Post on 01-Jan-2016
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Getting the Most Bang from our Post-Health Reform Buck:
Enrolling and Retaining Everyone Who’s Eligible
December 1, 2009Alliance for Health Reform Briefing
Tricia Brooks
How are we doing in Medicaid & CHIP?How can we do better post-health reform?
5 million of the 8 million uninsured children are currently eligible for Medicaid or CHIP…
As many of 40% of uninsured children were enrolled in Medicaid or CHIP in the prior year…
In 2008, the number of uninsured children dropped to it’s lowest rate in more than 2 decades largely due to
the success of Medicaid and CHIP but…
Lessons Learned from Medicaid and CHIP
Barriers to Enrollment & Retention
• Unnecessarily excessive paperwork and red tape
• Lack of clarity in communication• Affordability; payment policies• Past experiences with “the
system”• Cultural orientation to coverage
and access to healthcare• Outdated, inflexible technology
Coordination Issues
• Lack of alignment between programs:• Policies• Procedures • Requirements
• Separate eligibility systems with limited ability to exchange data
• Incomplete, unsuccessful hand-offs between programs
It’s Not Rocket Science
• Harness technology to enhance productivity and accuracy
• Engineer the business policies and processes to be:• Efficient• Client-focused• Performance-based
• Seamless to families and individuals
But There Are Challenges
• Resistance to change• Political will and State
resources• Technology costs• Data collection and
analysis capacity• Effort required to map processes, test new
ideas, identify best practices, spread change• Subsidies through tax code would add new
element to coordinate
Effective Strategies Moving Forward
Maximize the Use of Technology
• Program information• Self-service options• Screen, apply, renew and manage
account• Centralized eligibility or highly
functional data exchanges• Administrative verifications• Express lane eligibility• Better data; quality control
Make the System Simple and Consistent
• Requirements, processes, and procedures• Income, in particular
• Materials, forms, letters, all communications
• Multiple points of entry• Via mail, phone, web, in-person• Attention to consistency across venues• Screen and enroll for all programs regardless
of access point
Support Community-Based Assistance
• Help overcome stigma, cultural and language barriers
• Offer breadth of services from outreach to screening eligibility to app assistance
• Clarify requirements for families• Reduce administrative load on eligibility offices• Provide excellent feedback mechanism
Offer Affordable Premiums with Flexible Payment Policies
• No rule of thumb on affordability but must take into account all cost-sharing• Premiums impact enrollment• Co-payments impact access
• Need multiple payment options
• Generous grace periods and premium rescues can help
Focus on Outcomes
• Establish clear program goals and outcomes measures
• Collect, analyze and act on enrollment and retention data
• Adopt a continuous improvement approach to program administration
• Report data publicly to enhance accountability and transparency
Put Out the Welcome Mat
• Reform offers opportunity to create renewed interest in and enthusiasm for all coverage programs
• Care should be taken to create and refine a system of coverage that is seamless and easy to maneuver for families and individuals
Contact Information
Tricia BrooksSenior FellowGeorgetown University Center for
Children and Familiespab62@georgetown.eduhttp://ccf.georgetown.edu/http://www.theccfblog.org/202-365-9148