Robin Callahan, Director of Member Policy & Program Development, Massachusetts Office of Medicaid presents Transforming Enrollment Systems: Massachusetts’ Experience presented for the Maximizing Enrollment National Briefing.

1. Commonwealth of
Massachusetts
Executive Office of Health and
Human Services
Transforming Enrollment
Systems: Massachusetts’
Experience
Maximizing Enrollment for Kids
National Briefing
December 10, 2010
Robin Callahan
Director of Member Policy & Program Development,
Massachusetts Office of Medicaid

2. Improving the Model: Massachusetts
Maximizing Enrollment for Kids
!! Background
•! Massachusetts 1115 Waiver and State Health Reform
•! Enrollment Model – Systems and Outreach
!! Massachusetts Experience with Maximizing Enrollment
for Kids
!! Massachusetts MaxEnroll Improvement Plan Projects
!! Next Steps: Affordable Care Act
!! Early Lessons Learned
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3. Massachusetts Section 1115 Waiver
Demonstration Project
!! Implemented in July 1997
!! Streamlined Medicaid eligibility
•! Eliminated face-to-face interviews, shortened Medicaid application,
eliminated asset test, eliminated spenddowns for most populations,
switched to gross income test
!! Expanded Medicaid eligibility for certain populations
•! Higher income children and families
•! Higher income disabled individuals
•! Unemployed adults
•! HIV positive adults
•! Creation of Insurance Partnership Program to provide premium subsidies
to qualified small employers and their low-income employees
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4. Mass. Health Reform: Chapter 58 of the Acts of
2006, An Act Providing Access to Affordable,
Quality, Accountable Health Care
!! Support and collaboration from legislature, consumer
advocates, state and federal officials, providers, health plans,
employers, employees, small business leaders, unions, and
the general public.
!! Shared Responsibility
•! Individual Mandate
•! Employer Contribution
•! Public Subsidies
!! Insurance Market Reform
•! Including merger of Non-Group and Small-Group Markets
!! Insurance Exchange
•! Connector Authority created to make policy decisions under Health Reform Law.
•! Connector Authority operates two programs: Commonwealth Care (subsidized
insurance for low-income workers and single adults) and Commonwealth Choice
(unsubsidized non-group and small-group insurance.)
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5. Background:
Massachusetts Enrollment System Model
!! One front door for subsidized health programs.
!! MassHealth provides the eligibility and enrollment
infrastructure for health programs.
!! Adding Commonwealth Care (exchange program for
low-income adults) to the MassHealth eligibility
system ensures maximum benefits for applicants
and notice of eligibility for all family members.
!! Commitment to ongoing engagement and education
of community partners who assist and enroll
members.
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6. What is the Virtual Gateway?
Public
Agency Worker
Service Providers
Health and Human Services
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7. Virtual Gateway Facts
Virtual Gateway Facts:
"!Eleven different programs can be applied for online. This
includes MassHealth and all health assistance programs as
well as SNAP, child care, WIC, elder services, etc.
"!Over 200,000 families and individuals in 2009 applied for
services through the Common Intake application. Those
who qualified were eligible for over one billion dollars worth of
benefits (includes services in addition to MassHealth and
Health Assistance).
"!Average percentage of electronic Virtual Gateway
applications reached a high of 60% in August ’10.
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8. Virtual Gateway and
MA21 Eligibility System
!! Internal MA21 eligibility system decision logic
determines eligibility for most comprehensive coverage.
!! Virtual Gateway and MA21 enabled the Commonwealth to
place all health programs on a single platform and single point
of entry.
!! Applicant doesn’t need to know in advance which program for
which they may be eligible.
!! Cascading eligibility design – we apply rules and system
makes choice of the most appropriate benefit level and FFP.
!! MA21 is a mainframe eligibility determination system built in
the mid 1990’s and may need to be retired.
!! If so, a similar eligibility logic design would be used to
accommodate federal health reform along with the greater
flexibility and functionality of newer technology.
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9. Massachusetts Health Care Training Forum
Program Goal: MTF communicates accurate, timely information about
operations and policies of Massachusetts State Health Care Programs
to community health and human service partners.
20 Meetings Annually in 5 locations
•! North
Total Attendance annually ~ 2,000 •! Central
(Tewksbury)
- Email Updates (Shrewsbury) •! Boston
- Website •! West
- Outreach (Formal and Informal) (Holyoke) •! Southeast
(Taunton)
•!Formal presentations about issues related to:
•! Eligibility/Enrollment/Retention
•! Case Management
•! Billing/Claims
•! Information directly enhances attendees’ ability to assist current and potentially
eligible individuals.
•!Roundtable sessions with state experts, trainers and advocates.
•!Network opportunity for state and community organizations to build collaborative
relationship. 9

