ADRC IM Work Group Overview April Heim (Southern Consortium Operational Lead and Rock County Economic Support Division Manager) Mary Fredrickson (Deputy Director, Human Services, Winnebago County) Debbie Waite (Deputy Bureau Director, Division of Medicaid Services, Bureau of Enrollment Policy & Systems)

Background and History Formed in August 2017 Meets regularly every 4 to 6 weeks Started with 32 participants MCO representatives added Feb 2018 51 Current participants: 19 IM 14 ADRC 7 MCO & ICA 11 DHS Staff Is growing!

The Partners - Reasons for Formation of the Work Group Aging & Disability Resource Center Perspective Income Maintenance Perspective DHS – Income Maintenance Perspective

Challenges Multiple players supporting an inter- connected process Inconsistent service area boundaries A complex process to the customer Demanding work loads for staff - with limited resources

Challenge: Multiple Players The long term care eligibility and enrollment process involves multiple players who each play a key role in that process Income maintenance agencies – eligibility for Medicaid and other programs ADRC’s – functional screen and options/enrollment/benefit counseling MCO’s and ICA’s – long term care services and care management

Challenge: Geographic Dis-alignment IM Consortia ADRCs MCOs

The Geographic Dis-alignment (cont.) Result – each entity likely dealing with multiple partners that are using different processes and tools

Other Challenges Income Maintenance move to call center model Multiple hats for ADRC staff Process partners may not be co-located Resources to support the customer – always an issue!

Work Group Purpose Statement To promote clarity of roles and support better coordination of the eligibility and enrollment process for customers applying for Medicaid Long Term Care programs. Specifically to: Clarify roles of each entity Identify and implement best practices which promote collaboration Identify need for standardizing forms and informational materials

Work Group Purpose Statement (cont.) To provide input to the proposed enrollment plan document to support the 2018 ADRC/MCO contract Process used to review template and populate content Status of work

Purpose 1 – Clarity of Roles & Improved Communication The Work Group: Brainstormed issues & opportunities Grouped issues & opportunities into 8 buckets

Bucketed Issues and Opportunities Issues/Opportunities Potential Best Practices Electronic Systems 9 7 Training 10 5 Forms and Notices Worker Materials 1 Roles and Responsibilities 20 16 Inter-Agency Communications 12 Policy Clarifications Miscellaneous Items 4 2

Sub-Work Groups Created To discuss and categorize the issues and opportunities as: “Pursue action item” “Disseminate as best practice” Identify as low or non priority Cross representational participants Facilitated by DHS Area Admin staff

Sub-Work Groups (cont.) Three are operational at this time: Roles and Responsibilities Communications and Interrelationships Forms, Notices, and Worker Materials

Chart Example – In Draft Form

Short Term “Wins” CARES overview for non-IM workers – April 20th & October 19th Systems fixes proposed for prioritization in CARES project portfolio 8-10 forms and notices gathered from partners to share statewide MCO and ICA representatives now at table

Developing Process Flows Developed application process flow Drafting renewal process flow “To do” list– create disenrollment process flow

DRAFT LTC Eligibility & Enrollment Renewal Process IM Processes Renewal Phone If both spouses are on the line take electronic signature from each If both spouses not on the line, pend for signature Paper PPRF ACCESS renewal (rare) Face to Face    45 Day Renewal Letter Sent systematically by CARES DRAFT MCO’s Proactively assist customers with renewals (from a report) Help with the renewal paperwork Ideally, turning in a complete renewal, with both signatures (if needed) and all needed verifications. If a BC+ or MAPP case – complete the Divestment Document (not a standard form) – Western created this form for MCOs to use Access CWW pages (via read-only access) to assist member, if needed If case fails at renewal, the MCO will continue to try to resolve the issue Once confirmed, the case will either be: Ongoing – If the member remains eligible Closed – if the member is no longer eligible This will result in dis-enrollment from any Managed Long Term Care services the member may be receiving After processing, IM will either: Confirm ongoing benefits If needed, manually send updated spousal income allocation form Pend for any needed verifications If PPRF is returned, pend the asset gatepost page for Divestment form (not a standard form – Western created this)

Remaining Issues & Challenges Customer application assistance Communication and exchange of information among partners CARES access or portal structure E-mail or other strategies Relationship building

Next Steps Complete remaining sub-group work Capture best practices in useable document Disseminate and encourage use of standardized forms and tools Develop plan and schedule to implement recommended action items Develop strategy for broader sharing, dissemination and reinforcement of work WCHSA ADRC Directors ADPAW IMAC MCO Association

Could use your help with… Supporting deployment and dissemination Identifying issues and challenges that may have been missed

Contact Information Mary Fredrickson (920) 236-1193 MFredrickson@co.winnebago.wi.us April Heim (608) 741-3491 April.Heim@co.rock.wi.us Debbie Waite – DHS (608) 261-9421 Deborah.Waite@dhs.wisconsin.gov

Questions and Discussion