1 North Carolina Department of Health & Human Services 1 NC FAST and Work Support Strategies Operational Readiness Workshop July – August 2013

22 TimeAgenda TopicsPresenter 9:00-9:15Welcome & IntroductionsWorkshop Team 9:15-9:45NC FAST Project UpdateReadiness Team 9:45-11:15P7 Ecosystem & Division of Responsibilities P7 Liaisons 11:15-12:00DMA UpdateDMA 12:00-1:00Lunch: Work Support Strategies Update WSS Team 1:00-2:00Managing Applications & CasesP7 Liaisons 2:00-3:30Break-Out Discussion: Communications Strategy All 3:30-4:00Questions & AnswersWorkshop Team Agenda

3 North Carolina Department of Health & Human Services 3 NC FAST Project Update July 2013

44 Project Update  ePASS  Document Management  Deployment Update  Help Desk  Schedule Update  Training Update  County Security Configuration  Project 7 Update  Project 3 Update

55 ePASS – Statewide Volumes Transaction – through July FNS Screenings40,68772,32368,94634,372 FNS Potential Eligibility 28,21251,54549,43325,391 FNS Applications3,33337,50551,87023,487 FNS Electronic Apps00010,689 MA Screenings0012,21116,478 MA Applications009,95510,803 Quick Screens28,07156,99957,46829,846 EA Screenings13,76522,71020,1889,758 EA Potential Eligibility 3,8355,4384,4882,087 The number of FNS Electronic Apps has gone up over 4,000 in a month

6  Completed functional and detail design documents (integration with NC FAST)  Completed County Guidelines document  Completed development and testing (integration with NC FAST)  FileNet production architecture is readied for configuration  Deployed document management capability as part of Project 2&6 Pilot rollout  Working on County Sync Guide  Working on draft functional and detail design documents for county sync piece  Preparing to initiate development of county sync capability Document Management Update

77  Document management design document has been posted in FAST Help  A webinar will be scheduled to discuss the design document  A job aid has been posted providing guidance on what should be scanned

88 Deployment Update  Upgraded NC FAST to P2&6 version of code; a significant upgrade to the base NC FAST system  Working through identified defects; continuing build activities and defect fix activities  Continue to identify and prioritize Cúram tickets  Refining data conversion approach in preparation for Hard Launch  Continue submitting test conditions, scripts, and test data sheets for Business team review  Respond to Business team comments and receive sign-off for test conditions and scripts  Continue to plan and execution of Cycle 3 – Day in the Life execution cycle and Frequency 1,2,3,4,5 scripts  Refining internal team communication protocol to streamline getting updates to the counties

99 Help Desk Update  Significant increase in call volumes last week  Identified limitation with current phone system causing some calls to roll to voice mail; new phone system on order  If users call the Help Desk and are unable to speak to someone or cannot leave a voic message, send your issue via .  Agents work to resolve tickets in the order in which they are received  NC FAST Help Desk can be reached at or , Option 3  Help Desk is available Monday – Thursday, 8:00 a.m. – 6:00 p.m. and Friday, 8:00 a.m. – 10:00 a.m., 11:00 a.m. – 6:00 p.m.  Please report only one incident/issue per .

10 Help Desk Metrics Open Tickets (as of date) 7/22/20137/23/20137/24/20137/25/20137/26/2013 Tier Tier 3/Config/User Setup Tier 3 Dev/Other Total Tier 2/ Tickets Resolved (daily) 7/22/20137/23/20137/24/20137/25/20137/26/2013 Tier Tier 3/Config/User Setup Tier 3 Dev/Other Total Tier 2/

11 P2&6 Schedule Update

12 P2&6 Training Update  Over 40 trainers have gone through Train-the-Trainer  Launched the NC FAST Learning Gateway  Posted web-based training (WBT) content into Learning Gateway  Exposed Pilot counties to preliminary version of classroom training  Delivered WBT and instructor-led content to Pilot counties and state office  Initiated training of southeast counties  Wrapping up development of final classroom training activities  Feedback from Pilot and state office delivery has been quite positive  Expectations:  Use of Captivate simulations  Training scenarios  Sandbox availability  Availability of program subject matter experts

