1. Online Enrollment System www.mySoonerCare.org
No wrong door
Online Enrollment System
Oklahomans are counting on us….

2. What is No Wrong Door (NWD)?
Online
Application
Streamlines
policy and processes
Immediate decision
On-line application for:
SoonerCare – Oklahoma Medicaid Program
FPW – Family Planning Waiver
Behavioral Health
No Wrong Door or a single-point-of-entry is the first step in an important process to intake information about the applicant or client that results in their SoonerCare (or State Behavioral Health Services) eligibility. It is anticipated that the No Wrong Door project will help to create a technological infrastructure within Oklahoma, allowing future health care initiatives across the state to utilize or learn from the advancements made through the project.
This process will encompass:
creation and programming of a web-based online application and eligibility determination system,
development of the detailed policies and procedures governing such a process,
purchase and installation of the equipment necessary to handle operational intake, and
technical support resources.
Determines if you qualify in real-time
Streamlines policy and processes
Provides immediate feedback/confirmation
Requires selection of Primary Care Provider
Oklahomans are counting on us….

3. Why create this program?
Oklahomans are unsure if they would qualify.
Private, real-time determination
Oklahomans do not want to admit needing State assistance.
Online application available 24/7
Oklahomans are unsure of their SoonerCare status.
Review/renew at any time
Applicants will know if they qualify, what documents are needed, and their member ID and PCP if they qualify.
Applicants will have an online application available
Opportunity to review at any time during their eligibility period.
Oklahomans are counting on us….

4. Goals Eliminate barriers that prevent applications
Provides Premium Assistance
Dedicated Funding Source
Increase effectiveness and efficiency
No Wrong Door will remove many obstacles and “open the door” for thousands of low-income, uninsured Oklahomans. It will not only inform the public about SoonerCare but other state services they may be eligible for and allow access to much needed health care coverage.
It will ensure expedited eligibility determinations resulting in better access to care and better clinical outcomes. Newly eligible members will have quicker access to primary care services, helping to reduce the level of uncompensated care and diminish inappropriate ER use.
For the providers, the online enrollment process would create several administrative benefits assisting their low-income, uninsured patients apply for coverage thereby reducing the amount of uncompensated care.
Vehicle for multiple program applications
Oklahomans are counting on us….

5. NWD Populations (Phase I)
SoonerCare
SoonerPlan
(family planning
services)
State Mental
Health and
Substance
Abuse
Targets Low-Income Uninsured Adults
Dedicated Funding Source
For the initial phase the online application will be available for the following populations:
Children – 185% FPL
Pregnant women – 185% FPL
Adults with minor children – 37% FPL
Individuals seeking family planning and – 185% FPL
Individuals seeking behavioral health services – 200% FPL
THIS COVERS nearly 500,000 of the 700,000 unduplicated we serve in a given year. 70% of the population.
Oklahomans are counting on us….

6. Changing the way we do business
New and Improved
Old
Changing the way we do business
Business hours
8am – 5pm
Apply any time
Waiting days
for determination
Real Time Eligibility
Welfare
Reducing Social
Stigma
Policy applied by
Individual workers
Policy uniformally
applied
No Primary Care
Provider Choice
Primary Care
Provider selected
on application
New

7. Benefits of NWD Streamlined Business Processes No Wrong Time Household
PCP
Selection
No Wrong Door
Program
Referrals
Absorbs
Operational
Functions
Streamlined Business Process:
Centralized Website
Centralized Phone (1-800) number
Centralized address
Normalized Data:
Street Addresses
Uses matching criteria to align old and new data for a particular client
Policy
Consistency
Normalized Data
Oklahomans are counting on us….

8. New Process Description
Apply or Renew
Online
Real-time eligibility
decision & enrollment
Data Verification
Oklahomans are counting on us….

