Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
OHA MAGI Medicaid
System Transfer Project
Oregon Eligibility (ONE)
Oregon CIOs Conference
Presented By: Julie Bozzi
11/17/...
2
Table of Contents
Project Overview 3
Eligibility and Enrollment 4
Project Mission and Key Benefits 5
Median Household In...
3
Project Overview
• Kentucky system exists in production and works correctly
• Minimum necessary system customizations we...
4
Oregon’s Medicaid Eligibility & Enrollment
• Applicants apply for Oregon Health Plan (OHP) coverage via ONE (Medicaid
El...
Project Mission and Key Benefits
5
Improve Oregonians’ access to health care by providing a simplified process
for eligibi...
Median Household Income Key Benefit
6
100%
200%
300%
400%
QHP
APTC
OHP
Pregnant
Woman
Child
APTC
QHP
OHP
QHP
APTC
OHP
Adul...
7
Benefit Programs
Capabilities
ApplicantPortal&
CommunityPartners
Channels
WorkerPortal
(Mail/Fax/Phone)
Screening
MEC Ch...
Project Approach
8
Status Phase WhatWe’re Doing
Design • Finalize requirements
• Define future-state business processes su...
Project Status Summary
9
2015 2016
Phase Aug Sep Oct Nov Dec Jan Feb Mar
Test
Implementation
Planning
Training
Go-Live
Sup...
ONE System Go-Live Dates
10
Worker Portal Go-Live
December 15, 2015
• Used for eligibility determinations
• Read only acce...
11
A Day in the Life of an Eligibility Worker
11
Applicant provides verification
documents
Receive
Verification
Documents
...
Application Lifecycle for Applicants and Workers
General New Applicant — Does not have Medicaid
Existing Applicant — Has M...
Application Lifecycle for Applicants and Workers
Applicant Applies
Completes their
application via Paper,
Fax, Fillable PD...
Project Team Contact Information
14
For additional information regarding the OHA MAGI Medicaid System
Transfer Project or ...
Appendix
10 Things to Know About the ONE Project
l. Oregon has elected to transfer and implement the Kentucky eligibility and enrol...
10 Things to Know About the ONE Project
8. OHA is convening a group of external advisors – including Legislators, Coordina...
Updated ONE System Experience
18
After December 15th internal OHA Staff will access the Worker Portal to complete all elig...
Updated ONE System Experience
19
After February 6th new and returning applicants who have had an initial
redetermination c...
Upcoming SlideShare
Loading in …5
×

