1 North Carolina Department of Health & Human Services Draft North Carolina Association of County Commissioners NC FAST Update June 9, 2015

22 Draft County Workload Impacts An influx of applications began being received from Intuit (Turbo Tax) on January 9 th and continued through April 15 th, These must be processed in the same manner as other FNS applications. These applications are received via ePASS. NC FAST received 22% more FNS applications via ePASS for the period of January – April 2015 compared to the same period in Potential FNS Workload Growth: Medicaid Workload Impact: NC FAST received notification from CMS on May 21, 2015 that a additional Federal Facilitated Marketplace (FFM) applications will be sent to states due to a FFM Healthcare.gov system issues. These system issues have prevented the account transfer of approximately 9,100 accounts where a full state determination for Medicaid eligibility when applying via the FFM was requested. Subsequently, North Carolina began receiving these account transfers on May 27th and the corresponding applications are now being sent to the applicable county work queues. If received, these applications should be processed per normal procedures. *Data as of April 30 th

3 Draft As of May 29 th, In an effort to assist counties with performance monitoring of NC FAST, the BSM performance monitoring tool has been installed and reporting in the following locations. NC FAST is continuing to reach out to all counties. The goal is to have all 100 counties utilizing the BSM tool by July General NC FAST Update Alamance CountyCumberland CountyJones CountyStanly County DSS Albemarle NC Avery CountyDare countyLincoln CountyStokes County Bertie CountyDare CountyMacon CountySurry County Brunswick CountyDavidsonMartin CountyUnion County BSM03-RobesonDavie CountyMitchell CountyVance Camden CountyDuplin CountyMoore CountyWake County Carteret CountyEdgecombe CountyNash CountyWake County_ATC CaswellFranklinPamlico CountyWake County_CW Cherokee CountyGaston CountyPasquotank countyWake County_Millbrook Chowan CountyGraham CountyPerquimans CountyWake County_SRC Clay CountyGreene CountyPerson CountyYadkin County Cleveland CountyHertford countyPolk County Craven CountyHoke CountyRockingham County CumberlandJackson CountyRutherford County

4 Draft FNS Issuances Over Time 1 Nov 2013 ARRA funding was removed by policy. 2 Oct 2014 Benefits increased based on Federal COLA adjustments.

5 Draft  Counties successfully met Feb. 10, 2014 and March 31, 2014 USDA FNS processing deadlines. *There will always be some applications that remain pending with good cause. As of May 31 st, 727 untimely pending applications remained. FNS Applications Processing Status Note- An influx of applications began being received from Intuit (Turbo Tax) on January 9th and continued through April 15 th,. These must be processed in the same manner as other FNS applications and may cause an increase in untimely pending FNS applications beginning in February. This increase in pending FNS applications may in turn cause an increase in pending FNS recertifications. Several days of winter weather impacted county office operations in Feb

6 Draft  Counties successfully met Feb. 10, 2014 and March 31, 2014 USDA FNS processing deadlines. FNS Recertifications Workload Snapshot *There will always be some recertifications that remain pending with good cause. As of May 31 st, 1,529 untimely pending recertifications remained. Note- An influx of applications began being received from Intuit (Turbo Tax) on January 9th and continued through April 15 th,. These must be processed in the same manner as other FNS applications and may cause an increase in untimely pending FNS applications beginning in February. This increase in pending FNS applications may in turn cause an increase in pending FNS recertifications. Several days of winter weather impacted county office operations in Feb **The April increase is primarily attributable to a large spike in one county. The county has developed a Plan of Action and is working with State leadership to remediate the issue within the next 30 days.

7 Draft Overall Medicaid Applications Processed Overall Medicaid Apps includes Adult Medicaid (includes SDX), Traditional Family and Children’s Medicaid, and MAGI Family and Children’s Medicaid (including those from HealthCare.gov). *Data as of June 3 rd **Several days of winter weather impacted county office operations in Feb ***The quarterly SDX catch-up was processed at the beginning of April. Note- An influx of FNS applications began being received from Intuit (Turbo Tax) on January 9 th and continued through April 15 th,., These must be processed in the same manner as other FNS applications This increase in pending FNS applications may in turn affect Medicaid application processing due to increased workload, most likely in counties where workers work both FNS and Medicaid applications.

8 Draft ACA Year 1 Open Enrollment ACA Year 2 Open Enrollment  During Year 1 Open Enrollment ( ), NC did not begin receiving applications from HealthCare.gov until January. This caused applications from Oct.-Dec to accumulate, creating a burden for our counties.  For Year 2 Open Enrollment ( ), NC will receive applications from HealthCare.gov as they are submitted, which will help create a more steady workload of HealthCare.gov applications. Year 2 included a Special Enrollment Period (SEP) from March 15 to April 30. HealthCare.gov Open Enrollment Comparison *Data as of June 4 th Note: CMS notified States on May 22, 2015 that there was an issue on the Federal side regarding the Account Transfer functionality. CMS will be sending a total of 9,168 account transfers to NC over the next few weeks. NC FAST notified the counties last week.