10. EOHHS Enrollment, Outreach & Access to Care Grants
Grant Recipients
51 Community Based Organizations
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11. Massachusetts Uninsurance Rate for
Children
Massachusetts Uninsurance Rate for Children 2004-2010
3.5%
3.2%
3.0%
2.5% 2.5%
2.3%
2.0% 1.9%
1.5%
State Health Reform Began 1.2%
1.0%
0.5%
0.2%
0.0%
2004 2006 2007 2008 2009 2010
Source: Massachusetts Division of Health Care Finance and Policy Health Insurance Surveys 2004-2010
Note: Survey methodology changed in 2007.
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12. MassHealth Enrollment for Children
MassHealth Enrollment for Children 2005 - 2010
550,000
525,000
State Health Reform
521,319
Began
500,000
499,227
489,350
475,000
450,000 457,663
425,000 434,790
Awarded Maximizing
Enrollment for Kids Grant
421,743
400,000
375,000
350,000
June '05 June '06 June '07 June '08 June '09 June '10
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13. Improving the Model:
Maximizing Enrollment for Kids
Program
!! Received $1million grant in February 2009.
!! Objective of the grant is to improve enrollment policies,
systems and process to increase enrollment and
retention for children in Medicaid and CHIP.
!! Participation includes an in-depth diagnostic assessment
of enrollment systems, policies and process and a
development of a detailed improvement plan to address
problem areas.
!! The diagnostic assessment results and report were
accurate and well-received.
!! Improvement plan is aligned with MassHealth
Operations’ strategic initiatives.
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14. Massachusetts Improvement Plan:
Increase Retention
!! Both the MaxEnroll diagnostic assessment and our own
study on retention identified need to improve the loss of
eligibility due to paperwork issues.
!! Implemented a new annual renewal process for certain
members that dramatically decreases the chance of
loss of coverage for administrative reasons.
!! This new process currently impacts approx. 13,500
(48%) nursing facility residents and will potentially
include and additional 70,000 community long-term care
and disabled members.
!! We are also considering the use of third party data
sharing for eligibility and renewal purposes.
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15. Massachusetts Improvement Plan:
Improve Capacity and Use of Data
!! Used data analysis to determine the need to eliminate a
process that relied on the member to complete and
return a paper form to verify information received on a
data match from the Department of Revenue.
!! The data analysis identified that the need to return the
paper form caused unnecessary loss of coverage due to
an administrative reason.
!! A new paperless process is being developed to use the
match data to improve program integrity and ensure
members are enrolled in the most appropriate coverage.
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16. Massachusetts Improvement Plan:
Improve Customer Service/Enhance
Customer Interface
!! Implemented customer-facing My Account Page (MAP)
and Change Form to the Virtual Gateway in SFY10.
!! Customer-facing MAP and the Change Form provide
members with the ability to access and update
information without the need to call the customer service
line or send in paper to update their case record.
!! Members may view information about benefits as well as
the notices that have been sent.
!! The Change Form allows members to update, edit, or
delete the information such as address, telephone,
homeless indicator, pregnancy status, race and ethnicity.
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17. Massachusetts Improvement Plan:
Improve Customer Service/Enhance
Customer Interface (Continued)
!! Currently implementing an electronic document
management (EDM) initiative to digitize all paper
received as part of the application and renewal process.
!! EDM will improve workflow and standardize the business
process of the four regional MassHealth Enrollment
Centers, Central Processing and Central Filing Units.
!! Customer service will be significantly improved as staff
will have real time access to every document and a
statewide workforce will be utilized instead of having a
paper case record tied to a regional office.
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18. Next Steps: Affordable Care Act
!! Individual mandate sends the message that health
insurance is for everyone and lower income individuals
have access to government subsidized insurance.
!! Eligibility determination will no longer be about deciding
whether an individual can or cannot get coverage.
!! Eligibility determination will need to match individuals to
most appropriate coverage.
!! Policies, systems and process will need to:
•! Know the correct buckets to enroll individuals.
•! Adjust to an individual’s changing circumstances to prevent gaps in
coverage.
•! Use data matching in order to more quickly process enrollment
•! Not place unreasonable verification requirements on individuals and
enrollment staff.
•! Provide clear messages to enrollees.
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19. Early Lessons Learned
!! Data Matters. MaxEnroll diagnostic assessment and
improvement plan were useful in helping to pinpoint
areas on which the state could focus.
!! Strategies that improve retention also reduce paper
processing and alleviate pressure on the operational
work flow.
!! A culture of coverage is best advanced when:
•! Needless administrative activities are eliminated.
•! Necessary administrative activities are as simple as possible.
•! Communications are clear.
•! All stakeholders are heard and valued.
•! Participation has social and health rewards.
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20. Transforming Health Coverage Enrollment
Systems: Massachusetts’ Experience
!! Thank you.
!! For more information contact:
Robin Callahan
Director, Member Policy & Program Development,
Massachusetts Office of Medicaid
robin.callahan@state.ma.us
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