13 County Security Configuration County Reception Unit Reception Supervisor 1 Reception Worker 1 Reception Worker 2 Reception Worker 3 Eligibility Unit 1 Eligibility Supervisor 1 Eligibility Worker 1-1 Eligibility Worker 1-2 Eligibility Worker 1-3 Eligibility Unit 2 Eligibility Supervisor 2 Eligibility Worker 2-1 Eligibility Worker 2-2 Eligibility Worker 2-3 User Role: Eligibility Worker User Role: Inquiry Only

14  Business team continues to work closely with DMA to:  Finalize Project 7 requirements  Complete documentation for State Plan Amendments (SPA), elected state options, targeted enrollment strategies, and federal hub waiver  Design team completed joint design sessions for functionality needed to be ACA compliant; finalizing review and sign-off  Intake and assessment for Medicaid/NCHC  Integration with federal data hub for account transfers and verifications  Eligibility determination/redetermination under MAGI and non-MAGI rules  Coordination of appeals processing with FFM  Implementation of federal and state mandated reports and notifications  Interfaces team began federal data services hub Wave 4 testing with CMS Project 7 Update

15  Team is composed of Services Business Lead Tracey Duncan, an NC FAST Business Analyst and 3 SMEs from DCDEE  Continue to reassess the business requirements  Reassessment of the Child Care Subsidy business requirements should be complete in August  Requirements for Energy Assistance (CIP and LIEAP) will then be addressed with a SME from Economic Services  Fit gap analysis is planned to begin in August, with the goal of beginning functional design in October  Deployment is targeted for late 2014 Project 3 Update

16 North Carolina Department of Health & Human Services 16 Project 7 FFMI P7 ‘Ecosystem’ & Division of Responsibilities

17 FFM DSS FDSH State Verification Systems MA Application Electronic In-person, by phone, mail-in PATHWAYS Database Interface The New P7 Ecosystem

18 The New P7 Ecosystem  New Streamlined application for MA  Additional questions required for an MA eligibility determination under current rules and/or FNS  Depending on programs for which the applicant is eligible, benefits may begin at different times  Additional electronic verifications from federal sources may be used  Ineligible applications will be transferred to the FFM/Health Insurance Marketplace for potential Advanced Payment Tax Credit (APTC) or Cost-Sharing Reduction (CSR) eligibility

19 What is New?What has changed? Potential for increase in applications with roll-out of ACA May need to refer customers to the FFM/Health Insurance Marketplace Caseworkers will ask new questions when customers are applying for MA Potential for new work queues for Streamlined applications submitted via ePASS MA applications completed on ePASS may now be submitted electronically A link will be added to ePASS to allow applicants to connect directly to the FFM/Health Insurance Marketplace Entirely new web-based access point for customers Potential for new work queues for Streamlined applications submitted via FFM Applications may be transferred from the FFM to NC FAST and vice versa ‘One-Stop shop’ now available for customers; whether looking for Medical Assistance or shopping for insurance plan The New P7 Ecosystem

20 Streamlined Application keyed by caseworker Traditional determination/ additional program requested? Enroll in MAGI program Send application to FFM Answer additional questions for traditional MA (and FNS, if requested) Enroll in Traditional MA and/or FNS Benefits under MAGI programs will not begin until January 1, If eligible for FNS but not for traditional MA, enroll in FNS and MAGI. Note: benefits will begin on different dates. MAGI Notice Generated and Held by NC FAST. DSS MA Applications Completed via the DSS