9 Draft HealthCare.gov Applications by Status 70,635 applications from Open Enrollment submitted at healthcare.gov (FFM) have been transferred to NC FAST. 87% of those applications have been fully processed by the state. 12% of the fully processed applications were approved for Medicaid; the remainder were denied or withdrawn. Data as of June 4 th Open Enrollment Open Enrollment Status of Healthcare.gov/FFM Applications Application CountApplication %Application CountApplication % FFM applications received by NC FAST 86,932100%70,635 Total FFM applications being processed 00%8,99913% Total FFM applications fully processed 86,932100%61,63687% Applications approved for Medicaid ("woodwork effect") 9,004 10% 7,287 12% Applications denied for Medicaid 77,928 90% 54,349 88% Duplicate Application 7,0639%10,64920% Already on Medicaid 12,44116%11,94422% Withdrawn/ Found Ineligible 58,42475%31,75658% The counts were adjusted to report “Already on Medicaid” as its own category, rather than a subset, to provide a better comparison between Open Enrollment and Open Enrollment Open Enrollment Dates: November 15 th - February 15 th ; Special Enrollment Period for Tax Season: March 15 th – April 30 th Approved: Applications approved for MAGI-based programs from the FFM Denied: Applications denied for MAGI-based programs from the FFM (this includes duplicate applications, applicants already receiving Medicaid, applicants found ineligible, and out of state applications.) Withdrawn: Applicant requested to withdraw the application Note: CMS notified States on May 22, 2015 that there was an issue on the Federal side regarding the Account Transfer functionality. CMS will be sending a total of 9,168 account transfers to NC over the next few weeks. NC FAST notified the counties last week.

10 Draft Pending Medicaid Applications *Data as of June 3 rd There are currently 9,062 pending Medicaid applications that are beyond standard processing time (Compared to 2014 peak of 104,070): HealthCare.Gov Applications: 1,224 (Compared to 2014 peak of 45,058) NC-Based MAGI Applications: 1,524 (Compared to 2014 peak of 31,890) Traditional Applications: 6,314 (Compared to 2014 peak of 20,938)

11 Draft Total Untimely Pending Medicaid Applications  We continue to monitor statewide and individual county progress in working through untimely pending Medicaid applications.  Since the peak of untimely pending applications at the beginning of June 2014, counties have been successful in lowering the overall backlog by 91% which includes a reduction of approximately 95,000 untimely pending applications.  30% of the untimely pending Medicaid applications are directly related to Affordable Care Act changes. *There will always be some applications that remain pending with good cause.

12 Draft Untimely Pending Medicaid Apps- Most Impacted Counties by Total Untimely County Change from Last Week Total Untimely Pending Applications (as of 5/27) Total Untimely Pending Applications (as of 6/3) Untimely HealthCare.gov Apps (as of 6/3) Historical Avg. # of Medicaid Apps Processed (in EIS) Total Apps Processed in Current Month (as of 6/3) Wake1291,8341, , Mecklenburg641,2121, ,7041,222 Forsyth , Randolph , Gaston , Davidson , Onslow , Durham , Rockingham Guilford , Rowan , Iredell , Harnett Pitt , Burke Hoke Buncombe , Halifax Union , Columbus TOTAL 2706,8566, ,142 5,528 Of all Medicaid applications beyond the standard processing time, 73% are from 20 counties. 13% of the pending untimely applications are from HealthCare.gov The following county is no longer considered a Most Impacted by Total Untimely county: Cumberland The following county has been added to the Most Impacted by Total Untimely list this week: Union *There will always be some applications that remain pending with good cause.

13 Draft Untimely Pending Medicaid Apps- Most Impacted Counties by Volume County Current Untimely Medicaid Applications as a % of Typical Monthly Application Volume Total Untimely Pending Applications (as of 6/3) Historical Avg. # of Medicaid Apps Processed (in EIS) Total Apps Processed in Current Month (as of 6/3) Pamlico89% Hyde67%25387 Washington66% Graham58%48829 Randolph42%4531, Hoke35% Wake34%1,7054, Yancey33% Davie30% Rockingham28% Jones24% Avery24% Halifax21% Davidson21%2841, Forsyth21%6172, Columbus20% Onslow17%2031, Mecklenburg17%1,1486,7041,222 Mitchell17% Moore16% TOTAL25%5,47122,0543,702 *There will always be some applications that remain pending with good cause. The following counties are no longer considered Most Impacted by Volume counties: Burke, Harnett The following counties have been added to the Most Impacted by Volume list this week: Moore, Onslow

