Families USA Health Action 2010 Conference Washington, DC January 30, 2010 Kyle C. Viator La. Dept of Health & Hospitals

High rate of poverty and poor health outcomes Absolute minimum levels of coverage for children Onerous application and verification requirements Nations third highest percentage of uninsured kids Almost 1 in 3 low income children had no health coverage 2

Strong support from 3 consecutive administrations from both major parties Genuine desire to reduce number of uninsured children Eligibility workloads spiraling out of control Positive administrative impact for cash strapped state Advances in technology presented new opportunities Tremendous Success in Retaining Eligibile Kids Possible to achieve without compromising program integrity Recognized for lowest error rates in country in 2009

Present for over a decade now (since CHIP began) 800+ statewide Medicaid managers, supervisors, Eligibility Examiners, and clerical staff Brainstorming and implementing regional initiatives Working with local coalitions and partners Placing application form and holders in their communities Doing local mediaTV, radio, newspapers Onsite application assistance in communities

The sum is better than the parts Wide array –public as well as private Louisiana Covering Kids & Families, Childrens Partnership Outreach and enrollment contracts with 11 community organizations 6

Nearly $1 Million for additional outreach in Louisiana Targeted to underserved populations Hispanic and Immigrant Families Rural Areas Cross-Border Outcome-driven community partnerships Contracting with 10 Community Canvassers Enhanced payments for successful applications Incentives for innovative outreach and enrollment techniques Technical assistance; sharing best practices

700,458 children enrolled in Medicaid and LaCHIP 577,390 enrolled in Medicaid 123,068 enrolled in LaCHIP (at or below 200% FPL) 2,920 enrolled in LaCHIP Affordable Plan (between 200% FPL and 250% FPL)

9 700, ,515

Number of uninsured kids eligible for CHIP or Medicaid has dramatically declined But still ~40K kids remain uninsured

4 year RWJF-funded project that started in February 2009 Complements outreach initiatives with systems improvements and policy changes Goal is to enroll 98% of children eligible for Medicaid or CHIP by Major source of funding for implementation costs of ELE

The department, upon enactment by Congress of legislation allowing the same may utilize income determinations made by the Food Stamp Program, WIC, or National School Lunch Program for determining income eligibility for the Louisiana Medicaid program or LaCHIP. La. R.S. 46:

Highest % of states uninsured kids are from 50% to 100% FPL Literacy issues Simplicity of enrollment is relative Complicated lives Different agencies determine Medicaid/CHIP and FS, WIC, and School Lunch eligibility Parental priorities Maslows hierarchy of needs 15

Simplification Isnt Simple Spring 2009 started intensive workgroup planning, after CHIPRA signed Eligibility Systems programmers focusing majority of their time State Administrative Rulemaking Process Internal marketing about need to pursue despite fiscal impact SPA Submitted in late October Approval received last Friday (01/22/10)!!!

Request to SNAP agency for opt out language revision to forms Identification of public agencies capable of determining income eligibility at 97% or higher rate of accuracy Collecting application forms Reviewing income policies Determined data fields from ELA needed for fully automated enrollment Projecting volume estimates for both renewals and applications (for fiscal impact projections) Significant system changes by both ELA & us Planning for eligibility accuracy review of ELE sample 17

File of currently eligible children <19 received from SNAP Agency We did file match with Medicaid and CHIP & removed children with coverage ~12 K children identified who were enrolled in SNAP, but not in Medicaid or CHIP ~8 K additional children may or may not already be enrolled manual review being done to determine if already enrolled slow and resource intensive process lessons learned: data matching isnt magic or totally clean automatic is relative human intervention is still important 18

Based on early conversations with CMS-- Sent families a letter in early December giving them the option to opt out of having coverage added for child Out of 12,301 only 313 children opted out of coverage Subsequently, a different interpretation by CMS legal staff of affirmative consent requirement in statute Final negotiations for SPA approval Creative (we think!) solution CMS agreed to allow us to enroll and send Medicaid card to all identified children who did not opt out Child will not officially gain coverage until parent/guardian affirmatively consents by using Medicaid card to access services

Citizenship will be verified through new CHIPRA authorized SSA Verification System Procedures incorporate new CHIPRA policy which calls for coverage to begin pending citizenship verification File match through TPL contractor after eligibility will identify any TPL Plan is to move quickly to joint SNAP/Medicaid application by ELA Opportunity on their revised application to opt in Newly enrolled SNAP children not already enrolled in Medicaid will be enrolled in Medicaid nightly Next Step: Using ELE for automatic re-enrollment

Even further reduction in administrative costs No longer a need for any caseworker action Reduces exposure to eligibility errors True ELE cases excluded from Quality Control and PERM reviews Simplifies eligibilityfor us all children eligible for SNAP will be eligible for Medicaid With Medicaid stimulus, La has higher FMAP for Medicaid than CHIP (through at least 12/31/10!) Performance bonuses based on Medicaid increase 21

22 Players constantly change Families needing our help Stakeholders who interact with those families Lack of focus leads to drift and slippage Outreach Simplifications Eligibility Improvements Still > 40,000 uninsured kids eligible but not yet enrolled in La

23 Kyle C. Viator Deputy Medicaid Director La Department of Health & Hospitals P.O. Box Baton Rouge, LA Telephone: Fax: Blackberry: