Enrollment, Marketing & Outreach for Coverage

Expansions

The Louisiana Experience

State Coverage InitiativesNational Workshop

New Orleans, LAJanuary 25, 2007

J. Ruth KennedyLa. Dept of Health & Hospitals

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Overview of Louisiana Strategies

Engaging eligibility employees in outreach, marketing, & enrollment

Successfully reducing procedural closures as renewal

Major organizational change in our eligibility operations

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The Importance of Informing Families

Children will not be helped if we don’t intervene. Parents are either unconcerned or unaware. --LA Congressman Rodney Alexander

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Louisiana Eligibility Administrative Overview Eligibility is determined by state Medicaid

agency employees Medicaid Analysts process only Medicaid

and SCHIP cases Approximately 50 local eligibility offices Medicaid Program has direct line authority

over 844 eligibility employees

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Medicaid Eligibility Staff are Major Players in Outreach

843+ local Medicaid managers, supervisors, eligibility caseworkers, and clerical staff

Brainstorming and implementing Regional Outreach Plans

Organizing and conducting launch meetings Telling friends, family, neighbors, and

acquaintances about LaCHIP Distribution of application form and holders in

their communities

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Connecting the Dots . . . Why Health Coverage Matters

Health CareAccess

EducationalOutcomes

Poverty Rate in

Louisiana

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HCFA’s 2000 Summation of LaCHIP Outreach Efforts

. . .the State has been both aggressive and innovative inmarketing the program and enrolling eligible children. Thestate has worked arduously in establishing an effectivegrassroots eligibility outreach network and has taken fulladvantage of vital partnership opportunities, such as withthe Robert Wood Johnson grantee. As a result the State enrolled a significant number of previously uninsured children and exceeded its established enrollment goals. The State has also substantially reduced the number of uninsured children by identifying and enrolling eligible Medicaid children. --Draft Review of Louisiana’s LaCHIP Program Dated 8/16/00

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Net Change in Monthly Enrollment of Children--Medicaid and SCHIP

“Houston, we’ve got a problem” -6000

-4000

-2000

0

2000

4000

6000

8000

10000

12000

14000

D-98

M-99

J-99

S-99

Dec-99

Mar-00

Jun-00

Sep-00

Dec-00

1-Mar

1-Jun

1-Sep

1-Dec

2-Mar

2-Jun

2-Sep

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A “Hole in the Bucket” or Renewal Woes

New enrollees can be exceeded by closures at renewalMany closures for “procedural” reasons

Failure to return renewal formFailure to submit essential verificationUnable to locate

Problem more pronounced for “traditional” Medicaid children

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“Closing the Door” on Procedural Closures at Renewal Matters

Essential to “maintain the gains”

More costly to process applications than renewals

Protects investment in outreach & marketing

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Our Recipe for “Closing the Door” on Procedural Closures Simplify the renewal process

Renewal form Verification requirements

Ex Parte renewals when possible Aggressive follow-up when renewal form

is not received Telephone renewals Automated Voice Response renewals Web based renewals [Coming Soon!]

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Spotlight on Retention Began in 2001

A “new name”—name for process formerly known as “redetermination” changed to “renewal”

New simplified Renewal Form Ex parte renewals mandated for

children with active Food Stamp cases

Involved local offices in identifying solutions

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Ex Parte Renewal Defined “Action by one party

without the involvement of the other”

Described in 4/7/00 State Medicaid Director’s Letter

Heavy reliance on other computer systems for verification Food Stamps TANF Child Support More than 60% of Title 19 Medicaid

children are extended 12 months using exparte renewal

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“Ex Parte” --New Eligibility Vocabulary Word

It’s an adjective! CMS advised that we should do ex parte

renewals. It’s a verb!

Is there any way you can possibly ex parte it?

It’s a noun! I did 8 ex partes yesterday.

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Aggressive Follow-up When Renewal Form in Not Received Incorporated into policy and procedures

since July 2001 Phone calls must be attempted and

documented Efforts to find new address and locate

family Other computer systems Internet Schools, medical providers

Major losses when temporarily discontinued from 7/06 to 11/06

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Telephone Renewals Benefit Families and the Agency

Federal regulations require annual review—not signed form

Implemented 11/03 as option when ex parte can’t be done

Two types of telephone renewals In lieu of mailing a Renewal Form At follow-up when Renewal Form is

not returned Key to our getting procedural

closures below 5% Reduces administrative cost—

postage, paper, staff time

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Automated Voice Response (AVR) Renewals

