Paving a Health Coverage Enrollment Superhighway: Bridging State Gaps Between 2014 and Today

Alice M. Weiss, JD Co-Director, Maximizing Enrollment

Program Director, NASHP February 3, 2011

Overview

  ACA’s Vision: An Enrollment Superhighway

  State Gaps and Challenges in Streamlining Enrollment

  Bridging State Gaps to 2014

  Conclusion

2

ACA’s Vision: An Enrollment Superhighway

3

ACA’s Enrollment Vision Transformation from:

 Welfare-Era  Burdensome  Disconnected  Complex  Paperwork-intensive

…To:

  Modern   Easy to Use   Seamless   Interconnected   Simple   Technology-Enabled

4

Gaps and Challenges for States

5

Gaps and Challenges for States: Consumer Experience

 Welfare Era Approach Despite De-linking

 Customer Service Demands

 Assistance/Human Touch

 Accessibility Needs – Language, Disability, Literacy

 Different ACA Enrollment Rules Based on Medicaid-eligibility and Immigration Status

 Risk of Coverage Gaps

6

Gaps and Challenges for States: Consumer Experience

Source: Congressional Budget Office.  “Recent Trends in the Variability of Individual Earnings and Household Income.”  June 2008.  http://www.cbo.gov/ftpdocs/95xx/doc9507/Frontmatter.1.2.shtml.

7

Gaps and Challenges for States: Eligibility and Enrollment Policy

  Streamlined Enrollment Policies  New Coverage Paradigm

 Major Eligibility Expansions  Different Eligibility Rules for Medicaid vs. Exchanges

  Separate Rules for MAGI/Non-MAGI Populations  Need to Track Newly Eligibles for Increased FMAP   State/Federal Eligibility Policies Conflict with ACA Intent

8

Photo courtesy of Southern Institute on Children and Families

Gaps and Challenges for States: Technology and Infrastructure

 Limited Online/Phone Enrollment  Existing Eligibility Systems Often:

 Outdated  Disconnected   Shared

  Redundant

 Technology Literacy Challenges  Procurement, Legislative Oversight  Speedy Implementation Timeframes  Financing

9

Gaps and Challenges for States: Governance and Administration

 Political Leadership

 Siloed Agency Work

 Culture Change Imperative

 Role of Local Agencies

 Horizontal Integration of Human Service Programs

10

Bridging the Gap

Helping States Reach 2014

11

Bridging the Gap: Consumer Experience

 Adopt Technologies to Support Consumer Connections

 Enable Consumer Assistance and Engagement

 Facilitate Coverage Transitions

 Ensure Accessibility for Diverse Populations

12

Bridging the Gap: Eligibility and Enrollment Policy

 Simplify Processes and Policies

 Minimize Data Collection; Increase Data-Sharing

 Review and Address Policy Conflicts

 Support Agency/Caseworker Culture Change

13

Bridging the Gap: Technology and Infrastructure

 Pursue New System Upgrades Through Federal Guidance

 Evaluate Technology Needs and Available Resources

 Pursue Economies of Scale

14

Bridging the Gap: Governance and Administration

 Identify State Priority Opportunities in Reform

 Invest in Multi-Agency Collaboration

 Develop Inventory of Local Functions to Inform Discussion of Future Local Roles

 Choose Degree of Integration Between Health and Human Service Programs

15

Conclusion

States at Crossroads:   Major challenges, changes

needed

  Opportunities for transformative change

  State investment, leadership, planning critical

  Federal support and oversight also essential

  “Superhighway” within reach

16