1. Electronic Medicaid Enrollment in New York: Vision, Opportunities, and Challenges Michael Birnbaum Director of Policy, Medicaid Institute United Hospital Fund May 8, 2008

2. 2 The Medicaid Institute at the United Hospital Fund provides information and analysis explaining New York’s Medicaid program, with the goal of helping all stakeholders redesign, restructure, and rebuild the program. “The Institute’s mission is to shape sound health policy and practice so that Medicaid can meet its most important challenges: covering more low-income New Yorkers, better managing patient care, reforming payment systems, providing effective long-term care, and improving program administration.” James R. Tallon, Jr. President United Hospital Fund

3. 3 A cornerstone of New York’s health insurance system  Medicaid serves 4.1 million low-income New Yorkers  1.6 million children  1.5 million (non-elderly, non-disabled) adults  Over 1 million elderly or disabled beneficiaries  Annual spending on services = $44.7 billion in FFY 2006  Nearly one-third of New York’s health care economy Note: Medicaid enrollment is from June 2007. Source: United Hospital Fund analysis of NYS DoH enrollment reports; CMS NHE and 64 data.

4. 4 Rationale for electronic applications and enrollment  Increase coverage among eligible New Yorkers  1 million uninsured are eligible for Medicaid  Increase efficiency of Medicaid administration  Direct spending on administration = $1.2 billion  Indirect costs: plans, providers, and CBOs  “Hundreds of thousands of hard-copy application pages are in transit every day.” Source: Cook A, D Holahan, and A Williams. 2008. Health Insurance Coverage in New York, 2005- 2006. New York, NY: United Hospital Fund. Medicaid Institute at UHF analysis of CMS 64 data for FFY 2006. Birnbaum M, and K Haslanger. 2004. Bringing Information Technology Innovation to New York’s Public Health Insurance Programs. New York, NY: United Hospital Fund.

5. 5 Medicaid serves more New Yorkers than several other critical programs and services Note: Medicaid enrollment given for June 2007. Public school enrollment given for 2007-2008 academic year. Food stamps and cash assistance enrollment given for January 2008. Source: New York Office of Temporary and Disability Assistance Caseload Statistics. United Hospital Fund analysis of NYS DOH enrollment reports. New York State Education Department, Education Statistics for New York State. Enrollment in millions

6. 6 “Bringing IT Innovation to New York’s Public Health Insurance Programs” (UHF initiative: 2001-2005)  Analyze pathways into public health insurance programs through a range of portals  Identify potential gains from applying IT innovation (and simplification) to enrollment processes  Distill lessons from policy reforms in other states  Identify opportunities for further simplification reforms in New York

7. 7 Acknowledgments United Hospital FundAltman Foundation David GouldKate Liebman Kathryn Haslanger Danielle HolahanNYS Department of Health Elise HubertNYC Human Resources Administration The Lewin Group Lisa ChimentoManaged care plans Anna Theisen-OlsonHospitals Community health centers AMEX TBSCommunity-based organizations Charles ReissConsumer advocates Tony Mahler “Bringing IT Innovation to New York’s Public Health Insurance Programs” (UHF initiative: 2001-2005)

8. 8 Baseline snapshot of application process in NYC Measurement goals  Estimate resources expended by participating plans, providers, and CBOs (“person time” analysis)  Estimate how long the application process takes (“calendar time” analysis)  Provide a snapshot of application outcomes  Identify opportunities to realize efficiency gains Data collection methods  In-person interviews at plans, providers, CBOs  Staff participating in each stage of the process  Extensive document and database review

9. 9 Person time analysis  Initial screening interviews  Application interview  Health plan selection  Photocopying applications  Internal quality control  Delivering applications  Tracking applications via internal databases  Follow-up with applicants, health plans, HRA  Total person-time per application  Best estimate: 90 to 120 minutes  Up to 200 minutes Source: Chimento L, et al. 2004. Electronic Applications Present Opportunities to Improve Enrollment into New York’s Public Health Insurance Programs. The Lewin Group.

10. 10  Initiation of application to completion  Completion of application to submission  Submission of application to eligibility determination  Total calendar time per application  Best estimate: 32 to 40 days Calendar time analysis Source: Chimento L, et al. 2004. Electronic Applications Present Opportunities to Improve Enrollment into New York’s Public Health Insurance Programs. The Lewin Group.

11. 11 Application outcomes  Vast majority of submitted applications are accepted  Vast majority of rejected SCHIP applications were due to administrative issues  Missing paperwork and signatures  Majority of rejected Medicaid applications for children were due to duplicate applications or enrollment  Significant minority of rejected Medicaid applications for adults were due to administrative issues  Duplicates, missing paperwork, and signatures Source: Chimento L, et al. 2004. Electronic Applications Present Opportunities to Improve Enrollment into New York’s Public Health Insurance Programs. The Lewin Group.

12. 12 Potential efficiency gains  Reduce time elapsed between completion and submission of applications through electronic transmissions  Reduce time spent processing applications by automating a range of tasks  Enter data once to reduce duplication of effort and errors  Eliminate photocopying in favor of scanning  Reduce costs of data transmission and storage  Reduce duplicate applications through an automated screen of current enrollment files Source: Chimento L, et al. 2004. Electronic Applications Present Opportunities to Improve Enrollment into New York’s Public Health Insurance Programs. The Lewin Group.