RE-ENGINEERING THE ENROLLMENT PATHWAY FOR NEW YORK STATE PUBLIC HEALTH PROGRAMS

United Hospital Fund Roundtable

Patricia Boozang, MPH Kinda Serafi, JD Elisabeth Benjamin, JD, MSPH

October 14, 2009

Project Overview2

Policy Issue/Imperative Streamlining initiatives provide new options for

application and enrollment Challenges remain in current application and enrollment

process Goal: Re-evaluate and re-engineer

application to improve consumer access to coverage through every available doorway:

LDSS Facilitated enrollment Consumer mail-in application (with elimination of F2F) Enrollment center (future)

Project Overview3

Project Funders United Hospital Fund, New York Community Trust

Project Partners CDF-NY, CSS, PHP Coalition

Project Components Phase 1

Identify barriers and challenges in current enrollment process

Provide initial recommendations to SDOH for April 2010 application

Phase 2 Develop and field test model application and

consumer tools Provide final recommendations to SDOH for

consumer-friendly, re-engineered enrollment pathway

Phase 1: Project Activities4

Facilitated Enroller Feedback Sessions Legal and Regulatory Analysis Feedback and Work Sessions with New

York State Department of Health Recommendations for April 1, 2010 ANY

Revision Consumer Application Pilot

Facilitated Enroller Sessions5

Asking the on-the-ground experts about the pitfalls of the current Access NY application

4 roundtables with facilitated enrollers: 2 health plan sessions 2 CBO sessions Participation of over 50 upstate and NYC FEs

Yielded valuable insights driving partner recommendations: High level – Citizenship, application format Nitty-gritty – Email address, legal name,

language

“Additional Application Forms”

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Investigating the lore of “other forms” The facts behind the lore:

58 forms identified One-third “county specific” versions of

the same form 34 “unique” forms 25 collect information already in Access

NY 18 reflect more stringent eligibility

requirements of counties 7 reflect information not needed for

eligibility

“Additional Application Forms”

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Partner Recommendations: Eliminate Incorporate Standardize

Consumer Pilot Project

FEs conducted consumer pilot to assess barriers to navigating current application independently. Process

Consumer completes application and submits documents FE and consumer complete survey together to

discuss application FE correctly completes application and completes survey

Participants 143 consumer surveys submitted by health plans and CBOs NYC, Long Island, Binghamton, Rochester, Albany, Syracuse

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Ease of Completing Application 62% (89) reported they were able to

complete application on their own. Just 1 application was successfully completed

38% (54) reported they were not able to complete the application alone

Over one-half indicated confusing language or format

One-third pointed to unclear or inadequate instructions

84% (118) reported it took them less than an hour to complete

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Initial Key Findings

Section K: Health Plan Selection 28% of consumers found Hard/Very Hard 41% of applications needed this section corrected

• Did not understand what “health plan” meant • Did not know how to choose a plan

Section E: Household Income 25% of consumers found Hard/Very Hard 50% of applications needed this section corrected

• Unsure what and whose income to include• Unclear how to calculate income

Section C: Health Insurance 20% of consumers found Hard/Very Hard 41% of applications needed this section corrected

• Skipped this section altogether• Didn’t understand term “policy holder” and CIN #

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Immigrants

Recommendations: Change “Citizenship” title to “Citizenship/Immigration” Eliminate A/B/C categories, gather documents instead Clarify that pregnant women & children are eligible,

regardless of status

Justification: Clarifies eligibility & documentation requirements

Resolution: New title “Citizenship/Immigration Status” Clarify immigrant women/children’s eligibility Clarify documents needed, eliminate categories

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Veterans

Recommendation: Eliminate veteran’s question as redundant

Justification: Household Income section lists veteran’s benefits Health Insurance section could add veteran’s benefits

Resolution: LDSSs maintain referrals to VA are made pursuant to

this question Advocates would like to continue to discuss this issue

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Maintenance of Income

Recommendation: Use 70% standard, not 50% standard

Justification: Statewide: median rental burden is 57% for low-

income renters. 28 out of 52 counties have median gross rental

income over 50% (82% in Putnam and Nassau) Provided sample low-income person budget

Resolution: SDOH adopted 60% standard & continue to discuss

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Maximize Efficient Collection of Individual Information

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Next Steps15

Consumer Pilot recommendations “Additional Application Forms” work Phase 2 Activities

Identify Best Practice from Other States Interview Key Stakeholders Develop Model Application and Field Test with

Consumers Develop Consumer Tools Final Recommendations for a Consumer

Friendly, Re-Engineered Enrollment Process

Questions16

Project Partner Contact InformationElisabeth Benjamin – ebenjamin@cssny.orgPatricia Boozang – pboozang@manatt.com

Kinda Serafi – kserafi@cdfny.org