Families USA Health Action 2010 Conference Washington, DC January 30, 2010 Kyle C. Viator La. Dept of Health & Hospitals
Mar 27, 2015
Families USA Health Action 2010 Conference
Washington, DCJanuary 30, 2010
Kyle C. ViatorLa. Dept of Health & Hospitals
High rate of poverty and poor health outcomes
Absolute minimum levels of coverage for children
Onerous application and verification requirements
Nation’s third highest percentage of uninsured kids
Almost 1 in 3 low income children had no health coverage
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Strong support from 3 consecutive administrations from both major parties Genuine desire to reduce number of
uninsured children Eligibility workloads spiraling out of control Positive administrative impact for cash
strapped state Advances in technology presented new
opportunities Tremendous Success in Retaining Eligibile Kids Possible to achieve without compromising
program integrity Recognized for lowest error rates in country
in 2009
Present for over a decade now (since CHIP began) 800+ statewide Medicaid managers, supervisors,
Eligibility Examiners, and clerical staff Brainstorming and implementing regional initiatives Working with local coalitions and partners Placing application form and holders in their
communities Doing local media—TV, radio, newspapers Onsite application assistance in communities
“The sum is better than the parts” Wide array –public as well as private Louisiana Covering Kids & Families,
Children’s Partnership Outreach and enrollment contracts
with 11 community organizations
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Nearly $1 Million for additional outreach in Louisiana
Targeted to underserved populations Hispanic and Immigrant Families Rural Areas Cross-Border
Outcome-driven community partnerships Contracting with 10 “Community Canvassers” Enhanced payments for successful applications Incentives for innovative outreach and enrollment
techniques Technical assistance; sharing best practices
700,458 children enrolled in Medicaid and LaCHIP
577,390 enrolled in Medicaid 123,068 enrolled in LaCHIP (at or below
200% FPL) 2,920 enrolled in LaCHIP Affordable Plan
(between 200% FPL and 250% FPL)
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700,458
314,515
83,669
72,429
41,595 39,765
-
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
2003 2005 2007 2009
Children Eligible for Mediciad
Count
Number of uninsured kids eligible for CHIP or Medicaid has dramatically declined But still ~40K kids remain uninsured
4 year RWJF-funded project that started in February 2009
Complements outreach initiatives with systems improvements and policy changes
Goal is to enroll 98% of children eligible for Medicaid or CHIP by 2013.
Major source of funding for implementation costs of ELE
The department, upon enactment by Congress of legislation allowing the same may utilize income determinations made by the Food Stamp Program, WIC, or National School Lunch Program for determining income eligibility for the Louisiana Medicaid program or LaCHIP.
La. R.S. 46:977.8
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6.0%
7.1%
6.3%
4.8% 4.8%4.6%
2.5%
16,510
11,504
8,566
5,2284,585 4,212
7,595
<50% FPL 50-100% FPL 100-150% FPL
150-200% FPL
200-250% FPL
250-300% FPL
>300% FPL
Percent Number
Highest % of state’s uninsured kids are from 50% to 100% FPL Literacy issues “Simplicity” of enrollment is relative Complicated lives
Different agencies determine Medicaid/CHIP and FS, WIC, and School Lunch eligibility Parental priorities Maslow’s hierarchy of needs
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Simplification Isn’t Simple Spring 2009 started intensive workgroup
planning, after CHIPRA signed Eligibility Systems programmers focusing
majority of their time State Administrative Rulemaking Process
Internal marketing about need to pursue despite fiscal impact
SPA Submitted in late October Approval received last Friday (01/22/10)!!!
Request to SNAP agency for opt out language revision to forms
Identification of public agencies “capable” of determining income eligibility at 97% or higher rate of accuracy Collecting application forms Reviewing income policies
Determined data fields from ELA needed for fully automated enrollment
Projecting volume estimates for both renewals and applications (for fiscal impact projections)
Significant system changes by both ELA & us Planning for eligibility accuracy review of ELE
sample 17
File of currently eligible children <19 received from SNAP Agency
We did file match with Medicaid and CHIP & removed children with coverage ~12 K children identified who were enrolled in SNAP, but
not in Medicaid or CHIP ~8 K additional children may or may not already be
enrolled manual review being done to determine if already
enrolled slow and resource intensive process lessons learned:
data matching isn’t “magic” or totally clean “automatic” is relative human intervention is still important 18
Based on early conversations with CMS-- Sent families a letter in early December giving them the
option to “opt out” of having coverage added for child Out of 12,301 only 313 children opted out of coverage
Subsequently, a different interpretation by CMS legal staff of affirmative consent requirement in statute
Final negotiations for SPA approval— Creative (we think!) solution CMS agreed to allow us to enroll and send Medicaid card to
all identified children who did not opt out Child will not officially gain coverage until parent/guardian
“affirmatively consents” by using Medicaid card to access services
Citizenship will be verified through new CHIPRA authorized SSA Verification System
Procedures incorporate new CHIPRA policy which calls for coverage to begin pending citizenship verification
File match through TPL contractor after eligibility will identify any TPL
Plan is to move quickly to “joint SNAP/Medicaid application” by ELA Opportunity on their revised application to “opt
in” Newly enrolled SNAP children not already
enrolled in Medicaid will be enrolled in Medicaid nightly
Next Step: Using ELE for automatic re-enrollment
Even further reduction in administrative costs No longer a need for any caseworker action Reduces exposure to eligibility errors
True ELE cases excluded from Quality Control and PERM reviews
Simplifies eligibility—for us all children eligible for SNAP will be eligible for Medicaid With Medicaid stimulus, La has higher FMAP for
Medicaid than CHIP (through at least 12/31/10!) Performance bonuses based on Medicaid increase
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Players constantly change Families needing our help Stakeholders who interact with
those families Lack of focus leads to “drift” and
slippage Outreach Simplifications Eligibility Improvements
Still > 40,000 uninsured kids eligible but not yet enrolled in La
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Kyle C. ViatorDeputy Medicaid DirectorLa Department of Health & HospitalsP.O. Box.91278Baton Rouge, LA 70821Telephone: 225 342 6043Fax: 225 342 9508Blackberry: 225 274 6423E-Mail: [email protected]
www.lachip.org