Families USA Health Action 2010 Conference

Washington, DCJanuary 30, 2010

Kyle C. ViatorLa. Dept of Health & Hospitals

High rate of poverty and poor health outcomes

Absolute minimum levels of coverage for children

Onerous application and verification requirements

Nation’s third highest percentage of uninsured kids

Almost 1 in 3 low income children had no health coverage

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Strong support from 3 consecutive administrations from both major parties Genuine desire to reduce number of

uninsured children Eligibility workloads spiraling out of control Positive administrative impact for cash

strapped state Advances in technology presented new

opportunities Tremendous Success in Retaining Eligibile Kids Possible to achieve without compromising

program integrity Recognized for lowest error rates in country

in 2009

Present for over a decade now (since CHIP began) 800+ statewide Medicaid managers, supervisors,

Eligibility Examiners, and clerical staff Brainstorming and implementing regional initiatives Working with local coalitions and partners Placing application form and holders in their

communities Doing local media—TV, radio, newspapers Onsite application assistance in communities

“The sum is better than the parts” Wide array –public as well as private Louisiana Covering Kids & Families,

Children’s Partnership Outreach and enrollment contracts

with 11 community organizations

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Nearly $1 Million for additional outreach in Louisiana

Targeted to underserved populations Hispanic and Immigrant Families Rural Areas Cross-Border

Outcome-driven community partnerships Contracting with 10 “Community Canvassers” Enhanced payments for successful applications Incentives for innovative outreach and enrollment

techniques Technical assistance; sharing best practices

700,458 children enrolled in Medicaid and LaCHIP

577,390 enrolled in Medicaid 123,068 enrolled in LaCHIP (at or below

200% FPL) 2,920 enrolled in LaCHIP Affordable Plan

(between 200% FPL and 250% FPL)

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700,458

314,515

83,669

72,429

41,595 39,765

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

2003 2005 2007 2009

Children Eligible for Mediciad

Count

Number of uninsured kids eligible for CHIP or Medicaid has dramatically declined But still ~40K kids remain uninsured

4 year RWJF-funded project that started in February 2009

Complements outreach initiatives with systems improvements and policy changes

Goal is to enroll 98% of children eligible for Medicaid or CHIP by 2013.

Major source of funding for implementation costs of ELE

The department, upon enactment by Congress of legislation allowing the same may utilize income determinations made by the Food Stamp Program, WIC, or National School Lunch Program for determining income eligibility for the Louisiana Medicaid program or LaCHIP.

La. R.S. 46:977.8

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6.0%

7.1%

6.3%

4.8% 4.8%4.6%

2.5%

16,510

11,504

8,566

5,2284,585 4,212

7,595

<50% FPL 50-100% FPL 100-150% FPL

150-200% FPL

200-250% FPL

250-300% FPL

>300% FPL

Percent Number

Highest % of state’s uninsured kids are from 50% to 100% FPL Literacy issues “Simplicity” of enrollment is relative Complicated lives

Different agencies determine Medicaid/CHIP and FS, WIC, and School Lunch eligibility Parental priorities Maslow’s hierarchy of needs

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Simplification Isn’t Simple Spring 2009 started intensive workgroup

planning, after CHIPRA signed Eligibility Systems programmers focusing

majority of their time State Administrative Rulemaking Process

Internal marketing about need to pursue despite fiscal impact

SPA Submitted in late October Approval received last Friday (01/22/10)!!!

Request to SNAP agency for opt out language revision to forms

Identification of public agencies “capable” of determining income eligibility at 97% or higher rate of accuracy Collecting application forms Reviewing income policies

Determined data fields from ELA needed for fully automated enrollment

Projecting volume estimates for both renewals and applications (for fiscal impact projections)

Significant system changes by both ELA & us Planning for eligibility accuracy review of ELE

sample 17

File of currently eligible children <19 received from SNAP Agency

We did file match with Medicaid and CHIP & removed children with coverage ~12 K children identified who were enrolled in SNAP, but

not in Medicaid or CHIP ~8 K additional children may or may not already be

enrolled manual review being done to determine if already

enrolled slow and resource intensive process lessons learned:

data matching isn’t “magic” or totally clean “automatic” is relative human intervention is still important 18

Based on early conversations with CMS-- Sent families a letter in early December giving them the

option to “opt out” of having coverage added for child Out of 12,301 only 313 children opted out of coverage

Subsequently, a different interpretation by CMS legal staff of affirmative consent requirement in statute

Final negotiations for SPA approval— Creative (we think!) solution CMS agreed to allow us to enroll and send Medicaid card to

all identified children who did not opt out Child will not officially gain coverage until parent/guardian

“affirmatively consents” by using Medicaid card to access services

Citizenship will be verified through new CHIPRA authorized SSA Verification System

Procedures incorporate new CHIPRA policy which calls for coverage to begin pending citizenship verification

File match through TPL contractor after eligibility will identify any TPL

Plan is to move quickly to “joint SNAP/Medicaid application” by ELA Opportunity on their revised application to “opt

in” Newly enrolled SNAP children not already

enrolled in Medicaid will be enrolled in Medicaid nightly

Next Step: Using ELE for automatic re-enrollment

Even further reduction in administrative costs No longer a need for any caseworker action Reduces exposure to eligibility errors

True ELE cases excluded from Quality Control and PERM reviews

Simplifies eligibility—for us all children eligible for SNAP will be eligible for Medicaid With Medicaid stimulus, La has higher FMAP for

Medicaid than CHIP (through at least 12/31/10!) Performance bonuses based on Medicaid increase

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Players constantly change Families needing our help Stakeholders who interact with

those families Lack of focus leads to “drift” and

slippage Outreach Simplifications Eligibility Improvements

Still > 40,000 uninsured kids eligible but not yet enrolled in La

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Kyle C. ViatorDeputy Medicaid DirectorLa Department of Health & HospitalsP.O. Box.91278Baton Rouge, LA 70821Telephone: 225 342 6043Fax: 225 342 9508Blackberry: 225 274 6423E-Mail: kyle.viator@la.gov

www.lachip.org