Reach Out And Keep Reach Out And Keep SomeoneSomeone

The California ExperienceThe California Experience

Reach Out And Keep Someone The California Experience

Janette LopezDeputy Director

Eligibility, Enrollment & Marketing

CA Managed Risk Medical Insurance Board

Removing Barriers

• Simplify the application

• Apply via phone

• Apply via internet application

• Minimize documentation requirements

• Allow documentation to be submitted post enrollment

Reach Out And Keep Someone The California Experience

Removing Barriers (cont’d)

• Grant presumptive eligibility at various entities

• Create enrollment gateways such as Child Health & Disability Prevention (CHDP) Program & Women Infants & Children (WIC)

• If SCHIP program has premium requirement, bill family after enrollment v. require premium with application

• Auto assign to a plan if family omitted selection

Reach Out And Keep Someone The California Experience

Use Media for Program Recognition

New program – public exposure

Renaming the program to emphasize coverage expansion, i.e. Insure All Kids

Develop and promote “One Door” enrollment concept

Reach Out And Keep Someone The California Experience

OUTREACH, ENROLLMENT, RETENTION & UTILIZATION (OERU) STRATEGIES

•Need varied and multiple strategies

•Train and reimburse application assistants

•Outreach grants to provide cultural and linguistic appropriate outreach at the local level

Reach Out And Keep Someone The California Experience

OERU (cont’d)

•“One Door” approach – ability to offer coverage to all children in a household regardless of immigration status

•Local efforts also include various levels of case management to assure enrollment, member education regarding the annual review process and utilizing servicesReach Out And Keep

Someone The California Experience

Express Lane Eligibility (ELE)

Good concept – grant presumptive eligibility until a final Medicaid eligibility determination is made

Requires ability to interface between ELE site and the Medicaid enrollment system

May require funding for schools if the Free Lunch Program is included

May need to address differences in eligibility rules, i.e. how family size or income is determined

Reach Out And Keep Someone The California Experience

ANNUAL ELIGIBILITY REVIEW PROCESS (AER)

• Keep it simple

• Preprint Annual Review Form

• Develop internet based system for annual renewal

• Minimize documentation requirements

• Allow re-determinations by phoneReach Out And Keep Someone The California Experience

AER (cont’d)

• Allow application assistants to assist families and provide incentives $$

• Improve coordination with Medicaid

• Establish presumptive eligibility (until a final eligibility determination) for children moving between SCHIP and Medicaid

• Develop a simple process for families in SCHIP to be evaluated for Medicaid prior to their AER

Reach Out And Keep Someone The California Experience

QuestioQuestions?ns?

Reach Out And Keep SomeoneReach Out And Keep SomeoneThe California ExperienceThe California Experience

CA Managed Risk Medical CA Managed Risk Medical Insurance BoardInsurance Board

Janette LopezJanette Lopez(916) 324-4695(916) 324-4695jlopez@mrmib.ca.govjlopez@mrmib.ca.gov