First Friday Forum June 5, 2015 Mick Pettersen & Rebecca Janeczko King County Regional Policy Representatives.

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Presentation transcript:

First Friday Forum June 5, 2015 Mick Pettersen & Rebecca Janeczko King County Regional Policy Representatives

Auto-renewal rate 2 May67% June65%

Total renewal rate May85% 3

Retro update On June 5: 1738 cases were waiting to be worked The oldest case is from April 28,

AEM update In the past I told you: More resources are being devoted to AEM, and internal processing times are improving. But you hungered for details on AEM process improvement. To satisfy that hunger, I had to journey to the heart of AEM claims processing. 5

6

Process comparison for one application Previous state Steps: 112 Hand-offs: 31 Touch time: 1:34 Wait time: Up to 175 days Developing state Steps: 66 Hand-offs: 15 Touch time: TBD (shorter) Wait time: TBD (shorter) 7

The (short version) of the workflow MEDS  AUTH  CLINICAL 50 mins. 5 mins. 60 mins. 8

The Backlog at MEDS Then:Roughly a month Now:About 10 days Staffing remained the same, but IT systems were simplified. 9

The backlog at Clinical Speed per application was fine, but the staffing did not match the caseload. So: Clinical identified the segment of their workload that could be processed by MEDS and trained them to recognize select ICD-9 codes and approve them. About 25% of the caseload now follows that process. 10

Clinical: Loosening a bottleneck Then:1,300 case backlog at clinical Now:400 case backlog at clinical Projected to hit standard of promptness for typical cases sometime this summer. 11

Tips from the AEM Team 1.Send no more than one status-request per application. 2.Direct pregnant applicants to HPF for an eligibility decision. 3.Double check your mailing address so you get the approval/denial letter. 4.Attend the June 10 th AEM webinar. 12

AEM Webinar June 10, 2015 | 2:00pm to 3:00pm Health Care Authority invites all HCA Community Partners, Assisters, Providers and state agency staff to join us on June 10 th to receive updates to the Alien Emergency Medical (AEM) process. Those who are assisting individuals with applying for and renewing AEM coverage for both Apple Health MAGI and Classic Medicaid are encouraged to participate. RegistrationLink: Contact: for registration assistance. 13

AEM Contacts For routine questions: For urgent cases requiring on-going care: Call

Share Your Apple Health Story The HCA is looking for people in Washington whose lives are better because they received Washington Apple Health coverage under the new MAGI eligibility. The HCA and the Health Benefit Exchange are working together to build a collection of these stories. Tell us the stories you want others in the community to hear. 15

Vexed by a rule? Put “BAD WAC” in the subject line. 16

Vexed by anything else? (In actuality, you should CC both of us.) 17

Community-Based Specialists 18