1. Paving a Health Coverage
Enrollment Superhighway:
Bridging the Gap to 2014
and Beyond in New York
NASHP
Briefing
February
3,
2011
Beth
Osthimer
Division
of
Coverage
and
Enrollment
Office
of
Health
Insurance
Programs

2. New York Health Coverage and
Enrollment: 2011
 Public
coverage-­‐
5
million
 Employer-­‐
based-­‐10.5
million
 Uninsured-­‐
2.7
million
2

3. New York Health Coverage and
Enrollment: 2014
 Increase
Medicaid
enrollment
by
about
25%
 Add
Exchange
coverage
for
over
one
million
more
New
Yorkers
(700,000
subsidized)
3

4. New York : Key Challenges
 30+
year
old,
mulUple
legacy
eligibility
and
enrollment
systems
encompassing
health
and
human
services
 Jointly
administered
by
state/
58
local
districts-­‐
variaUon,
costs
 Budget
constraints
4

5. New York : Key Challenges
 Technical
infrastructure
to
support
a
more
uniform,
automated,
consumer-­‐friendly
administraUon
of
health
coverage
programs
by
2013
 Align
and
integrate
public
and
Exchange/subsidized
opUons
 Building
the
plane
while
we
fly
5

6. New York : Strategies to Help
Bridge the Gap
 Leverage
Medicaid
Enterprise
assets,
federal
funding
for
technical
infrastructure
to
support
integrated
health
coverage
eligibility
and
enrollment
 90/10
match
-­‐
key

SoluUons
have
to
move
us
in
the
right
direcUon-­‐
2014
and
beyond
6

7. New York : Strategies to Help
Bridge the Gap
 Statewide
Call
Center
 Telephone
Renewal
supported
by
HEART
rules
engine
 State
Medicaid
AdministraUon
7

8. State Medicaid Administration:
Background
 June
2010-­‐
LegislaUon
required
Commissioner
of
Health
to
develop
plan
to
assume
Medicaid
administraUon
from
counUes
within
5
years.
 November
30
2010
Report-­‐
first
step,
strategic
direcUon,
recommendaUons,
many
more
discussions
with
stakeholders
before
final
comprehensive
plan.
8

9. State Medicaid Administration:
Recommendations
 Short
term
–
e.g.
consolidaUng
health
plan
contracts
for
Medicaid
and
FHPlus
(waiver)
 Longer
term-­‐
e.g.
centralizing
eligibility
determinaUons
as
move
forward
under
ACA
 Issues
for
discussion
include
transiUon
of
personnel,
local
presence
to
assist
consumers-­‐parUcularly
most
vulnerable,
personal
care
services,
long
term
care,
financing
related
to
administraUon,
etc.
9

10. State Medicaid Administration:
Going Forward
 Offers
opportunity
to
improve
efficiency,
uniformity
 Raised
frequently
during
stakeholder
engagement
process
of
Medicaid
Redesign
Team
(MRT).
 Reasonable
to
expect
that
implementaUon
of
many
of
the
recommendaUons
in
the
November
30
report
will
become
part
of
broader
Medicaid
Redesign
effort.
1
0

11. Elimination of Enrollment Barriers Helps
Pave the Way : Key Challenge is Eligibility
Systems
 Self
declaraUon
of
income/
residency
at
renewal
 12
month
conUnuous
enrollment
for
most
adults
Automated
Eligibility
 No
resource
test
for
most
Medicaid
beneficiaries
 No
finger
imaging
requirement
 No
face-­‐to-­‐face
interview
1
1

12. No High Volume , Consumer Oriented
Eligibility and Enrollment Experience
Under ACA Unless:
 Underlying
rules
are
simple
and
aligned
across
all
public/private
(subsidized)
opUons
 Have
resources
,technical
infrastructure
to
support
automated
processes
for
eligibility,
verificaUon
and
communicaUon/noUficaUons
1
2

13. Federal Actions Needed to
Help Bridge the Gap
 Key
rules
early
in
2011-­‐
e.g.
MAGI
 Same
rules
to
apply
across
Medicaid,
CHP
and
Exchange/
subsidies
 Finalize/fund
NPRM
for
new
eligibility
and
enrollment
systems
(90/10).
1
3

14. Federal Actions Needed to
Help Bridge the Gap
 Align
audit
requirements
(MEQC,
PERM)
with
ACA
rules
and
systems
 Establish
“federal
hub”
elements,
components,
processes
for
state
access
1
4