Commonwealth of Massachusetts Executive Office of Health and Human Services

Robin Callahan Director of Member Policy & Program Development, Massachusetts Office of Medicaid

Transforming Enrollment Systems: Massachusetts’

Experience

Maximizing Enrollment for Kids National Briefing

December 10, 2010

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Improving the Model: Massachusetts Maximizing Enrollment for Kids

!! Background •! Massachusetts 1115 Waiver and State Health Reform •! Enrollment Model – Systems and Outreach

!!Massachusetts Experience with Maximizing Enrollment for Kids

!!Massachusetts MaxEnroll Improvement Plan Projects

!! Next Steps: Affordable Care Act

!! Early Lessons Learned

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Massachusetts Section 1115 Waiver Demonstration Project

!! Implemented in July 1997

!! Streamlined Medicaid eligibility •! Eliminated face-to-face interviews, shortened Medicaid application,

eliminated asset test, eliminated spenddowns for most populations, switched to gross income test

!! Expanded Medicaid eligibility for certain populations •! Higher income children and families •! Higher income disabled individuals •! Unemployed adults •! HIV positive adults •! Creation of Insurance Partnership Program to provide premium subsidies

to qualified small employers and their low-income employees

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Mass. Health Reform: Chapter 58 of the Acts of 2006, An Act Providing Access to Affordable,

Quality, Accountable Health Care !! Support and collaboration from legislature, consumer

advocates, state and federal officials, providers, health plans, employers, employees, small business leaders, unions, and the general public.

!! Shared Responsibility •! Individual Mandate •! Employer Contribution •! Public Subsidies

!! Insurance Market Reform •! Including merger of Non-Group and Small-Group Markets

!! Insurance Exchange •! Connector Authority created to make policy decisions under Health Reform Law. •! Connector Authority operates two programs: Commonwealth Care (subsidized

insurance for low-income workers and single adults) and Commonwealth Choice (unsubsidized non-group and small-group insurance.)

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Background: Massachusetts Enrollment System Model

!!One front door for subsidized health programs. !!MassHealth provides the eligibility and enrollment

infrastructure for health programs. !! Adding Commonwealth Care (exchange program for

low-income adults) to the MassHealth eligibility system ensures maximum benefits for applicants and notice of eligibility for all family members.

!!Commitment to ongoing engagement and education of community partners who assist and enroll members.

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What is the Virtual Gateway?

Health and Human Services

Public

Agency Worker Service Providers

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Virtual Gateway Facts

"!Eleven different programs can be applied for online. This includes MassHealth and all health assistance programs as well as SNAP, child care, WIC, elder services, etc.

"!Over 200,000 families and individuals in 2009 applied for services through the Common Intake application. Those who qualified were eligible for over one billion dollars worth of benefits (includes services in addition to MassHealth and Health Assistance).

"!Average percentage of electronic Virtual Gateway applications reached a high of 60% in August ’10.

Virtual Gateway Facts:

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Virtual Gateway and MA21 Eligibility System

!! Internal MA21 eligibility system decision logic determines eligibility for most comprehensive coverage.

!! Virtual Gateway and MA21 enabled the Commonwealth to place all health programs on a single platform and single point of entry.

!! Applicant doesn’t need to know in advance which program for which they may be eligible.

!! Cascading eligibility design – we apply rules and system makes choice of the most appropriate benefit level and FFP.

!! MA21 is a mainframe eligibility determination system built in the mid 1990’s and may need to be retired.

!! If so, a similar eligibility logic design would be used to accommodate federal health reform along with the greater flexibility and functionality of newer technology.

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Massachusetts Health Care Training Forum

20 Meetings Annually in 5 locations Total Attendance annually ~ 2,000 - Email Updates - Website - Outreach (Formal and Informal)

•! North (Tewksbury)

•! Boston •! Central (Shrewsbury)

•! West (Holyoke) •! Southeast

(Taunton)

Program Goal: MTF communicates accurate, timely information about operations and policies of Massachusetts State Health Care Programs to community health and human service partners.

•!Formal presentations about issues related to: •! Eligibility/Enrollment/Retention •! Case Management •! Billing/Claims •! Information directly enhances attendees’ ability to assist current and potentially

eligible individuals. •!Roundtable sessions with state experts, trainers and advocates. •!Network opportunity for state and community organizations to build collaborative relationship.

