Eligibility... To Touch or Not to Touch?

Transcription

1 1 Eligibility... To Touch or Not to Touch? A Tale of Innovation to Comply With Conflicting Regulations Florida s Timesaving Innovation Process (TIP) Montana s Service First

2 2 State of Florida Program Overview Florida 22nd in geographic area 4th in population (19M) 23.5% population growth rate

3 3 No-Touch in Florida When Florida implemented its Medicaid Eligibility System project (December 2013), No Touch was introduced for Family-Related Medicaid. Some Family-Related Medicaid cases were automatically processed through No Touch to authorization without worker intervention, and other cases required a worker to review them. Operational Impact No-touch automated work flow enabled Florida to not only achieve compliance with federally mandated Affordable Care Act requirements, but also helped process an increase in application volume with reduced processing times. An additional 830,000 applications were received from the Marketplace and CHIP agency, allowing 181,000 additional Medicaid customers to be served. Increased workload was mitigated by automating worker actions. No touch processing redirected approximately $2.2 million annually. Average processing time for Medicaid dropped from 19.5 days to 14.5 days. Backlog was reduced enabling workforce redeployment to improve customer service.

4 Florida s Timesaving Innovation Process (TIP) 4 TIP was implemented (April 2015) to allow more applications to auto-populate in the eligibility system, thereby reducing manual data entries even further. TIP replaced No Touch for the Family-Related Medicaid automatic processing. TIP began auto-populating applications for Food and Temporary Cash Assistance, and SSI-Related Medicaid, as well as adding the features below: Automated Driver Flow - Using information entered by the customer on the Web application, the system autopopulates mandatory fields and verifications. Workers complete the process and dispose of the case. Standardization of System Defaults - After the automated process populates from the customer application, the system generates defaults for missing information into the applicable fields. New Driver Added - When initiated, the new driver (ASVR) takes the worker through all of the pending and mandatory screens that have not been completed to that point. New Family-Related Medicaid Verification Code - In cases involving Family-Related Medicaid, when the customer s income is verified through the Hub or State wage information, a new code auto-populates the verification field.

5 5 TIP Data and Statistics Summary Since the implementation of TIP in April 2015, Florida has received a total of 6,814,059* web applications. TIP was able to automatically start and complete the full application entry for 2,356,918 which represents 34.60% of all applications with an average of 155,953 per month. TIP was able to not just complete the application entry driver but also to complete the case and authorize benefits without the need of human intervention for 638,696 cases, with an average of 42,364 per month. On average, an eligibility worker processes and authorizes a total of 639 applications per month. TIP authorizes the equivalent work of 66 eligibility workers per month. TIP successfully completes the client registration process for 54% of all registrations every month, versus 46% completion by human workers. While No-Touch allowed reducing the processing time for Medicaid from 19.5 to 14.5 days, with the introduction of TIP the processing time dropped even more to 6 days. * Note: Stats as of July 31 st, 2016

6 Florida's Low-Touch 6 The Timesaving Innovation Process (TIP) uses information entered by the customer in Florida's Web application to auto-populate mandatory fields and verifications. Family-Related Medicaid is the only program eligible to be automatically authorized by TIP. Food and temporary cash assistance and SSI Medicaid continue to require worker authorization. The Low-Touch automated process populates as much as possible from the Web application. If the customer does not submit information, or if additional verifications are required, the system generates defaults into the applicable fields. Some examples of the defaults are: TIP generates a? when information or verification is required. The worker must complete the process by reviewing the information and performing any final verifications or data entry not completed by TIP. TIP auto-populates $1 in instances where the customer did not report an amount. The entire screen must then be reviewed and updated. For Medicaid, TIP defaults the Living Arrangement Date to the date of application. The worker must update the date for any retroactive coverage request.

7 Florida's Application Flow 7

8 8 State of Montana Program Overview Montana 4 th in geographic area 44 th in population (1M) 48 th in pop density

9 9 State of Montana Program Overview Montana DPPHS is a combined public health and social services agency. Spans Medicaid, Eligibility, Mental Health, Disability, Seniors, Child Welfare, Child Support Enforcement, and Public Health activities. Enrollment stats: Medicaid 200,000 people SNAP 115,000 people TANF 3,700 people CHIMES is the integrated eligibility system for SNAP, TANF, & Medicaid. Est 2009 with Medicaid migration Nov 2012 added SNAP/TANF and enterprise systems components (ESB, CCI, etc ) ACA, Business process, and Medicaid Expansion changes.

10 10 State of Montana Service First Why Service First? Maintain a main street presence in most Montana communities and necessity to share work across offices with consistent service delivery Increased caseload pressures no additional staff resources What is it? Service First is Montana s implementation of task based processing and business process reengineering. Goal is to enable prompt, accurate, respectful services. Commitment to Prompt, Accurate and Respectful services! Efficient and consistent work processes and handling of cases/tasks Using technology to support clients during their time of need, the way they choose- online, over the phone, mail or in person Using technology to support staff with improved automation, modern technology and providing transparent data analytics for managing work

11 11 State of Montana Application flow Electronic verifications Business rules Not eligible for MAGI, potentially non-magi eligible High touch - assess disability, collect/verify resources, determine level of care needed Customer applies online for only multiple assistance programs Evaluate real-time eligibility for Health Coverage Eligible for MAGI Medicaid/CHIP with partial verifications Low touch - enroll and pursue post-enrollment verification Eligible for MAGI Medicaid/CHIP No touch enroll! ID Proofing Screen for expedited benefits (SNAP) and route to application inbox High touch conduct interview (phone, in-person, etc.) and verify household information

12 12 Post Session Housekeeping RATE this session in the conference app To download the conference app search for APHSA Events VISIT the vendors in the Exhibit Hall during Breakfast and the Networking Breaks to learn more about the solutions presented throughout the day. DONATE to Childhelp the ISM Technology for a Cause campaign to raise $10,000 to help stop child abuse in Arizona and across the country.

13 13 THANKS FOR COMING See you again soon