21 Streamlined Application keyed by applicant Traditional determination/ additional program requested? Enroll in MAGI program Send application to FFM Answer additional questions for traditional MA (and FNS, if requested) Enroll in Traditional MA and/or FNS Benefits under MAGI programs will not begin until January 1, If eligible for FNS but not for traditional MA, enroll in FNS and MAGI. Note: benefits will begin on different dates. MAGI Notice Generated and Held by NC FAST. Applicant registers for NCID MA Applications Completed via ePASS

22 Streamlined Application completed through FFM Seeking Financial Assistance ? Potentially MA eligible? Enrolled in QHP of choice Application transferred to NC FAST Calculate APTC/CSR Full determination requested? FFM MA Applications Completed via the FFM

23  Beginning October 1, 2013 – the Streamlined Application will always be completed FIRST when applicant is seeking Medical Assistance.  To receive a determination based on ‘traditional’ rules (between 10/1/2013 and 12/31/2013) and/or to apply for FNS in addition to MA, additional questions will need to be answered.  Regardless of the entry point, the Medicaid/NCHC determination will ultimately be done in NC FAST.  Benefits under MAGI programs will not begin until January 1, 2014  As of January 1, 2014 – MAGI rules become the standard for most Family & Children’s MA programs.  Applicants who do not qualify for Medicaid/NCHC may still be eligible for APTC/CSR (federal subsidies) to help pay for insurance and should utilize the FFM/Health Insurance Marketplace. Key Points

24 North Carolina Department of Health & Human Services 24 P7 Division of Responsibilities: DHHS/FFM/FFMI

25 Health Insurance Marketplace

26 Health Insurance Marketplace

27 FFM DSS If a customer requires assistance completing the streamlined application for Medicaid/NCHC while using ePASS, they are advised to call the DHHS Customer Service Center. If a customer requires assistance completing the streamlined application for Medicaid/NCHC while at the local DSS, they are assisted by the caseworker. If a customer requires assistance completing the streamlined application for Medicaid/CHIP while using the FFM, they are advised to call the Federal Call Center and/or Navigator. Customer Assistance

28 Provide customers with information that assists with the following: submitting the eligibility application clarifying distinctions in QHPs making informed decisions during the health plan selection process Can assist in all different types of marketplaces State-based Marketplace State Partnership Marketplace Federally-facilitated Marketplace Funded through State and Federal grants Customer Assistance Must complete comprehensive training to become a navigator.

29 Serve many of the same functions as Navigators including: Providing education to customers Assistance completing applications Organizations can apply online to be designated by the Marketplace to certify application counselors. Some examples of organizations include: Social service agencies Hospitals Community health centers No funding mechanism available for this program Customer Assistance Must complete comprehensive training to be a Certified Application Counselor.

30 Customer Assistance NavigatorsNon-Navigator assistance personnel Certified application counselors Agents and Brokers State-based Marketplace YesOptional for states YesOptional for states State Partnership Marketplace Yes Yes, if state permits it Federally- facilitated Marketplace YesNot applicable; Navigators provide this assistance YesYes, if state permits it *Source: cms.gov

31  Role: To assist the customer in applying for an insurance affordability program  Can be a person or organization  May assist with Streamlined application completion, or complete on behalf of the applicant  Explaining APTC/CSRs or insurance options to customers  Navigators are not responsible for:  Assisting customers with ‘Traditional’ MA applications  Explaining North Carolina DMA policy  Contacting the DSS It has not been determined if Navigator’s will be assisting customers with ePASS (Streamlined) applications Navigators

32  Role: Take applications for Medical Assistance (and FNS/SNAP, if applicable)  Will manage integrated cases in NC FAST (Income Support and/or Insurance Affordability)  May refer ineligible applicants to the Health Insurance Marketplace as an alternative to Medicaid/NCHC  Caseworkers are not responsible for:  Helping customers navigate the FFM/Health Insurance Marketplace  Helping customers complete the application on the FFM/Health Insurance Marketplace  Explaining specific details regarding APTC/CSRs or insurance options to customers Consider having the website and/or phone number for the Health Insurance Marketplace to give customers a place to start. DSS Caseworkers

