Many states are innovating the way they perform enrollment to be more efficient and effective, both in the way they do business and in updating technical systems, whether they are expanding Medicaid under the Affordable Care Act or not.
There has been a lot of activity by states to modernize and overhaul their underlying programs and to improve the experience in Medicaid just to do a better job of enrolling and renewing existing eligible residents, said Matt Salo, executive director of the National Association of Medicaid Directors.
“States have been frantic at work the last couple of years trying to take legacy eligibility systems from the 1980s and trying to convert them into a modern system that is going to handle connectivity with the exchanges and with the systems among multiple agencies,” he said at a recent conference.
Two states – Virginia and Alabama – are not participating in Medicaid expansion but they are improving their enrollment process and IT in order to make it easier to get those who are eligible into the system, in part from grants from the Robert Wood Johnson Foundation.
“It is worth the effort to get folks enrolled, quickly and without a lot of effort,” said Gretel Felton, director of the technical support division of the Alabama Medicaid Agency.
In 2012, Alabama automated express lane eligibility enrollment. It uses the eligibility processes and determination findings from Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP).
Medicaid conducts a monthly automated match of persons on SNAP or TANF or both to automatically renew their eligibility with Medicaid, with 43 percent, or about 2,000, renewal enrollments done through express lane eligibility. “It cuts out administrative staff time, money and resources and sending out packets to enrollees,” Felton said in a recent webinar.
“Express lane eligibility is the difference between going on the superhighway and not having to get off at any exits and going straight to where you need to go and going through the city,” Felton said.
In another example of innovating the enrollment process, Virginia tested in early 2013 with three hospitals an expedited enrollment process for newborns, who are automatically eligible for one year when born to Medicaid and CHIP mothers, said Rebecca Mendoza, CHIP director and director of the maternal and child health division at the Virginia Department of Medical Assistance Services. “Through the pilot, we were able to enroll them in the system within one business day of hospital notification of birth,” she said in the webinar. “We wanted to make sure that they were enrolled in the system so providers would know that they were eligible.”
As of January, the pilot has been broadened statewide, along with the hospital-based presumptive eligibility, in which hospitals may enroll patients and their families who are likely to be Medicaid eligible.
The District of Columbia is participating in Medicaid expansion, but it has been adding more groups to its Medicaid program over the last few years so it has a high rate of coverage, said Claudia Schlosberg, director of the Health Care Policy and Research Administration in the D.C. Department of Health Care Finance. One third of D.C. residents get health coverage through Medicaid. Only 6 percent of D.C. residents are uninsured, second only to Massachusetts.
“We are in many ways in a place where many states want to be after they have implemented healthcare reform,” she said. D.C. has a lot of employer-sponsored, including government, insurance.
One unique program that D.C. has locally funded is a Medicaid-like benefit but without all the coverage elements to cover individual adults who were HIV-infected and extended it to those who were HIV-positive with incomes below 100 percent of poverty level, in an effort to control costs, Schlosberg said. “That drove pharmacy off the charts,” she said. “We carved out HIV drugs from managed care organization rates so that we could take advantage of the Department of Health’s pharmaceutical warehouse pharmacy that uses Department of Defense pricing,” Schlosberg said.