How We Transformed the Medicaid Eligibility Process in Louisiana (and Lived to Tell About It!) Churn in Public Programs Washington, DC May 20, 2011 Don Gregory, Medicaid Director

Childrens Health Coverage in Louisiana in 1998 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

A Hole in the Bucket–Our Renewal Woes Circa Early Net loss of more than 6000 kids in a single month Thousands of closures each month for procedural/paperwork reasons Failure to return renewal form Failure to submit verification Unable to locate

4 Dramatically Reducing Closures at Annual Renewal for Paperwork Reasons Ex Parte renewals when possible Telephone renewal processes Administrative renewals Express Lane Eligibility renewals NEW in 2010

5 Ex Parte Renewal Defined Action by one party without the involvement of the other Described in 4/7/00 State Medicaid Directors Letter Fully embraced since 2000 Heavy reliance on other computer systems for verification – SNAP (Food Stamps) – TANF – Child Support

6 Maximizing Alexander Graham Bells Great Invention Aggressive follow up phone calls when paperwork is not received AVR--Automated Voice Response Renewals Telephone renewals

7 Telephone Renewals Benefit Families and the Agency Federal regulations require annual review but not signed form Implemented 11/03 as option when ex parte cant be done Reduces administrative cost postage, paper, staff time Key to our getting procedural closure rate from above 22% to below 1%

Paths to Renewal for Children in August, 2010 MedicaidCHIP

What Difference Does Fixing Renewals Make? 45,809 Total Kids Couldnt renew 327 of them 327 <1% (2010 Rate) August % (2001 Rate) 10,078 CHURNERS

Administrative Savings from Paperless Renewals Ex Parte, Telephone & Web Renewals – No renewal form Cost of printing Postage Manpower necessary to process outgoing and incoming forms – Annual savings: $10.7 M Targeted Administrative Renewals – If no reported changes, totally automated process – Annual savings: $8.25 M – 288,000 annual renewals

Improving Work Processes Through Technology Paperless eligibility case records Web–based application, renewal, & change reporting Real time verification through other data bases SSA citizenship verification Electronic newborn enrollment Web-based nursing facility admission & change reporting Remote wireless access to all eligibility systems

Reasons We Pursued Paperless Eligibility Records in 2002 Interminable problem of lost and misplaced records Labor issues associated with paper records and file rooms Other administrative costs Bottleneck in business process while waiting for records Multiple processing locations - postage costs Vision of greater simplicity by reducing paper 12

Louisiana Medicaid/CHIP Enrollees

Workload / Case Worker Ratio

Organizational Change A Major Factor in Simplification Even more important than technology Caseworkers open and close the door Major changes in expectations of caseworkers – From passive – To proactive Its about winning hearts & minds 17

Our Internal Marketing Messages to Eligibility Employees Why health coverage for kids is important – to child – to family – to State – to society Barriers to getting and staying enrolled – Misinformation/lack of knowledge – Literacy Parental apathy is not the childs fault 18

Are They REALLY Eligible? PERM Medicaid eligibility error rate of 1.54% -one of lowest of any state! Greatest vulnerability is overestimating income & placing Medicaid child in CHIP

Childrens Health Coverage in Louisiana in 2011 High rate of poverty and poor health outcomes – still a challenge to be met Absolute minimum levels of coverage for children – now offer coverage to 250% FPL Onerous application and verification requirements – much improved Nations third highest percentage of uninsured kids – now less than 5%; lowest quintile per 8/10/10 Urban Institute report Almost 1 in 3 low income children had no health coverage – now fewer than 1 in 20 20

21 Our Secrets Revealed Commitment to Simplification Improving Retention Integration of Technology Organizational Change Continuous Process Improvement

22 Don Gregory Medicaid Director Louisiana Department of Health & Hospitals P.O. Box Baton Rouge, LA Telephone: Fax: Never doubt that a small group of thoughtful, caring people can change the world. Indeed, it is the only thing that ever has! Dr. Margaret Mead