Paving a Health Coverage Enrollment Superhighway

Paving a Health Coverage Enrollment Superhighway: Bridging State Gaps Between 2014 and Today

Alice M. Weiss, JD Co-Director, Maximizing Enrollment

Program Director, NASHP February 3, 2011

Overview

  ACA’s Vision: An Enrollment Superhighway

  State Gaps and Challenges in Streamlining Enrollment

  Bridging State Gaps to 2014

  Conclusion

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ACA’s Vision: An Enrollment Superhighway

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ACA’s Enrollment Vision Transformation from:

 Welfare-Era  Burdensome  Disconnected  Complex  Paperwork-intensive

…To:

  Modern   Easy to Use   Seamless   Interconnected   Simple   Technology-Enabled

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Gaps and Challenges for States

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Gaps and Challenges for States: Consumer Experience

 Welfare Era Approach Despite De-linking

 Customer Service Demands

 Assistance/Human Touch

 Accessibility Needs – Language, Disability, Literacy

 Different ACA Enrollment Rules Based on Medicaid-eligibility and Immigration Status

 Risk of Coverage Gaps

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Gaps and Challenges for States: Consumer Experience

Source: Congressional Budget Office.  “Recent Trends in the Variability of Individual Earnings and Household Income.”  June 2008.  http://www.cbo.gov/ftpdocs/95xx/doc9507/Frontmatter.1.2.shtml.

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Gaps and Challenges for States: Eligibility and Enrollment Policy

  Streamlined Enrollment Policies  New Coverage Paradigm

 Major Eligibility Expansions  Different Eligibility Rules for Medicaid vs. Exchanges

  Separate Rules for MAGI/Non-MAGI Populations  Need to Track Newly Eligibles for Increased FMAP   State/Federal Eligibility Policies Conflict with ACA Intent

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Photo courtesy of Southern Institute on Children and Families

Gaps and Challenges for States: Technology and Infrastructure

 Limited Online/Phone Enrollment  Existing Eligibility Systems Often:

 Outdated  Disconnected   Shared

  Redundant

 Technology Literacy Challenges  Procurement, Legislative Oversight  Speedy Implementation Timeframes  Financing

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Gaps and Challenges for States: Governance and Administration

 Political Leadership

 Siloed Agency Work

 Culture Change Imperative

 Role of Local Agencies

 Horizontal Integration of Human Service Programs

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Bridging the Gap

Helping States Reach 2014

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Bridging the Gap: Consumer Experience

 Adopt Technologies to Support Consumer Connections

 Enable Consumer Assistance and Engagement

 Facilitate Coverage Transitions

 Ensure Accessibility for Diverse Populations

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Bridging the Gap: Eligibility and Enrollment Policy

 Simplify Processes and Policies

 Minimize Data Collection; Increase Data-Sharing

 Review and Address Policy Conflicts

 Support Agency/Caseworker Culture Change

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Bridging the Gap: Technology and Infrastructure

 Pursue New System Upgrades Through Federal Guidance

 Evaluate Technology Needs and Available Resources

 Pursue Economies of Scale

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Bridging the Gap: Governance and Administration

 Identify State Priority Opportunities in Reform

 Invest in Multi-Agency Collaboration

 Develop Inventory of Local Functions to Inform Discussion of Future Local Roles

 Choose Degree of Integration Between Health and Human Service Programs

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Conclusion

States at Crossroads:   Major challenges, changes

needed

  Opportunities for transformative change

  State investment, leadership, planning critical

  Federal support and oversight also essential

  “Superhighway” within reach

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