New approaches improve enrollment processes

Kindle Morell is the electronic marketing and multimedia manager for the Colorado Health Foundation.

Editor's note: Portions of this posting originally appeared in the National Academy of State Health Policy's State Refor(u)m discussion page.

States anticipate increased enrollment in health coverage programs along with the establishment of health insurance exchanges by 2014. To meet these growing demands, policymakers are trying to make state enrollment systems as streamlined as possible.

During the National Academy of State Health Policy's 24th Annual State Health Policy Conference held in October in Kansas City, state leaders shared best practices about enrollment processes and other topics related to the Affordable Care Act.

One way to create new efficiencies lies in creating state "data warehouses" to eliminate cumbersome (and often duplicative) paperwork. Using this strategy, states can simplify the process of getting eligible clients enrolled in the appropriate coverage system, while also saving money.

Another big challenge is figuring out how Medicaid, children's health plans and insurance exchanges will work together. Every state is different, but they all share the key need for collaboration among these programs.

Presenters at the NASHP conference consistently came back to the theme of bringing in multiple stakeholders (consumers, advocates, businesses, community partners and funders) early, building personal relationships and establishing regular communication. "It's the trust you build with your stakeholders that gets you through," said Robin Callahan, deputy Medicaid director for policy and programs for the Massachusetts Office of Medicaid.

Some states participating in the Robert Wood Johnson Foundation-supported Maximizing Enrollment initiative are already seeing successes from streamlining their systems:

• Utah has an online customer facing account management tool called MyCase, which allows Medicaid and CHIP enrollees to access all their information online, as well as complete updates and notice reviews. The state has used grants to update computers in community-based advocacy organizations and taps into assisters at those sites and at other state agencies to help walk clients through the process of enrollment. Utah is now receiving 90 percent of enrollment applications online — significantly decreasing workload.

• Virginia is using its grant to make a number of improvements to its enrollment system. These include streamlining the renewal process by sending out pre-populated forms with bar-codes that can be easily uploaded to an electronic case record and implementing an online renewal option as a part of their customer-friendly website. They've also implemented telephonic signatures allowing applicants to complete initial applications and renewals by telephone. These changes reduced paper applications and renewals by half in one year.

• Alabama is gearing up for an expected 500,000 more Medicaid eligible clients. In its work as a Maximizing Enrollment grantee, the state has implemented express-lane eligibility simplifying eligibility determinations for 190,000 people since October, 2009. Alabama also adopted 12-month continuous eligibility for children and uses administrative renewal to ease the documentation burden on families at renewal. Based on these successes, the state has received a $93 million CHIPRA performance bonus over the last two years.

One important element of enrollment systems is being designed for voluntary state adoption. Enroll UX 2014 is a public-private partnership project aimed at creating a streamlined online health insurance portal that can support all insurance affordability programs. Eleven states are participating in the project.

Improving enrollment and eligibility systems is a heavy lift for states but many are working towards a single streamlined application, a data-driven eligibility verification process and training assistants to help people through the enrollment process. By fostering agency and community collaboration and maximizing data matching, states can minimize the burden.