410,000

430,000Ju

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Oct

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Actuals

Final DRAFT Nov 03 Forecast

Jul-03 eligibles w/predicted actuals

Nov-03 Primary Trend

Looking Closely at One Aspect of the Caseload Puzzle:

Renewals in CSO 128

M 4.2: % Closed at Renewal

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Nov-02

Dec-02

J an-03

Feb-03

Mar-03

Apr-03

May-03

J un-03

J ul-03

Aug-03

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Months

Perc

en

tag

e C

losu

res

PDSAs for “Postcard” Reminders

• PLAN – Send 20 reminders – English or Spanish – to those due for renewal and compare to 20 in control group

• DO – Sent reminders on 1/16

• STUDY – Compared results on 2/6. Inconclusive.

• ACT – Run larger groups of 40 in February

23

13

11

56

0

2

4

6

8

10

12

14

1 2 3

Flyer No flyer

r

No review received

Processed and Recert

Rec. Pending income

Postcards don’t matter

• Larger test and control groups of 40 do not show that reminders make a difference.

• Our team will bring the postcards (and other renewal docs to TN for review with Penny Lane and others).

98

22

24

56

4 4

100

1

0

5

10

15

20

25

30

1 2 3

Flyer No flyer

No review received

Processed and Recert

Received not processed

Rec. Pending income

Processed/Denied no

income

Client request closure

PDSAs for Phone Renewals

• First PDSA was conducted by Annette at clinic when client sought medical services and had positive pregnancy test. Annette called Anna at CSO and completed phone renewal in 21 minutes.

• Anna out-stationed to YNHS in January. For next PDSA, Annette renewed coverage for 8 children (4 families/calls). Income Verification for one required “prudent person, income review.”

1

2

Phone Renewals PDSA 3

• PLAN – Spread to 45 workers so when client calls regarding Child Care, can renew Medical and synchronize dates for both. Compare time and pending rate to 10 done by paper/batch method. Note I.V.

• DO – 96 calls in February provided opportunity to renew

• STUDY – Tallied data and compared to 10 paper/batch renewals

• ACT – Report to Eligibility Workgroup on 3/17 and agree to next steps

Time for Renewal Method

0 5 10 15 20 25

Phone

ColoredEnvelope

WhiteEnvelope

Minutes

Number of Pends by Renewal Method

Phone

Paper

0.00% 5.00% 10.00% 15.00% 20.00% 25.00%

Percentage of Total

• Phone Renewals appear to take less time than paper/batch method but comparison is rough• Allows synchronization of renewal dates• Color-coded envelopes decrease time needed in mail room for paper/batch method• Phone renewals result in a lower percentage of cases pended than the paper/batch method• In this set of data, income verification was confirmed as follows:

Analysis of Phone Renewals to Date

Method used to verify income

0 10 20 30 40 50 60

EmploySecurity

Call toemployer

Other

Percentage of total

It’s now time to involve Eligibility Workgroup

• Eligibility Workgroup is MAA, reps from 6 CSO regions, and CBO stakeholders

• Meets monthly• Will consider spread of strategy statewide• Successes to date:

Helped coordinate trainings for CSOs and communityForum for policy makers and implementersForum for sharing best practicesDiscussion led to rescinding renewal signature WACDiscussion helped draw attention to problems which

led to adding 68 FTEs