1 North Carolina Department of Health & Human Services 1 NC FAST and Work Support Strategies Operational Readiness Workshop July – August 2013

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North CarolinaDepartment ofHealth & Human Services

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NC FAST and Work Support Strategies

Operational Readiness Workshop

July – August 2013

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Time Agenda Topics Presenter

9:00-9:15 Welcome & Introductions Workshop Team

9:15-9:45 NC FAST Project Update Readiness Team

9:45-11:15 P7 Ecosystem & Division of Responsibilities

P7 Liaisons

11:15-12:00 DMA Update DMA

12:00-1:00 Lunch: Work Support Strategies Update

WSS Team

1:00-2:00 Managing Applications & Cases P7 Liaisons

2:00-3:30 Break-Out Discussion: Communications Strategy

All

3:30-4:00 Questions & Answers Workshop Team

Agenda

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NC FASTProject Update

July 2013

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Project Update

ePASS Document Management Deployment Update Help Desk Schedule Update Training Update County Security Configuration Project 7 Update Project 3 Update

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ePASS – Statewide Volumes

Transaction 2010 2011 2012 2013 – through July

FNS Screenings 40,687 72,323 68,946 34,372

FNS Potential Eligibility

28,212 51,545 49,433 25,391

FNS Applications 3,333 37,505 51,870 23,487

FNS Electronic Apps 0 0 0 10,689

MA Screenings 0 0 12,211 16,478

MA Applications 0 0 9,955 10,803

Quick Screens 28,071 56,999 57,468 29,846

EA Screenings 13,765 22,710 20,188 9,758

EA Potential Eligibility

3,835 5,438 4,488 2,087

The number of FNS Electronic Apps has gone up over 4,000 in a month

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Completed functional and detail design documents (integration with NC FAST) Completed County Guidelines document Completed development and testing (integration with NC FAST) FileNet production architecture is readied for configuration Deployed document management capability as part of Project 2&6 Pilot rollout Working on County Sync Guide Working on draft functional and detail design documents for county sync piece Preparing to initiate development of county sync capability

Document Management Update

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Document Management Update

Document management design document has been posted in FAST Help A webinar will be scheduled to discuss the design document A job aid has been posted providing guidance on what should be scanned

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Deployment Update

Upgraded NC FAST to P2&6 version of code; a significant upgrade to the base NC FAST system

Working through identified defects; continuing build activities and defect fix activities

Continue to identify and prioritize Cúram tickets Refining data conversion approach in preparation for Hard Launch Continue submitting test conditions, scripts, and test data sheets for

Business team review Respond to Business team comments and receive sign-off for test

conditions and scripts Continue to plan and execution of Cycle 3 – Day in the Life execution cycle

and Frequency 1,2,3,4,5 scripts Refining internal team communication protocol to streamline getting updates

to the counties

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Help Desk Update

Significant increase in call volumes last week Identified limitation with current phone system causing some calls to roll to

voice mail; new phone system on order If users call the Help Desk and are unable to speak to someone or cannot

leave a voicemail message, send your issue via email. Agents work to resolve tickets in the order in which they are received NC FAST Help Desk can be reached at [email protected] or 919-

855-3200, Option 3 Help Desk is available Monday – Thursday, 8:00 a.m. – 6:00 p.m. and

Friday, 8:00 a.m. – 10:00 a.m., 11:00 a.m. – 6:00 p.m. Please report only one incident/issue per email.