Julie Bozzi Oregon MAGI Project Overview 112015

Julie Bozzi Oregon MAGI Project Overview 112015

  • Be the first to comment

Julie Bozzi Oregon MAGI Project Overview 112015

  1. 1. OHA MAGI Medicaid System Transfer Project Oregon Eligibility (ONE) Oregon CIOs Conference Presented By: Julie Bozzi 11/17/2015
  2. 2. 2 Table of Contents Project Overview 3 Eligibility and Enrollment 4 Project Mission and Key Benefits 5 Median Household Income Benefits 6 System Functionality 7 Project Approach 8 Project Milestones and Status 9 ONE System Go-Live Dates 10 What to Expect:Worker and Applicant Processes 11 – 13 Team Contact Information 14 Appendix 15
  3. 3. 3 Project Overview • Kentucky system exists in production and works correctly • Minimum necessary system customizations were planned and made • Policy and business processes will change wherever feasible Kentucky’s Affordable Care Act-compliant system (called kynect), was transferred and configured to meet Oregon’s MAGI Medicaid/CHIP eligibility determination needs. Oregon’s system is called Oregon Eligibility (ONE) or just ONE.
  4. 4. 4 Oregon’s Medicaid Eligibility & Enrollment • Applicants apply for Oregon Health Plan (OHP) coverage via ONE (Medicaid Eligibility Determination) • Applicants eligibility information is passed from ONE to MMIS to enroll in OHP and get a coverage card (Medicaid Enrollment) • MMIS sends CCO enrollment files to enroll OHP members in particular CCOs Medicaid eligibility will be completed in the ONE System. The Medicaid enrollment system of record is Oregon’s MMIS. Oregon MMIS Oregon CCOs
  5. 5. Project Mission and Key Benefits 5 Improve Oregonians’ access to health care by providing a simplified process for eligibility determination and enrollment in Oregon Health Plan (OHP) The Mission • Better coordination of care for mixed household families because applicants complete a single application through the HealthCare.gov website or within the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP or private health insurance • Oregonians can set-up an account, report changes and receive real-time eligibility determinations via the user-friendly Applicant Portal • Simplified OHA eligibility workload via automated process that generates tasks for case management • Centralized and verified enrollment data available for Coordinated Care Organizations • Consistent quality data source for reporting CMS-mandated operational statistics Key Benefits
  6. 6. Median Household Income Key Benefit 6 100% 200% 300% 400% QHP APTC OHP Pregnant Woman Child APTC QHP OHP QHP APTC OHP Adult %ofFPL The Median Household Income in Oregon often results in mixed eligibility households. A key benefit of the ONE system will be the ability to track these households and service each member of the family. Median Household Income in Oregon = Between 200-300% FPL Applicants complete a single application through the HealthCare.gov website or within the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP 190% 138% 305%
  7. 7. 7 Benefit Programs Capabilities ApplicantPortal& CommunityPartners Channels WorkerPortal (Mail/Fax/Phone) Screening MEC Check for Adult Advanced Premium Tax Credit (APTC) (Disabled) Continuous Eligibility MAGI Account Registration Non-MAGI Referral CAWEM / CAWEM Plus (Emergency Medicaid) Former Foster Care Children New Existing Emergency Medicaid Federal Healthcare.gov ONE System Functionality Check Benefits Document Management Reasonable Compatibility Case Maintenance Verification Real Time Eligibility Manage Tasks Inquiry Hospitalized Inmate Application Bi-directional Account Transfer Correspondence & ReportsRenewals Eligibility Override Public Assistance Reporting Information System Medicaid Management Information System Oregon Employment Dept. Federal Data Services Hub Interfaces Qualified Health Plan/ Employee Sponsored Insurance (Disabled)
  8. 8. Project Approach 8 Status Phase WhatWe’re Doing Design • Finalize requirements • Define future-state business processes supporting new capabilities • Capture all changes occurring as a result of the new technology and processes • Planning to move data from existing systems into the new tool, known as the “cutover strategy” • Communicating with staff and stakeholders about the project Build • Build technology, integrating and “talking to” current systems not being replaced • Write scenarios that simulate how the system is used • Develop detailed training courses • Communicate specifics about changes and benefits that ONE will bring Test • Extensively test the system to confirm it is running correctly and works with other systems OHA currently uses • Make final adjustments to technology and processes as necessary, based on the results of tests Implement • Conduct training to help staff and others learn new technology and processes • “Turn on” the system to perform business processes • Conduct additional training as needed Support • Continuous support with help of “Local Experts”, or staff highly trained on the system • Encourage continued momentum among staff to use the system, ask questions, and raise concerns We are here
  9. 9. Project Status Summary 9 2015 2016 Phase Aug Sep Oct Nov Dec Jan Feb Mar Test Implementation Planning Training Go-Live Support Worker Portal Go-Live Applicant Portal Go-Live Milestone Date User Acceptance Testing (UAT) Begins 9/15/15 Worker Portal Training Materials Complete 9/30/15 Submit Authority to Connect Packet to CMS 10/15/15 Worker Portal End User Training begins 10/19/15 Milestone (cont.) Date Applicant Portal End User Training begins 11/30/15 CMS Operational Review 11/4/15 - 11/5/15 Worker Portal Go-Live 12/15/15 Applicant Portal Go-Live 2/6/16 User Acceptance Testing Begins On Track for On-time Go-Live, Tight Schedule Creates Risk
  10. 10. ONE System Go-Live Dates 10 Worker Portal Go-Live December 15, 2015 • Used for eligibility determinations • Read only access for DHS staff as needed to review status of client applications Applicant Portal Go-Live February 6, 2016 • Community Partners/Assisters and public use for self-servicing new eligibility determinations and enrollments • Current Medicaid enrollees will need to have an eligibility determination completed in ONE by a worker before they can use the Applicant Portal S M T W T F S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 December February S M T W T F S 1 2 3 4 5 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 15 6
