By David Blatt, Director of Oklahoma Policy Institute
“Is there anyone here from Oklahoma?”
I was at a national conference of health care policy
experts and advocates last month when the morning’s plenary speaker, Cindy
Mann, Medicaid Director for the Centers for Medicare and Medicaid Services,
posed that ominous question. “Uh-oh. What have we done this time?”, I wondered,
as I tentatively lifted my hand.
But this time, Oklahoma was being singled out for major praise, not
ridicule. What Oklahoma had done that had Mann and several others at the
conference gushing was launch a new streamlined enrollment system for the
Medicaid program that may be the most user-friendly in the nation – and that
positions Oklahoma at the front of the pack as states face the challenges and
opportunities of implementing health care reform in the coming years.
Until the launch of the new enrollment system, applicants
for SoonerCare health insurance coverage, the state’s Medicaid program,
submitted a paper application to the Oklahoma Department of Human Services
(DHS) during regular office working hours. In most cases an eligibility
determination would be made 20 to 30 days later after information was entered
into the agency’s legacy mainframe computer and verified. Policies and
procedures were handled at least slightly differently in each county office and
by each caseworker, and the client numbering and tracking system was prone to
errors.
The new online enrollment system, which is now operated
by the Oklahoma Health Care Authority (OHCA), simplifies, standardizes, and
expedites the process. Individuals can apply at any time from any computer,
either on their own or with the assistance of trained community or state agency
partners (For the computer-shy, paper applications may still be submitted). As
with an online tax return, the process is logic-driven and rules-based,
ensuring that applicants provide all required information on family members,
income, health status, and the like needed to make a determination. After the
application is completed and submitted, eligibility is determined in real-time
and those found to be eligible are enrolled in the program immediately and
automatically (contingent on some follow-up verification of information). Once
they are enrolled, applicants can review their status and update their
information online at any time, in many cases doing away with the need for the
state to send out annual eligibility redetermination letters. This process
empowers and equips the applicants/members to control their own household data.
The online enrollment system has been in development
since late 2007; after data on all current recipients – some 700,000
individuals – was transferred over from the old system, the new system launched
September 7, 2010. When I spoke with Richard Evans, OHCA’s Eligibility
Automation and Data Integrity Manager (a title itself in need of some
streamlining), he reported that since the system’s launch, more than half of
new applications have come directly through the online enrollment system; the
remainder are part of a common benefits application submitted to the Oklahoma
Department of Human Services. One limitation of the new system: While
SoonerCare applicants are informed that they may be eligible for benefits
administered by DHS, such as food stamps or child care subsidies, and provided
information on how to apply, OHCA and DHS are not directly sharing and
transferring data.
The new system moves Oklahoma towards a single
comprehensive application for public medical programs. Currently, the online
enrollment system is able to process SoonerCare applications for children,
families, and pregnant women, as well as for adults who may be eligible only
for family planning or behavioral health services in a single application. The
scheduled Phase II online
enrollment would expand the application to include the Oklahoma Care program,
which provides coverage for Breast and Cervical Cancer, the Insure Oklahoma
premium assistance program, and the WIC nutrition program administered by the
state Health Department.
As the national attention at my conference indicates, the
new system puts Oklahoma out in front among states in creating a simplified,
integrated and consumer-controlled enrollment process. It should also put
Oklahoma in an ideal situation for moving forward with health care reform.
Under the Affordable Care Act, states will have primary responsibility for
creating integrated, consumer-focused systems to determine whether low- and
moderate-income families are eligible for coverage under Medicaid (which will
be expanded to include all adults up to 133 percent of the federal poverty
level) or for tax credits to purchase private policies through the new Health
Insurance Exchanges beginning in 2014. As Tricia Brooks discussed in this
recent blog post, the federal government is committing significant resources to
helping states develop enhanced eligibility systems that will be up to the
task. Soon the federal government will select five states for Innovator Grants
to design and implement the IT
infrastructure needed to operate Health Insurance Exchanges – bolstered
by 100 percent federal funding. Based on the progress the state has already
made with online enrollment, Oklahoma is believed to be a leading candidate to
be one of the five successful states – assuming the new Governor and her
administration sign off on the application. If Oklahoma does become a model for
integrated and simplified enrollment across health care programs, many more of
us may be quicker to raise our hands when Oklahoma is mentioned in national
meetings in the years ahead.
The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families. This blog was originally posted on the Oklahoma Policy Institute’s blog.