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Help Desk Metrics

Open Tickets (as of date) 7/22/2013 7/23/2013 7/24/2013 7/25/2013 7/26/2013

Tier 2 741 797 818 859 914

Tier 3/Config/User Setup 4 8 5 6 6

Tier 3 Dev/Other 249 265 276 293 293

Total Tier 2/3 994 1070 1099 1158 1213

Tickets Resolved (daily) 7/22/2013 7/23/2013 7/24/2013 7/25/2013 7/26/2013

Tier 2 93 91 92 79 76

Tier 3/Config/User Setup 2 4 3 1 3

Tier 3 Dev/Other 5 3 2 1 3

Total Tier 2/3 100 98 97 81 82

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P2&6 Schedule Update

Anson

Beaufort

Bertie

Brunswick

Carteret

Columbus

Craven

Duplin

Gaston

Gates

Greene

Halifax

Harnett

Hertford

Hoke

HydeJohnston

Jones

Lee

Lenoir

Lincoln

Martin

Moore

Nash

Northampton

Onslow

Pender

Pitt

Robeson

Sampson

Scotland

Tyrrell

Union

Wayne

Wilson

Ala

man

ce

Alleghany

Ashe

Caldwell

Caswell

Catawba

ChathamDavidson

Davie

ForsythFranklinGuilford

Iredell

Person

Randolph

RockinghamStokesSurry Warren

Watauga Wilkes

Yadkin

Wake

Avery

Cherokee

Clay

Graham

BuncombeMcDowell

Macon

Polk

RutherfordSwain

Madison

Stanly

Cabarrus

Rowan

Burke

Ora

nge

Bladen

Dare

P2&6 Soft Launch Key

PilotAugust 5

Phase 1August 12

Phase 2August 19

Phase 3September 9

Phase 4September 30

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P2&6 Training Update

Over 40 trainers have gone through Train-the-Trainer Launched the NC FAST Learning Gateway Posted web-based training (WBT) content into Learning Gateway Exposed Pilot counties to preliminary version of classroom training Delivered WBT and instructor-led content to Pilot counties and state office Initiated training of southeast counties Wrapping up development of final classroom training activities Feedback from Pilot and state office delivery has been quite positive Expectations:

Use of Captivate simulations Training scenarios Sandbox availability Availability of program subject matter experts

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County Security Configuration

County

Reception Unit

Reception Supervisor 1

Reception Worker 1

Reception Worker 2

Reception Worker 3

Eligibility Unit 1

Eligibility Supervisor 1

Eligibility Worker 1-1



Eligibility Unit 2

Eligibility Supervisor 2




User Role: Eligibility Worker

User Role: Inquiry Only

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Business team continues to work closely with DMA to: Finalize Project 7 requirements Complete documentation for State Plan Amendments (SPA), elected state

options, targeted enrollment strategies, and federal hub waiver Design team completed joint design sessions for functionality needed to be

ACA compliant; finalizing review and sign-off Intake and assessment for Medicaid/NCHC Integration with federal data hub for account transfers and verifications Eligibility determination/redetermination under MAGI and non-MAGI rules Coordination of appeals processing with FFM Implementation of federal and state mandated reports and notifications

Interfaces team began federal data services hub Wave 4 testing with CMS

Project 7 Update

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Team is composed of Services Business Lead Tracey Duncan, an NC FAST Business Analyst and 3 SMEs from DCDEE

Continue to reassess the business requirements Reassessment of the Child Care Subsidy business requirements should

be complete in August Requirements for Energy Assistance (CIP and LIEAP) will then be

addressed with a SME from Economic Services Fit gap analysis is planned to begin in August, with the goal of beginning

functional design in October Deployment is targeted for late 2014

Project 3 Update

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Project 7FFMI

P7 ‘Ecosystem’ & Division of Responsibilities

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FFM

DSS

FDSH

State Verification Systems

MA

Application

Electronic

In-person, by phone,

mail-in

PATHWAYS

Database Interface

The New P7 Ecosystem

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New Streamlined application for MA Additional questions required for an MA eligibility

determination under current rules and/or FNS Depending on programs for which the applicant is

eligible, benefits may begin at different times Additional electronic verifications from federal sources

may be used Ineligible applications will be transferred to the

FFM/Health Insurance Marketplace for potential Advanced Payment Tax Credit (APTC) or Cost-Sharing Reduction (CSR) eligibility

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What is New? What has changed?

• Potential for increase in applications with roll-out of ACA

• May need to refer customers to the FFM/Health Insurance Marketplace

• Caseworkers will ask new questions when customers are applying for MA

• Potential for new work queues for Streamlined applications submitted via ePASS

• MA applications completed on ePASS may now be submitted electronically

• A link will be added to ePASS to allow applicants to connect directly to the FFM/Health Insurance Marketplace

• Entirely new web-based access point for customers

• Potential for new work queues for Streamlined applications submitted via FFM

• Applications may be transferred from the FFM to NC FAST and vice versa

• ‘One-Stop shop’ now available for customers; whether looking for Medical Assistance or shopping for insurance plan


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Streamlined Application keyed by

caseworker

Traditional determination/

additional program requested?

Enroll in MAGI

program

Send application to

FFM

Answer additional questions for traditional MA

(and FNS, if requested)

Enroll in Traditional MA

and/or FNS

Benefits under MAGI programs will not begin until January 1, 2014.

If eligible for FNS but not for traditional MA, enroll in FNS and MAGI. Note: benefits will begin on different dates.

MAGI Notice Generated and Held

by NC FAST.

DSS

YES

Eligible

NO

Ineligible Eligible

MA Applications Completed via the DSS

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Streamlined Application keyed by applicant

Traditional determination/

additional program requested?

Enroll in MAGI

program

Send application to

FFM

Answer additional questions for traditional MA

(and FNS, if requested)

Enroll in Traditional MA

and/or FNS

Benefits under MAGI programs will not begin until January 1, 2014.

If eligible for FNS but not for traditional MA, enroll in FNS and MAGI. Note: benefits will begin on different dates.

MAGI Notice Generated and Held

by NC FAST.

