1. Wyoming Process Improvement Collaborative Aim Statement The Wyoming Team will identify the number of incorrect closures in the Laramie Field Office and significantly reduce or eliminate them by May 1 st.

2. Wyoming Process Improvement Collaborative Challenges with gathering data for Core Measures: Lack of computer tech support to gather data No distinction between denials and closures Inconsistency with denial reasons used by workers Incorrect denial/closure reasons used by workers Lack of data to show number of cases due for renewal In Wyoming, we have long suspected that while enrollment is high, many eligible children lose coverage at renewal. Gathering data to show how this occurs was difficult.

3. Wyoming Process Improvement Collaborative Goal Statement: Wyoming’s team will work toward its aim statement through the following goals. Goal 1 – Develop a method for gathering and evaluating renewals and closures for Laramie Field Office. Goal 2 - Record and monitor information on denials, closures, renewals approved and denied and denial reasons. Goal 3 – Develop and implement intervention strategies. Goal 4 – Provide referrals to Kid Care CHIP for families who are denied for Medicaid at initial application or renewal due to income.

4. Wyoming Process Improvement Collaborative Improvement Strategies/Interventions Use different colored envelopes for renewal information to stand out from other mail, advertisements, and bills. Rubberstamp on envelopes to identify mailing as a renewal for health care coverage which requires attention. Follow-up phone calls to families. Other interventions as determined.

5. Laramie Field Office Incorrect Closure Reasons targeted for reduction. Failure to provide information, verification, or to complete the process (No verification is necessary for Medicaid in Wyoming, but a complete signed application is required.) Failure to complete review process Other- (Includes “No longer funded” and “Medicaid- Not CHIP eligible”) (While some “other “ reasons may be legitimate, “no longer funded “and “Medicaid -Not CHIP eligible” shouldn’t be used for Medicaid.) Closure of cases before 12 month eligibility period is over. (Should only happen when child moves out of state, turns 19, or becomes institutionalized.)

6. Laramie Field Office Core Closure Measures

7. Laramie Field Office Core Closure Measures

8. Laramie Field Office Core Closure Measures

9. Change 1: Simplification of Children’s Medicaid in 2001  12 month eligibility  Self declaration of income  Removal of asset test  Removal of interview requirements  Renewal form and letter mailed locally by caseworker Change 2: SCHIP Restructured  Kid Care CHIP implemented October 1, 2003  Moved eligibility to Kid Care CHIP office  Benefits administered by Blue Cross Blue Shield of Wyoming  Higher income guidelines with family cost-sharing Changes Implemented To Date

10. Wyoming Process Improvement Collaborative 1– Data needed that is specific to renewals  Closures vs. denials  Reasons for denials vs. closures  Total applications received  Total cases due for renewal each month 2 – The team will attempt to use interventions that will be effective and easy to implement statewide if they are declared successful. Conclusions What conclusions can be made from this team to guide future planning?