14 Draft Medicaid Recertifications Processed  Historically, the average number of recertifications processed each month in EIS is 82,191. The average overdue recertifications per month is 7,166, and the average extended per month is 6,578.  December 2014 through April 2014 totals are increased due to the Medicaid Waiver extensions. *Data as of June 3 rd **Family and Children’s Medicaid recertifications were auto-extended for 41 counties on the evening of May 20 th

15 Draft Pending Medicaid Recertifications  A total of 170,213 Medicaid recertifications are pending through the end of June *Data as of June 3 rd **Family and Children’s Medicaid recertifications were auto-extended for 41 counties on the evening of May 20 th

16 Draft Medicaid Recertification Workload *Data as of June 3 rd **Chart illustrates number of recerts due through the end of June. ***Family and Children’s Medicaid recertifications were auto-extended for 41 counties on the evening of May 20 th

17 Draft Pending Medicaid Recerts- Most Impacted Counties County Recerts Due through June (as of 6/3) as Percentage of "Typical" Monthly Average Total Recerts Due through June Past Due Recerts as of 6/3 June Recerts Due as of 6/3 (Originally Due and Extended Due) "Typical" Monthly Average of Recerts Due Harnett610%9, ,4551,585 Pamlico378% Rowan328%7, ,6592,170 Pitt327%5, ,3831,557 Union327%4, ,3441,423 Rockingham321%3, ,1351,072 Watauga316%1,096771, Randolph306%5, ,6631,944 Granville286%2, , Martin269% Surry255%2, ,8041,156 New Hanover239%5,106755,0312,136 Guilford231%9, ,0484,314 Durham216%6, ,1933,089 Polk206% Jones201% Davie200% Hoke180% Wayne178%2, ,1611,371 Washington176% Total284%70,2314,83965,39224,710 Statewide144%170,21310,777159,436117,998 The following counties are no longer considered Most Impacted Medicaid Recertification counties: Johnston, Wake The following counties have been added to the Most Impacted Medicaid Recertification list this week: Hoke, Washington

18 Draft Pending Medicaid Recerts- Counties Caught Up by Month End of December End of January End of FebruaryEnd of MarchEnd of AprilEnd of MayEnd of June (Projection) Caswell*Anson*Brunswick*Franklin* Alexander*Greene*Alleghany*Haywood*Caldwell*Avery Cherokee*Macon* (14%)Buncombe*Lenoir* (14%) Ashe* Hertford* Beaufort*Jackson*Forsyth*Gates Lee*Camden*Perquimans* Bertie* Nash* Cabarrus*Northampton*Henderson*Halifax Lincoln*Carteret*Person* Bladen* Richmond* (14%) Columbus*Robeson*Hoke*Johnston McDowell*Catawba*Rutherford* Chowan*Stokes* Edgecombe*Wilkes*Mecklenburg*Orange Moore*Cleveland*Vance (26%) Clay*Transylvania*Sampson Currituck*Wilson* Craven* Tyrrell* Scotland Dare* Duplin* Warren* Current.- 6 Counties Total Current- 6 Counties Current- 2 Counties Remaining Current- 1 County Total Current- 7 Counties Current- 15 Counties Remaining Current- 13 Counties Total Current- 20 Counties Current- 16 Counties Remaining Current- 15 Counties Total Current- 35 Counties * Denotes counties where Family and Children’s Medicaid recertifications are no longer being auto-extended. Burke, Chatham, Davie, Iredell, Swain, and Washington are also no longer being auto-extended. Note- Counties are considered “current” when they are within 10% of the typical monthly average for Medicaid recerts and remain current on all other application and recertification workloads. Counties in red were considered caught up in the month listed but had more than 10% of the typical monthly average remaining at the end of May. Current- 10 Counties Total Current- 45 Counties *Data as of June 3 rd  Total of 50 counties are current on Medicaid recertification processing through the end of May.  Total of 57 counties are projected to be current on Medicaid recertification processing by the end of June.  Total of 59 counties have been removed from the end of month automated recertification extension process for F&C Medicaid. Current- 5 Counties Total Current- 50 Counties Current- 7 Counties Projected Total Current- 57 Counties

19 Draft Child Welfare Assessment Activities The Child Welfare Committee is in the process of gathering information for the Business Plan. Currently, members of the group are engaged in Business System Function (BSF) reviews, conversations with other states to discuss lessons learned and visits to counties to document business processes. These activities will help inform the overall business model and implementation approach. The committee is also reviewing workload data gathered by DSS. Needs Review BSF Review Business Model Basis of Estimate Update Business Process Review Implementation Options Implementation Dependencies Business Plan Industry Surveys and Lessons Learned = Activities Completed = Activities In Progress