YES

Eligible

NO

Ineligible Eligible

Applicant registers for

NCID

MA Applications Completed via ePASS

2222

Streamlined Application completed

through FFM

Seeking Financial

Assistance?

Potentially MA

eligible?

Enrolled in QHP of choice

Application transferred to

NC FAST

Calculate APTC/CSR

Full determination requested?

NO

NO

YES

YES

FFM

YES

MA Applications Completed via the FFM

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Beginning October 1, 2013 – the Streamlined Application will always be completed FIRST when applicant is seeking Medical Assistance.

To receive a determination based on ‘traditional’ rules (between 10/1/2013 and 12/31/2013) and/or to apply for FNS in addition to MA, additional questions will need to be answered.

Regardless of the entry point, the Medicaid/NCHC determination will ultimately be done in NC FAST.

Benefits under MAGI programs will not begin until January 1, 2014 As of January 1, 2014 – MAGI rules become the standard for most

Family & Children’s MA programs. Applicants who do not qualify for Medicaid/NCHC may still be

eligible for APTC/CSR (federal subsidies) to help pay for insurance and should utilize the FFM/Health Insurance Marketplace.

Key Points

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P7 Division of Responsibilities: DHHS/FFM/FFMI

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Health Insurance Marketplace

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Health Insurance Marketplace

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FFMDSS

If a customer requires assistance completing the streamlined application for Medicaid/NCHC while using ePASS, they are advised to call the DHHS Customer Service Center.

If a customer requires assistance completing the streamlined application for Medicaid/NCHC while at the local DSS, they are assisted by the caseworker.

If a customer requires assistance completing the streamlined application for Medicaid/CHIP while using the FFM, they are advised to call the Federal Call Center and/or Navigator.

Customer Assistance

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Provide customers with information that assists with the following:• submitting the eligibility application• clarifying distinctions in QHPs• making informed decisions during the health plan selection process

Can assist in all different types of marketplaces • State-based Marketplace • State Partnership Marketplace • Federally-facilitated Marketplace

Funded through State and Federal grants

NAVIGATORS

Customer Assistance

Must complete comprehensive training to become a navigator.

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Serve many of the same functions as Navigators including:• Providing education to customers• Assistance completing applications

Organizations can apply online to be designated by the Marketplace to certify application counselors. Some examples of organizations include:• Social service agencies• Hospitals• Community health centers

No funding mechanism available for this program

Certified Application Counselors

Customer Assistance

Must complete comprehensive training to be a Certified Application Counselor.

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Customer Assistance

Navigators Non-Navigator assistance personnel

Certified application counselors

Agents and Brokers

State-based Marketplace

Yes Optional for states

Yes Optional for states

State Partnership Marketplace

Yes Yes Yes Yes, if state permits it

Federally-facilitated Marketplace

Yes Not applicable; Navigators provide this assistance

Yes Yes, if state permits it

*Source: cms.gov

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Role: To assist the customer in applying for an insurance affordability program

Can be a person or organization May assist with Streamlined application completion, or complete

on behalf of the applicant Explaining APTC/CSRs or insurance options to customers

Navigators are not responsible for: Assisting customers with ‘Traditional’ MA applications Explaining North Carolina DMA policy Contacting the DSS

It has not been determined if Navigator’s will be assisting customers with ePASS (Streamlined) applications

Navigators

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Role: Take applications for Medical Assistance (and FNS/SNAP, if applicable)

Will manage integrated cases in NC FAST (Income Support and/or Insurance Affordability)

May refer ineligible applicants to the Health Insurance Marketplace as an alternative to Medicaid/NCHC

Caseworkers are not responsible for: Helping customers navigate the FFM/Health Insurance

Marketplace Helping customers complete the application on the FFM/Health

Insurance Marketplace Explaining specific details regarding APTC/CSRs or insurance

options to customers

Consider having the website and/or phone number for the Health Insurance Marketplace to give customers a place to start.

DSS Caseworkers

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Role: Provide an eligibility determination for MAGI and non-MAGI programs and issue benefits when applicable

Will notify case worker via a task in a designated work queue when an application is received from ePASS or the FFM

Will notify applicant of eligibility result and/or when their application is transferred to the FFM

NC FAST is not responsible for: Providing an eligibility determination for APTC/CSR Notifying customers of insurance plan options Enrolling customers in QHP

NC FAST

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DMA Update

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Lunch and Work Support Strategies Update

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P7: Managing Applications & Cases

Streamlined App / Multiple Dispositions & Integrated Cases / The Evidence Broker / Impacts to the Universal

Worker

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Streamlined Application Demonstration

Note: The following includes preliminary screen shots which are

subject to change.

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What is the Streamlined Application? A simplified application used to apply for all Insurance

Affordability programs Used whether applying via the FFM, ePASS, or the DSS Will be the first application used when the customer is seeking

Medical Assistance

Streamlining the Process

Getting Started with the application.

