Reach Out And Keep Someone

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Janette Lopez

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Reach Out And Keep Someone

  1. 1. Reach Out And Keep Someone The California Experience
  2. 2. Reach Out And Keep Someone The California Experience <ul><li>Janette Lopez </li></ul><ul><li>Deputy Director </li></ul><ul><li>Eligibility, Enrollment & Marketing </li></ul><ul><li>CA Managed Risk Medical Insurance Board </li></ul>
  3. 3. <ul><li>Removing Barriers </li></ul><ul><li>Simplify the application </li></ul><ul><li>Apply via phone </li></ul><ul><li>Apply via internet application </li></ul><ul><li>Minimize documentation requirements </li></ul><ul><li>Allow documentation to be submitted post enrollment </li></ul>Reach Out And Keep Someone The California Experience
  4. 4. <ul><li>Removing Barriers (cont’d) </li></ul><ul><li>Grant presumptive eligibility at various entities </li></ul><ul><li>Create enrollment gateways such as Child Health & Disability Prevention (CHDP) Program & Women Infants & Children (WIC) </li></ul><ul><li>If SCHIP program has premium requirement, bill family after enrollment v. require premium with application </li></ul><ul><li>Auto assign to a plan if family omitted selection </li></ul>Reach Out And Keep Someone The California Experience
  5. 5. <ul><li>Use Media for Program Recognition </li></ul><ul><ul><li>New program – public exposure </li></ul></ul><ul><ul><li>Renaming the program to emphasize coverage expansion, i.e. Insure All Kids </li></ul></ul><ul><ul><li>Develop and promote “One Door” enrollment concept </li></ul></ul>Reach Out And Keep Someone The California Experience
  6. 6. <ul><li>OUTREACH, ENROLLMENT, RETENTION & UTILIZATION (OERU) STRATEGIES </li></ul><ul><li>Need varied and multiple strategies </li></ul><ul><li>Train and reimburse application assistants </li></ul><ul><li>Outreach grants to provide cultural and linguistic appropriate outreach at the local level </li></ul>Reach Out And Keep Someone The California Experience
  7. 7. <ul><li>OERU (cont’d) </li></ul><ul><li>“ One Door” approach – ability to offer coverage to all children in a household regardless of immigration status </li></ul><ul><li>Local efforts also include various levels of case management to assure enrollment, member education regarding the annual review process and utilizing services </li></ul>Reach Out And Keep Someone The California Experience
  8. 8. <ul><li>Express Lane Eligibility (ELE) </li></ul><ul><li>Good concept – grant presumptive eligibility until a final Medicaid eligibility determination is made </li></ul><ul><li>Requires ability to interface between ELE site and the Medicaid enrollment system </li></ul><ul><li>May require funding for schools if the Free Lunch Program is included </li></ul><ul><li>May need to address differences in eligibility rules, i.e. how family size or income is determined </li></ul>Reach Out And Keep Someone The California Experience
  9. 9. <ul><li>ANNUAL ELIGIBILITY REVIEW PROCESS (AER) </li></ul><ul><li>Keep it simple </li></ul><ul><li>Preprint Annual Review Form </li></ul><ul><li>Develop internet based system for annual renewal </li></ul><ul><li>Minimize documentation requirements </li></ul><ul><li>Allow re-determinations by phone </li></ul>Reach Out And Keep Someone The California Experience
  10. 10. <ul><li>AER (cont’d) </li></ul><ul><li>Allow application assistants to assist families and provide incentives $$ </li></ul><ul><li>Improve coordination with Medicaid </li></ul><ul><li>Establish presumptive eligibility (until a final eligibility determination) for children moving between SCHIP and Medicaid </li></ul><ul><li>Develop a simple process for families in SCHIP to be evaluated for Medicaid prior to their AER </li></ul>Reach Out And Keep Someone The California Experience
  11. 11. Reach Out And Keep Someone The California Experience Questions? CA Managed Risk Medical Insurance Board Janette Lopez (916) 324-4695 [email_address]

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