1. Getting the Most Bang from our Post-Health Reform Buck: Enrolling and Retaining Everyone Whos Eligible December 1, 2009 Alliance for Health Reform Briefing Tricia Brooks

2. How are we doing in Medicaid & CHIP? How can we do better post-health reform? 5 million of the 8 million uninsured children are currently eligible for Medicaid or CHIP… As many of 40% of uninsured children were enrolled in Medicaid or CHIP in the prior year… In 2008, the number of uninsured children dropped to its lowest rate in more than 2 decades largely due to the success of Medicaid and CHIP but…

3. Lessons Learned from Medicaid and CHIP

4. Barriers to Enrollment & Retention Unnecessarily excessive paperwork and red tape Lack of clarity in communication Affordability; payment policies Past experiences with the system Cultural orientation to coverage and access to healthcare Outdated, inflexible technology

5. Coordination Issues Lack of alignment between programs: Policies Procedures Requirements Separate eligibility systems with limited ability to exchange data Incomplete, unsuccessful hand-offs between programs

6. Its Not Rocket Science Harness technology to enhance productivity and accuracy Engineer the business policies and processes to be: Efficient Client-focused Performance-based Seamless to families and individuals

7. But There Are Challenges Resistance to change Political will and State resources Technology costs Data collection and analysis capacity Effort required to map processes, test new ideas, identify best practices, spread change Subsidies through tax code would add new element to coordinate

8. Effective Strategies Moving Forward

9. Maximize the Use of Technology Program information Self-service options Screen, apply, renew and manage account Centralized eligibility or highly functional data exchanges Administrative verifications Express lane eligibility Better data; quality control

10. Make the System Simple and Consistent Requirements, processes, and procedures Income, in particular Materials, forms, letters, all communications Multiple points of entry Via mail, phone, web, in-person Attention to consistency across venues Screen and enroll for all programs regardless of access point

11. Support Community-Based Assistance Help overcome stigma, cultural and language barriers Offer breadth of services from outreach to screening eligibility to app assistance Clarify requirements for families Reduce administrative load on eligibility offices Provide excellent feedback mechanism

12. Offer Affordable Premiums with Flexible Payment Policies No rule of thumb on affordability but must take into account all cost-sharing Premiums impact enrollment Co-payments impact access Need multiple payment options Generous grace periods and premium rescues can help

13. Focus on Outcomes Establish clear program goals and outcomes measures Collect, analyze and act on enrollment and retention data Adopt a continuous improvement approach to program administration Report data publicly to enhance accountability and transparency

14. Put Out the Welcome Mat Reform offers opportunity to create renewed interest in and enthusiasm for all coverage programs Care should be taken to create and refine a system of coverage that is seamless and easy to maneuver for families and individuals

15. Contact Information Tricia Brooks Senior Fellow Georgetown University Center for Children and Families pab62@georgetown.edu http://ccf.georgetown.edu/ http://www.theccfblog.org/ 202-365-9148