Customer must agree to privacy statement before continuing.

The first page of the streamlined application gathers details about the primary applicant.

The second page gathers additional details about the primary applicant.

Are there any other people in the household?

Enter details about the additional household member.

Enter additional details about the household member.

Review the household member summary. Are there more people to add?

How are the household members related?

Identify the tax filers in the household.

Identify the tax dependents in the household.

Review the Household Summary. Make changes if necessary before continuing.

Indicate household members who earn income.

Enter income details.

Are there any income deductions that can be deducted on an income tax return.

Review expected annual income.

Similar income information is collected for additional household members (if applicable).

Additional household information is collected, beginning with details on medical bills.

Indicate household members who are tobacco users or are incarcerated.

Additional questions are asked to determine if household members qualify under MAGI.

Review the summary screen and make necessary changes before continuing to next screen.

Documentation needed from the customer displays before the application is submitted.

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Streamlined Application Demonstration Q&A

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MAGI Non-MAGI

Streamlined application Non-MAGI Medical Assistance application

Eligibility determination and enrollment can begin as early as October 1, 2013

Eligibility determination and enrollment are on-going currently

Coverage begins as early as January 1, 2014

Coverage begins on the day indicated by policy

MAGI becomes the new standard for most Family and Children’s Medicaid programs after January 1, 2014

Non-MAGI-based programs continue to use Non-MAGI Medical Assistance application

MAGI vs. Non-MAGI

6363

The application process for all MA programs will start with the streamlined application after October 1, 2013.

Coverage for the MAGI based determinations does not begin until January 1, 2014 Customers should be given the opportunity to see if they currently qualify for a MA program

under the traditional (non-MAGI based) rules

Result: During the single application process, an Authorization/Disposition will need to be completed for the Streamlined and ‘traditional’ MA and/or FNS application(s).

MAGI

Streamlined Application

MA and/or FNS Application

Identical information prepopulates on the

Non-MAGI application

Potential for Multiple Dispositions

Non-MAGI

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‘Streamlined’ Medical Assistance

Application

Insurance Affordability (Integrated Case)

Product Delivery

Case

EvidenceSubmit

Income Support Application

(P26 Interview Questions)

Income Support

(Integrated Case)

Product Delivery

Case

EvidenceSubmit

EvidenceBroker

Identical information populated from

MAGI application

Potential for Multiple Integrated Cases

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The Evidence Broker is the functionality within NC FAST that allows evidence to be transferred from one integrated case to another

With multiple integrated cases there will be two types of evidence, identical and non-identical

Identical evidence is evidence that is used in the same way and is the same evidence type in both integrated cases

Non-identical evidence is evidence that is not used in the same way in both integrated cases

Once enabled, the Evidence Broker will broadcast the identical information so that it can be then used on the other “target” integrated case

Caseworkers will be able to accept or reject the evidence in the target case either manually piece by piece or in bulk at once

When evidence is entered in one case that could be broadcast to the other integrated case, the caseworker will receive a task informing them that they have evidence to accept or reject

The Evidence Broker

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Note: These screens are subject to change

Incoming Evidence: Identical

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Note: These screens are subject to change

Incoming Evidence: Non-Identical

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One Case Worker Customers will still have the ability to apply for multiple programs at the same time with one

caseworker, whether there is a MAGI-based program involved or not.

Reception, Tasks, Work Queues Other universal worker functionality associated with P2&6 such as work queues, reception,

and tasks will remain essential to the NC FAST process.

Potential Multiple Dispositions After completing the MAGI application, the customer may continue on to the Non-MAGI

(and/or FNS) questions to see if he or she is eligible for Medical Assistance (or FNS) prior to 1/1/14. Therefore, a caseworker may have two dispositions to complete.

Potential Multiple Integrated Cases One caseworker will be able to manage both integrated cases through the use of the

evidence broker, which will allow identical information to be shared amongst these cases.

Impacts to the Universal Worker

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Breakout Discussion:Communication

Strategies

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Increased awareness of the Affordable Care Act is expected to bring potential customers out of the woodwork.

Those who are currently eligible but not enrolled: DMA research suggests that 69,683 individuals will gain coverage in 2014.

Those who would potentially be eligible under a Medicaid expansion: Approximately ½ million additional applicants who will not be eligible may still want to apply.

Expect an impact, not only to numbers of Medicaid applicants, but to other programs as well.

The “Woodwork” Group

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Estimated Medicaid Expansion Population in 2014

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Breakout Session Report Out:

Communication Strategies Highlights

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Questions and Answers

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Thank You for participating today!

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Documents

1 North Carolina Department of Health & Human Services 1 NC FAST and Work Support Strategies Operational Readiness Workshop July – August 2013