1. Enrollment Standards and User Experience Sam Karp, VP of Programs October 6, 2011 Implications for Human Services Integration Work Support Strategies Webinar

2. C ALIFORNIA H EALTH C ARE F OUNDATION  Context and Current Practice  Enrollment Standards  User Experience (UX) Design Project  Vertical and Horizontal Integration  Q & A Webinar Outline

3. C ALIFORNIA H EALTH C ARE F OUNDATION  States vary…  ACA offers states opportunities  Challenges abound Context

4. C ALIFORNIA H EALTH C ARE F OUNDATION We Live in a Digital Society

5. C ALIFORNIA H EALTH C ARE F OUNDATION Current Practice

6. C ALIFORNIA H EALTH C ARE F OUNDATION Where Are We Today?  However, not widespread…  Impact of the recession  Best intentions  Significant simplification efforts

7. C ALIFORNIA H EALTH C ARE F OUNDATION Persistent Barriers  Local control  The welfare institution  Inadequacy of systems  Complexity of rules / silos

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9. Disclaimer

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12. Single Application Process  Medicaid  CHIP  SNAP  TANF  WIC  EITC  LIHEAP  County Indigent Care Programs  California Kids  Healthy Kids  Kaiser Permanente Child Health Plan  Child Health and Disability Prevention Program  Child Tax Credit  Low-Cost Auto Insurance Program

13. C ALIFORNIA H EALTH C ARE F OUNDATION Enrollment Standards and Protocols

14. C ALIFORNIA H EALTH C ARE F OUNDATION § 1561. HIT Enrollment, Standards and Protocols Not later than 180 days after the enactment, the Secretary, in consultation with the HIT Policy and Standards Committees, shall develop interoperable and secure standards and protocols that facilitate enrollment in Federal and State health and human services programs. Affordable Care Act

15. C ALIFORNIA H EALTH C ARE F OUNDATION Enrollment Workgroup  20 members representing various stakeholders  Integrated into CMS regulations and ACA guidelines  Held eight pubic hearings and “listening session” with State representatives  Developed 10 recommendations  Recommendations adopted by Secretary Sebelius on September 17, 2010 http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3161

16. C ALIFORNIA H EALTH C ARE F OUNDATION Enrollment Standards & Protocols 1.Consumer-Centric Approach 2.Core Data Elements 3.Electronic Verification 4.Business Rules 5.Transmission of Enrollment Information 6.Privacy and Security

17. C ALIFORNIA H EALTH C ARE F OUNDATION Core Data Elements  Reviewed 34 programs in 10 states  Variation in data name, format and definition  Standardize to increase interoperability  National Information Exchange Model selected as standard  Implementation approach  Range of complexity in data harmonization

18. C ALIFORNIA H EALTH C ARE F OUNDATION Electronic Verifications  ACA §1411 requirement o Citizenship SSA o Income IRS o Legal status DHS  Additional interfaces to Federal, State or other widely-available data sources  Federal reference software model  Standardized Web services exchange CMS building Federal Data Services Hub

19. C ALIFORNIA H EALTH C ARE F OUNDATION Business Rules  Express in consistent, clear and unambiguous language  Transparent to consumer by providing understandable eligibility determinations  Federal government establish repository of business rules needed to administer ACA health insurance coverage options

20. C ALIFORNIA H EALTH C ARE F OUNDATION Transmission of Enrollment Information Utilize existing HIPAA transaction standards — from health insurance coverage options to public and private health plans and to other health and human services programs

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22. Enroll UX 2014 Project Objectives  Provide federal and state governments with a human-centered design to support enrollment  Help achieve a first-class user experience that promotes informed enrollment decision-making  Help ensure that large numbers of eligible consumers successfully enroll in and retain coverage

23. C ALIFORNIA H EALTH C ARE F OUNDATION Public/Private Partnership

24. C ALIFORNIA H EALTH C ARE F OUNDATION 11 Participating States Alabama, Arkansas, California, Colorado, Illinois, Massachusetts, Minnesota, Missouri, New York, Oregon, Tennessee

25. C ALIFORNIA H EALTH C ARE F OUNDATION UX 2014 Design Partner World-class design, engineering and innovation firm www.ideo.com

26. C ALIFORNIA H EALTH C ARE F OUNDATION Project Overview  Individual market and SHOP  All insurance affordability programs (Medicaid, CHIP, tax credits, cost sharing reductions, BHP)  Full eligibility, enrollment, plan selection and retention experience  Multiple pathways  Designing for diversity and ADA compliance  Vendor / system neutral

27. C ALIFORNIA H EALTH C ARE F OUNDATION Design Phases / Timeline

28. C ALIFORNIA H EALTH C ARE F OUNDATION Research Phase

29. C ALIFORNIA H EALTH C ARE F OUNDATION Behavioral Segmentation Helps to design a system that is responsive to people’s different needs, desires and expectations.

30. C ALIFORNIA H EALTH C ARE F OUNDATION Initial System Flows and Wireframes

31. C ALIFORNIA H EALTH C ARE F OUNDATION Design Workshop San Francisco, September 12-13

32. C ALIFORNIA H EALTH C ARE F OUNDATION Multiple Enrollment Channels

33. C ALIFORNIA H EALTH C ARE F OUNDATION Immediate Mobile Opportunities ACTIONABLE ALERTS  Renewal reminders  Prompt to submit missing info  Status changes/updates  Secure messaging MOBILE HELP/SUPPORT TOOL  Voice/Text  Location-based support services ENROLLMENT TRACKER FOR APPLICATION STATUS  Text / Email  Automated phone messages MOBILE UPLOAD  Data upload with photo support

34. C ALIFORNIA H EALTH C ARE F OUNDATION Preliminary Visual Design

35. C ALIFORNIA H EALTH C ARE F OUNDATION Design Refinement Phase  Further review and user evaluation  Publish comprehensive design specifications  Develop working functional prototype  Develop communications materials for sharing design

36. C ALIFORNIA H EALTH C ARE F OUNDATION Public Website

37. C ALIFORNIA H EALTH C ARE F OUNDATION Vertical & Horizontal Integration

38. C ALIFORNIA H EALTH C ARE F OUNDATION Considerations for States  Does it makes sense to leverage interest, focus and resources on ACA enrollment modernization efforts?  What level of integration? What programs? Phased approach?  How or whether to conform eligibility rules?  Cost-allocation implications / August 2010 OMB Circular A-87 Exception Letter  Planning today for tomorrow…

39. C ALIFORNIA H EALTH C ARE F OUNDATION Questions & Answers