1. 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

2. Project Overview 2  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)

3. Project Overview 3  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

4. Phase 1: Project Activities 4  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

5. Facilitated Enroller Sessions 5  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

6. “Additional Application Forms” 6  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

7. “Additional Application Forms” 7  Partner Recommendations:  Eliminate  Incorporate  Standardize

8. 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 8

9. 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 9

10. 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 # 10

11. 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 11

12. 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 12

13. 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 13

14. Maximize Efficient Collection of Individual Information 14

15. Next Steps 15  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

16. Questions 16 Project Partner Contact Information Elisabeth Benjamin – ebenjamin@cssny.org Patricia Boozang – pboozang@manatt.com Kinda Serafi – kserafi@cdfny.org