1. Enrollment Modernization Can Radical Incrementalism Get Us There? Child Health Policy Research Symposium March 2, 2009

2. C ALIFORNIA H EALTH C ARE F OUNDATION “Modernization” Change the culture, organization and structure of how program eligibility is determined and how enrollment activities are carried out… to make it more efficient, consumer- friendly and comprehensive. No Wrong Door or Single Stop approach to enrollment.

3. C ALIFORNIA H EALTH C ARE F OUNDATION Key Barriers to Modernization  Categorical nature of of programs  Welfare Reform’s missing “de-link”  Outdated and disparate systems  Reliance on manual processes  County vs. statewide enrollment

4. Medi-Cal, CHDP, Healthy Families, Healthy Kids & WIC Community Clinics Medi-Cal, Food Stamps & Family Planning Social Services Breast Cancer Referral & CHDP Physician Offices Indigent Care WIC & CHDP Public Health Indigent Care WIC & CHDP County Clinics CHDP & Medi-Cal (School Lunch) Schools Breast & Cervical Cancer Treatment Hospitals ER Medi-Cal, Healthy Families Health Plans Medi-Cal, Healthy Families & Healthy Kids Maze of Local Health Program Referrals

5. C ALIFORNIA H EALTH C ARE F OUNDATION “Is this by design or what?” What most applicants experience…

6. C ALIFORNIA H EALTH C ARE F OUNDATION Real World Example 30,000 applications / month at Single Point of Entry for Healthy Families and Medi-Cal for Children programs  50% submitted on paper by applicants  20% submitted on paper with assistance from Certified Application Assistors (CAAs)  30% submitted electronically via Health-e-App with assistance from CAAs

7. C ALIFORNIA H EALTH C ARE F OUNDATION Single Point of Entry Enrollment Process Station #1 Open Envelopes Station #2 Remove Staples, Paperclips, etc. Station #3 Feed High- Speed Scanner Station #5 Call Family For Missing Information Station #4 Manually Enter Application Data Station #6 Apply Eligibility Rules Health-e-App

8. C ALIFORNIA H EALTH C ARE F OUNDATION Preliminarily Determined Applications Healthy Families Application Medi-Cal Application Final Eligibility Determined Batch Paper Applications; Mail to Counties County Worker Manually Enters Application Data Enrolled in Health Care Coverage

9. C ALIFORNIA H EALTH C ARE F OUNDATION Incremental Improvements  SPE, mail-in application and presumptive eligibility  Application simplification efforts  Express Lane Eligibility  CHDP Gateway / improved newborn enrollment  County / health plan call-in / continuation centers  Other policy and administrative changes Setbacks DRA requirements More frequent re-certification Loss of outreach funds

10. C ALIFORNIA H EALTH C ARE F OUNDATION

14. Key realization along the way…

15. C ALIFORNIA H EALTH C ARE F OUNDATION Future State*: Vision  Strong leadership, sustained sponsorship  Adequate funding  All-inclusive governance structure  Comprehensive IT solution State-level approach that uses integrated technology and shares information to streamline eligibility, enrollment and retention. * Recommendations from Modernizing Enrollment in California’s Health Programs: A Blueprint for the Future, Eclipse Solutions, November 2007 Requirements include:

16. C ALIFORNIA H EALTH C ARE F OUNDATION Future State: Technology Enterprise approach that uses shared services and shared information, including:  Common, web-based front-end that is publicly accessible, allows applicants to be screened for many programs, from many locations and transmits completed applications.  Common messaging infrastructure on which to build secure common back-end services.

17. C ALIFORNIA H EALTH C ARE F OUNDATION Enterprise Enrollment Project (EEP)  Led by Health & Human Services Agency  Established formal governance structure  Developing requirements for a single statewide enrollment process  Conducting cost–benefit study  Workgroups to standardize data elements and harmonize and privacy and security policies  Plan to be complete by July 2009

18. C ALIFORNIA H EALTH C ARE F OUNDATION Initial EEP Programs Available through a Single Application  Medi-Cal  Healthy Families  AIM  CHDP  County Medical Services Program  Breast and Cervical Cancer Treatment Program  Cancer Detection Programs: Every Woman Counts  WIC  TANF  Food Stamps  Family PACT

19. C ALIFORNIA H EALTH C ARE F OUNDATION Programs Not Yet Included Local Health Programs  County Indigent Care programs  Healthy Kids  CalKIDS  Kaiser Child Health Program  Earned Income Tax Credit  Low-Income Energy Assistance Program  Child Care Tax Credit  California Low Cost Automobile Insurance Program  Voter Registration Other Supplemental Programs

20. C ALIFORNIA H EALTH C ARE F OUNDATION How will it actually work…

21. C ALIFORNIA H EALTH C ARE F OUNDATION Service Oriented Architecture Enterprise Service Bus SearchOrdering & PaymentPersonalization Gift-Wrapping & Fulfillment Common Shared Services Amazon Store (Purchase) Rare Book Dealers (Purchase) Toy Stores (Purchase) Health & Beauty (Purchase) Common Business Processes Messaging Interface for Data Exchange Consumer Web-based application Amazon.com Example

22. C ALIFORNIA H EALTH C ARE F OUNDATION Service Oriented Architecture Enterprise Service Bus EDD (Income Verification) DMV (ID Verification) MEDS (File Clearance) Vital Statistics (Birth/Death Records) Common Shared Services CHDP (Program Enrollment) Single Point of Entry (Program Enrollment) SAWS Systems (Program Enrollment) WIC Program (Program Enrollment) Common Enrollment Business Processes Messaging Interface for Data Exchange Consumer Web-based application Source: Modernizing Enrollment in California’s Health Programs: A Blueprint for the Future, 2007 A Prototype to Modernize Public Program Enrollment

23. C ALIFORNIA H EALTH C ARE F OUNDATION Questions & Answers For more information: Sam Karp skarp@chcf.org