Medicaid and CHIP Eligibility Review Pilot – Round 1 Robert Sugawara, Chief Program Review Branch California Department of Health Care Services August 20, 2014

BACKGROUND The Department of Health Care Services is the Medicaid Agency in California California chose to develop its own State-based marketplace – California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) Pre-ACA – approximately 7.5 million beneficiaries Current – approximately 10.9 million beneficiaries

BACKGROUND (CONT.) California has three county-based eligibility systems collectively referred to as the Statewide Automated Welfare System (SAWS) LEADER CalWIN C-IV The Medi-Cal Eligibility Data System (MEDS) is California’s data repository for all Medicaid, APTC/CSR and other public assistance programs

KEY ASPECTS OF ROUND 1 PILOT Title 19 Title 21 Active: 8 Negative: 8 Total:16 Active: 43 Negative: 43 Total: 86 Total Sample Size Per Quarter: 102 December 2013 and March 2014

KEY ASPECTS OF ROUND 1 PILOT (Cont.) Eligibility Liability Pertinent Information Error Types Reviews were performed at the individual vs. case level

STAFFING 19 full-time staff statewide performing reviews * * * * * *

TIMELINE Round 1 Template Approval Pulled Sample Ongoing Training March 25, 2014 Round 1 Template Approval April 11, 2014 Pulled Sample April 2014 Ongoing Training May 2014 Reviews Began June 2014 Reviews Completed

KEY CHALLENGES CalHEERS and E-HIT Functionality Policy Changes Staff Training Covered California and County Consensus

PRELIMINARY ROUND 1 RESULTS Error Rate Errors by Type Causes of Errors

LESSONS LEARNED Lesson Learned Define Errors Differently Greater Internal Quality Controls Better Coordination with Business Partners Intensify Staff Training

QUESTIONS?