Enrollment, Marketing

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Enrollment, Marketing Outreach for Coverage
Expansions

• The Louisiana Experience
• State Coverage Initiatives
• National Workshop
• New Orleans, LA
• January 25, 2007
• J. Ruth Kennedy
• La. 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 dont
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
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HCFAs 2000 Summation of LaCHIP Outreach Efforts
. . .the State has been both aggressive and
innovative in marketing the program and enrolling
eligible children. The state has worked arduously
in establishing an effective grassroots
eligibility outreach network and has taken
full advantage of vital partnership
opportunities, such as with the 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
Louisianas LaCHIP Program Dated 8/16/00
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Net Change in Monthly Enrollment of
Children--Medicaid and SCHIP
14000
12000
10000
8000
6000
4000
2000
0
-2000
-4000
Houston, weve got a problem
-6000
J-99
D-98
S-99
M-99
1-Mar
1-Jun
1-Dec
2-Mar
2-Jun
1-Sep
2-Sep
Dec-99
Mar-00
Jun-00
Dec-00
Sep-00
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A Hole in the Bucket or Renewal Woes

• New enrollees can be exceeded by closures at
  renewal
• Many closures for procedural reasons
• Failure to return renewal form
• Failure to submit essential verification
• Unable 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 namename 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 Directors
  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

• Its an adjective!
• CMS advised that we should do ex parte renewals.
• Its a verb!
• Is there any way you can possibly ex parte it?
• Its 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 reviewnot
  signed form
• Implemented 11/03 as option when ex parte cant
  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 costpostage, paper, staff
  time

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Automated Voice Response (AVR) Renewals

• Families can renew anytimeoff-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 Supervisor
• Thibodaux, 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 Manager
• LaPlace, Louisiana

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Organizational ChangeA 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 focusadministrative 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 America2005 Update

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Louisiana Medicaid SCHIP Enrollment lt Age 19
Before Katrina 8/05
Now 1/07
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Success isnt PermanentChallenge 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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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
Ruth Kennedy LaCHIP Director Medicaid Deputy
Director Louisiana Department of Health
Hospitals P.O. Box 91030 Baton Rouge, LA
70821-9030 Telephone [phone] Fax 225 342
9508 E-Mail rkennedy _at_ dhh.la.gov
www.lachip.org