Families can renew anytime—off-cycle or “rolling” renewals encouraged

Option available when calling the LaCHIP toll-free hotline

“To renew by phone now, Press 3” Data retrieved daily & electronically

routed to local eligibility offices Reminder flyers advise of this 24/7

renewal option

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Local Office Involvement in Developing Retention Plans

Participating in workgroup resulted in greater awareness of the problem (education/training)

Front-line staff have unique insights and proposed excellent strategies

Ownership and buy-in was achieved“I think one of the highlights staff enjoyed was being able to come up with a renewal plan, and then watch their ideas at work”

-- Debbie Falgout, Medicaid Analyst SupervisorThibodaux, Louisiana

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Examples of Local Initiatives to Improve Retention Supervisory review of all procedural closures at

renewal Not requesting ANY verifications at renewal Adding a “drop box” outside the building for

after hours convenience to return renewal forms, verifications

Additional “reminders” e.g. fluorescent pink reminder flyer prior to advance notice of closure

Enclosing another renewal form/SASE with advance notice of closure

Using US Postal Return Service Telephone surveys of families who failed to

return the renewal form

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Ongoing Evaluation of Policies, Procedures and Practices Some policies and procedures have

unintended consequences, or in retrospect prove to be unnecessary; Example: policy to hold renewals and not

close them for procedural reasons until deadline day for closures

“Best practices” need to be identified, documented and shared with other offices

Good renewal outcomes by regions and offices deserve acknowledgement and recognition

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“Organizational Change” Can Be Achieved in Eligibility A key prerequisite to success

of other marketing and outreach efforts

Caseworkers “open” and “close” the door

Major changes in expectations of caseworkers Passive Pro-active

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Training for Managers Regarding Change in Focus

From strong emphasis on quality control, error reduction, thorough case documentation . . .

. . . To removing barriers, making enrollment process “user friendly”, enrolling eligible children and families, assuring loss of cash does not translate to loss of Medicaid as well.

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How Much is Too Much?

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“New Thinking” in Local Offices “What is making a difference is staff has

changed their way of thinking and they do bend over backwards to help the recipient. The mindset is that the applicant or recipient is our number one priority. . . .the Analyst continues to extend time when the recipient states he or she needs more time to get the information in. The Analyst will help the recipient to gather information or documentation whenever possible.”

--Margo Joseph, Medicaid Area ManagerLaPlace, Louisiana

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Organizational Change“A Long Hard Row to Hoe”

“The “old” way of thinking was that if “they” wanted the services “they” should be expected to do the legwork. Now [caseworkers] get forms completed and information verified [themselves], which, in the long run, actually saves time. But changing old habits has been a long, hard row to hoe.”

“The “old” way of thinking was that if “they” wanted the services “they” should be expected to do the legwork. Now [caseworkers] get forms completed and information verified [themselves], which, in the long run, actually saves time. But changing old habits has been a long, hard row to hoe.”

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Our “Who Moved the Cheese?” Training Remain Relevant They have moved

the cheese The quicker you let

go of old cheese, the sooner you can enjoy new cheese

They keep moving the cheese so be ready to change quickly!

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Lessons Learned from our Eligibility Transformation

Incremental changes rather than “big bang” approach”

Dual focus—administrative as well as health & social

Attention to messaging; internal as well as external marketing

Establish high expectations for staff Empowerment of state government

employees Expect initial pushback

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Low Income Uninsured Children in Selected States* 2004-2005

United States 19.3% Louisiana 12.5%!!! Mississippi 18.1% Georgia 18.5% California 21.6% Arizona 24.0% Texas 29.9%

•Based on 2006 CPS data (most current information available) and taken from Kaiser

• Health Insurance Coverage in America—2005 Update

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Louisiana Medicaid & SCHIP Enrollment < Age 19

600000

610000

620000

630000

640000

650000

660000

670000

680000

690000

Before Katrina 8/05

Now1/07

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“Success isn’t Permanent”Challenge of Sustaining Improvements

Reversals being driven at the federal level— DRA citizenship & identify documentation requirements

Vigilant monitoring of enrollment data Dramatic & rapid reduction in children

enrolled since July 2006 Ongoing process improvement and

adjustments are critically important Renewal and retention must continue to be a

major focus

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Ruth KennedyLaCHIP Director & Medicaid Deputy DirectorLouisiana Department of Health & HospitalsP.O. Box 91030 Baton Rouge, LA 70821-9030Telephone: 225 342 3032Fax: 225 342 9508E-Mail: rkennedy @ dhh.la.gov www.lachip.org

Never doubt that a small group of thoughtful, caring people can change the world Indeed, it is the only thing that ever has !— Dr. Margaret Mead