Paving a Health Coverage Enrollment Superhighway


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Paving a Health Coverage Enrollment Superhighway

  1. 1. Paving a Health Coverage EnrollmentSuperhighway: Bridging State GapsBetween 2014 and TodayAlice M. Weiss, JDCo-Director, Maximizing EnrollmentProgram Director, NASHPFebruary 3, 2011
  2. 2. 2Overview  ACA’s Vision: An Enrollment Superhighway  State Gaps and Challenges in Streamlining Enrollment  Bridging State Gaps to 2014  Conclusion
  3. 3. 3 ACA’s Vision: An EnrollmentSuperhighway
  4. 4. 4 ACA’s Enrollment VisionTransformation from: …To:  Welfare-Era   Modern  Burdensome   Easy to Use   Seamless  Disconnected   Interconnected  Complex   Simple  Paperwork-intensive   Technology-Enabled
  5. 5. 5Gaps and Challenges for States
  6. 6. Gaps and Challenges for States: 6 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
  7. 7. 7Gaps and Challenges for States:Consumer ExperienceSource: Congressional Budget Office.  “Recent Trends in the Variability of Individual Earnings and Household Income.”  June 2008.
  8. 8. Gaps and Challenges for States: 8 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 IntentPhoto courtesy of Southern Institute on Children and Families
  9. 9. 9 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for States: Technology and Infrastructure Limited Online/Phone Enrollment Existing Eligibility Systems Often:   Outdated   Disconnected   Shared   Redundant Technology Literacy Challenges Procurement, Legislative Oversight Speedy Implementation Timeframes Financing
  10. 10. 10 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
  11. 11. 11 Bridging the GapHelping States Reach 2014
  12. 12. Bridging the Gap: 12 Consumer Experience Adopt Technologies to Support Consumer Connections Enable Consumer Assistance and Engagement Facilitate Coverage Transitions Ensure Accessibility for Diverse Populations
  13. 13. Bridging the Gap: 13 Eligibility and Enrollment Policy Simplify Processes and Policies Minimize Data Collection; Increase Data- Sharing Review and Address Policy Conflicts Support Agency/Caseworker Culture Change
  14. 14. Bridging the Gap: 14 Technology and Infrastructure Pursue New System Upgrades Through Federal Guidance Evaluate Technology Needs and Available Resources Pursue Economies of Scale
  15. 15. Bridging the Gap: 15 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
  16. 16. 16 ConclusionStates at Crossroads:  Major challenges, changes needed  Opportunities for transformative change  State investment, leadership, planning critical  Federal support and oversight also essential  “Superhighway” within reach