9. Data Exchanges SSN Social Security Administration
OK State Dept of Health (OSDH)
Pregnancy
Income
OK Employment Securities Commission
Citizenship
OSDH, Electronic Verification of Vital Events, Systematic Alien Verification for Entitlements
Function – who we are working with
SSN verification – income verification -
OSDH pregnancy exchange / WIC eligibility
Citizenship / pregnancy verification-validation
CSED – TPL info; non-preg adults with children have to play
Interfaces
NWD will interface with other agencies to
verify client data and
increase program integrity.
Interfaces occur in batch processing or real-time.
Results of the interface queries may
Be sent to the user via on-line alerts or
Trigger automated update to a client's record
Require the user to assist in the disposition of the discrepancy.
NWD will interface with SSA, OKDHS, OESC, and OSHD, among others.
Oklahomans are counting on us….

10. Wireframe Applications
What have we done?
Wireframe Applications
Operations
Technical Design
Partner
Agencies
Project Status
No Wrong Door has had significant progress in the development phase in approving system change orders, finalizing the application ‘wireframe’, determining operations needs, and discussing the marketing/outreach campaign.
Technical Design:
91% of Change Orders necessary for go-live have been JAD (Joint Application Design) approved
Rules engine development - defining the eligibility determination, and business process for InRule.
Working out the bugs of the test files for data conversion. 
EDS is building the tables of the eligibility system.
Wireframe Applications:
The At-home view application has been approved. (April)
The Agency view application has been approved. (June)
Paper Application
The layout and content have been approved.
Operations:
SFY2010 budget request for additional staff and contracting Tier I phone calls and processing mail has been denied. 
Contingency planning for paper application, paper verification, and phone calls is being worked out.
EDS will scan and data enter all paper applications (through Sun Guard). Supporting documents and eligibility calls will be handled by the SC Support unit.
Partner Agencies:
OKDHS
Weekly status meetings
Contingency planning due to denied budget request
ODMHSAS
Decisions on income guidelines established
Approval of Enrollment Process -
OSDH
Weekly Status meetings
Discussions on security, iCE capabilities, and overall network architecture.
IHS
Indian Health Provider Training Presentation
Oklahomans are counting on us….

11. No Wrong Door How to Apply At Home Or Community Partner Agency Partner
Paper
How to Apply
At Home Or
Community
Partner
Agency
Partner
Paper

12. At-home & Community Partner Options
Manage My Account
Apply Now
Tell me more
(do I qualify?)
Paper app process- EDS sun guard – entire state ~20000
Oklahomans are counting on us….

13. Breast and Cervical Cancer Temporary Assistance for Needy Families
NWD Upcoming
Populations
Insure Oklahoma
Aged, Blind, Disabled
Breast and Cervical Cancer
Temporary Assistance for Needy Families
The phase in approach creates an infrastructure for future healthcare initiatives the state may embark on in efforts to improve healthcare access, enroll individuals, and reduce uninsured rates.
Subsequent phases of the transition to an online enrollment process may include the following populations:
Aged, Blind, and Disabled
Individuals seeking breast and cervical cancer programs and
Insure Oklahoma
Oklahomans are counting on us….

14. Phase II Planning Early Requirements Gathering
Create Employer Portal (Dashboard)
Project Status
No Wrong Door has had significant progress in the development phase in approving system change orders, finalizing the application ‘wireframe’, determining operations needs, and discussing the marketing/outreach campaign.
Technical Design:
91% of Change Orders necessary for go-live have been JAD (Joint Application Design) approved
Rules engine development - defining the eligibility determination, and business process for InRule.
Working out the bugs of the test files for data conversion. 
EDS is building the tables of the eligibility system.
Wireframe Applications:
The At-home view application has been approved. (April)
The Agency view application has been approved. (June)
Paper Application
The layout and content have been approved.
Operations:
SFY2010 budget request for additional staff and contracting Tier I phone calls and processing mail has been denied. 
Contingency planning for paper application, paper verification, and phone calls is being worked out.
EDS will scan and data enter all paper applications (through Sun Guard). Supporting documents and eligibility calls will be handled by the SC Support unit.
Partner Agencies:
OKDHS
Weekly status meetings
Contingency planning due to denied budget request
ODMHSAS
Decisions on income guidelines established
Approval of Enrollment Process
OSDH
Discussions on security, iCE capabilities, and overall network architecture.
IHS
Indian Health Provider Training Presentation
Combination of Applications
Oklahomans are counting on us….

15. Derek Lieser Richard Evans Questions 522-7376, Derek.Lieser@okhca.org,
Oklahomans are counting on us….