  11. 11. 11 A Day in the Life of an Eligibility Worker 11 Applicant provides verification documents Receive Verification Documents Eligibility Worker Other OHA / DHS System generates correspondence Request for Information Data needed to run verification is received and entered Re-run Verification Reassign applicant to appropriate queue Non-MAGI Referral Applicant is handed off to DHS and processed outside of the ONE system DHS Dashboard Pull appropriate task from queue. Manage from your dashboard Log In Single Sign On Verification successful? Verification Complete Applicant Registration and data collection Data Entry Authorize Benefits Authorize the appropriate benefits Authorize Benefits Authorize the appropriate benefits Yes No Report Results The eligibility results will be reported to the ONE System
  12. 12. Application Lifecycle for Applicants and Workers General New Applicant — Does not have Medicaid Existing Applicant — Has Medicaid Worker Log In Single Sign On Worker Dashboard Pull appropriate task from cue. Manage from your dashboard Verification successful Verification Applicant Applies Applicant Portal (On-Line) Community Partner Assistance in Applicant Portal Complete Applicant Registration and data collection Data Collection Eligibility Determined Applicant not previously known to the Oregon system has their eligibility determined CCO Selection Applicant or Community Partner selects a preference, MMIS assigns CCO finally Complete Applicant Registration and data collection *Applicant known to Oregon Systems? Data Collection Eligibility Determined Applicant not previously known to the Oregon system has their eligibility determined Verification successful. Verification Yes No
  13. 13. Application Lifecycle for Applicants and Workers Applicant Applies Completes their application via Paper, Fax, Fillable PDF IRMS Scans the application into the Worker Portal Worker Dashboard Pull appropriate task from cue, Manage from your dashboard Verification successful Verification Worker Log In Single Sign On Applicant without Computer or Access to a Community Partner Complete Applicant Registration and data collection Data Collection Eligibility Determined Applicant not previously known to the Oregon system has their eligibility determined
  14. 14. Project Team Contact Information 14 For additional information regarding the OHA MAGI Medicaid System Transfer Project or the ONE System, email the project team: OHAOregon.Eligibility@state.or.us
  15. 15. Appendix
  16. 16. 10 Things to Know About the ONE Project l. Oregon has elected to transfer and implement the Kentucky eligibility and enrollment system (called KYNECT) – meaning we are bringing a system that already works, to Oregon for use by OHA. 2. The project is minimizing changes to the KYNECT system and limiting them to the ones needed for Medicaid policies in Oregon that don’t exist in Kentucky (like emergency Medicaid for non-citizens) or are necessary to support a Supported State Based Marketplace – (like Account Transfer with the Federal Marketplace (FFM) or Medicaid Coverage Check (MEC)). 3. OHA is using a system integrator on the project – Deloitte Consulting – who built the original system in Kentucky. 4. The system will be hosted in the Oregon DAS Enterprise Technology Services State Data Center – under control of state resources to support it. 5. There are some technical changes that need to be made to the Kentucky system to make it work in Oregon, including integration with an existing Document Management Solution and a new security COTS software product (Kentucky had a custom developed application) for their specific needs. 6. The ONE system will have interfaces with Oregon’s MMIS (5 total), with the FFM (10 total) and with a few Oregon specific data sources (like Employment Department). Interface development is on-track based on the project schedule. 7. There is a phased implementation schedule planned for the ONE system: • Worker Portal & integration with FFM (i.e. Bi-Directional Account Transfer) – December 15, 2015 • Applicant Portal for client self-service – February 6, 2016 (after open enrollment finishes)
  17. 17. 10 Things to Know About the ONE Project 8. OHA is convening a group of external advisors – including Legislators, Coordinated Care Organization representatives, as well as Community Partner representatives – to advise on implementation planning for the ONE system. First meeting will be held in July 2015. 9. When the system goes live, each current Medicaid enrollee will need to have an eligibility determination completed in the ONE system by a worker before they can use the Applicant Portal for inquiries or reporting changes in circumstance, via self-service. 10. Nothing about the new ONE system makes the problem of Medicaid clients wanting to choose a CCO based on participating providers better (or worse).The ONE system will provide a webpage with links to CCO provider directories, maintained by CCOs so that Oregonians can search to see if their provider is in a particular organization.The ONE system does provide applicants (accessing the system through the online Applicant Portal) the ability to choose a preferred CCO based on residential zip code should the applicant be found eligible.The ONE system will NOT interface with OHA Office of Health IT (OHIT) Provider Directory at initial implementation. • OHIT is currently working on a statewide provider directory project that will leverage data from existing,authoritative, and accurate provider data sources, such as common credentialing.The provider directory is not anticipated to be consumer-facing but instead will be a resource for provider directory systems (potentially including MAGI) to validate their own directories and improve the accuracy of their data they provide. See attached PDF for useful information regarding the MAGI Medicaid System Transfer project.
  18. 18. Updated ONE System Experience 18 After December 15th internal OHA Staff will access the Worker Portal to complete all eligibility determinations, each current Medicaid eligible will have to have a redetermination completed through Worker Portal before using Applicant Portal to self-service. Worker Portal
  19. 19. Updated ONE System Experience 19 After February 6th new and returning applicants who have had an initial redetermination completed within Worker Portal will initiate their application or renewal by way of the Applicant Portal Applicant Portal

×