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EOHHS Enrollment, Outreach & Access to Care Grants Grant Recipients

51 Community Based Organizations

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Massachusetts Uninsurance Rate for Children

3.2%

2.5% 2.3%

1.2%

1.9%

0.2% 0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

2004 2006 2007 2008 2009 2010

Massachusetts Uninsurance Rate for Children 2004-2010

State Health Reform Began

Source: Massachusetts Division of Health Care Finance and Policy Health Insurance Surveys 2004-2010 Note: Survey methodology changed in 2007.

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MassHealth Enrollment for Children

421,743

434,790

457,663

489,350 499,227

521,319

350,000

375,000

400,000

425,000

450,000

475,000

500,000

525,000

550,000

June '05 June '06 June '07 June '08 June '09 June '10

MassHealth Enrollment for Children 2005 - 2010

State Health Reform Began

Awarded Maximizing Enrollment for Kids Grant

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Improving the Model: Maximizing Enrollment for Kids

Program !! Received $1million grant in February 2009. !!Objective of the grant is to improve enrollment policies,

systems and process to increase enrollment and retention for children in Medicaid and CHIP.

!! Participation includes an in-depth diagnostic assessment of enrollment systems, policies and process and a development of a detailed improvement plan to address problem areas.

!! The diagnostic assessment results and report were accurate and well-received.

!! Improvement plan is aligned with MassHealth Operations’ strategic initiatives.

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Massachusetts Improvement Plan: Increase Retention

!! Both the MaxEnroll diagnostic assessment and our own study on retention identified need to improve the loss of eligibility due to paperwork issues.

!! Implemented a new annual renewal process for certain members that dramatically decreases the chance of loss of coverage for administrative reasons.

!! This new process currently impacts approx. 13,500 (48%) nursing facility residents and will potentially include and additional 70,000 community long-term care and disabled members.

!!We are also considering the use of third party data sharing for eligibility and renewal purposes.

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Massachusetts Improvement Plan: Improve Capacity and Use of Data

!! Used data analysis to determine the need to eliminate a process that relied on the member to complete and return a paper form to verify information received on a data match from the Department of Revenue.

!! The data analysis identified that the need to return the paper form caused unnecessary loss of coverage due to an administrative reason.

!! A new paperless process is being developed to use the match data to improve program integrity and ensure members are enrolled in the most appropriate coverage.

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Massachusetts Improvement Plan: Improve Customer Service/Enhance

Customer Interface !! Implemented customer-facing My Account Page (MAP)

and Change Form to the Virtual Gateway in SFY10.

!! Customer-facing MAP and the Change Form provide members with the ability to access and update information without the need to call the customer service line or send in paper to update their case record.

!!Members may view information about benefits as well as the notices that have been sent.

!! The Change Form allows members to update, edit, or delete the information such as address, telephone, homeless indicator, pregnancy status, race and ethnicity.

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Massachusetts Improvement Plan: Improve Customer Service/Enhance

Customer Interface (Continued) !! Currently implementing an electronic document

management (EDM) initiative to digitize all paper received as part of the application and renewal process.

!! EDM will improve workflow and standardize the business process of the four regional MassHealth Enrollment Centers, Central Processing and Central Filing Units.

!!Customer service will be significantly improved as staff will have real time access to every document and a statewide workforce will be utilized instead of having a paper case record tied to a regional office.

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Next Steps: Affordable Care Act

!! Individual mandate sends the message that health insurance is for everyone and lower income individuals have access to government subsidized insurance.

!! Eligibility determination will no longer be about deciding whether an individual can or cannot get coverage.

!! Eligibility determination will need to match individuals to most appropriate coverage.

!! Policies, systems and process will need to: •! Know the correct buckets to enroll individuals. •! Adjust to an individual’s changing circumstances to prevent gaps in

coverage. •! Use data matching in order to more quickly process enrollment •! Not place unreasonable verification requirements on individuals and

enrollment staff. •! Provide clear messages to enrollees.

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Early Lessons Learned

!! Data Matters. MaxEnroll diagnostic assessment and improvement plan were useful in helping to pinpoint areas on which the state could focus.

!! Strategies that improve retention also reduce paper processing and alleviate pressure on the operational work flow.

!! A culture of coverage is best advanced when: •! Needless administrative activities are eliminated. •! Necessary administrative activities are as simple as possible. •! Communications are clear. •! All stakeholders are heard and valued. •! Participation has social and health rewards.

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Transforming Health Coverage Enrollment Systems: Massachusetts’ Experience

!! Thank you.

!! For more information contact: Robin Callahan Director, Member Policy & Program Development, Massachusetts Office of Medicaid robin.callahan@state.ma.us