33  Role: Provide an eligibility determination for MAGI and non-MAGI programs and issue benefits when applicable  Will notify case worker via a task in a designated work queue when an application is received from ePASS or the FFM  Will notify applicant of eligibility result and/or when their application is transferred to the FFM  NC FAST is not responsible for:  Providing an eligibility determination for APTC/CSR  Notifying customers of insurance plan options  Enrolling customers in QHP NC FAST

34 North Carolina Department of Health & Human Services 34 DMA Update

35 North Carolina Department of Health & Human Services 35 Lunch and Work Support Strategies Update

36 North Carolina Department of Health & Human Services 36 P7: Managing Applications & Cases Streamlined App / Multiple Dispositions & Integrated Cases / The Evidence Broker / Impacts to the Universal Worker

37 North Carolina Department of Health & Human Services 37 Streamlined Application Demonstration Note: The following includes preliminary screen shots which are subject to change.

38 What is the Streamlined Application?  A simplified application used to apply for all Insurance Affordability programs  Used whether applying via the FFM, ePASS, or the DSS  Will be the first application used when the customer is seeking Medical Assistance Streamlining the Process

Getting Started with the application.

Customer must agree to privacy statement before continuing.

The first page of the streamlined application gathers details about the primary applicant.

The second page gathers additional details about the primary applicant.

Are there any other people in the household?

Enter details about the additional household member.

Enter additional details about the household member.

Review the household member summary. Are there more people to add?

How are the household members related?

Identify the tax filers in the household.

Identify the tax dependents in the household.

Review the Household Summary. Make changes if necessary before continuing.

Indicate household members who earn income.

Enter income details.

Are there any income deductions that can be deducted on an income tax return.

Review expected annual income.

Similar income information is collected for additional household members (if applicable).

Additional household information is collected, beginning with details on medical bills.

Indicate household members who are tobacco users or are incarcerated.

Additional questions are asked to determine if household members qualify under MAGI.

Review the summary screen and make necessary changes before continuing to next screen.

Documentation needed from the customer displays before the application is submitted.

61 North Carolina Department of Health & Human Services 61 Streamlined Application Demonstration Q&A

62 MAGINon-MAGI Streamlined applicationNon-MAGI Medical Assistance application Eligibility determination and enrollment can begin as early as October 1, 2013 Eligibility determination and enrollment are on-going currently Coverage begins as early as January 1, 2014 Coverage begins on the day indicated by policy MAGI becomes the new standard for most Family and Children’s Medicaid programs after January 1, 2014 Non-MAGI-based programs continue to use Non-MAGI Medical Assistance application MAGI vs. Non-MAGI

63 The application process for all MA programs will start with the streamlined application after October 1,  Coverage for the MAGI based determinations does not begin until January 1, 2014  Customers should be given the opportunity to see if they currently qualify for a MA program under the traditional (non-MAGI based) rules Result: During the single application process, an Authorization/Disposition will need to be completed for the Streamlined and ‘traditional’ MA and/or FNS application(s). MAGI Streamlined Application MA and/or FNS Application Identical information prepopulates on the Non-MAGI application Potential for Multiple Dispositions Non-MAGI

64 ‘Streamlined’ Medical Assistance Application Insurance Affordability (Integrated Case) Product Delivery Case Evidence Submit Income Support Application (P26 Interview Questions) Income Support (Integrated Case) Product Delivery Case Evidence Submit Evidence Broker Identical information populated from MAGI application Potential for Multiple Integrated Cases

65  The Evidence Broker is the functionality within NC FAST that allows evidence to be transferred from one integrated case to another  With multiple integrated cases there will be two types of evidence, identical and non-identical  Identical evidence is evidence that is used in the same way and is the same evidence type in both integrated cases  Non-identical evidence is evidence that is not used in the same way in both integrated cases  Once enabled, the Evidence Broker will broadcast the identical information so that it can be then used on the other “target” integrated case  Caseworkers will be able to accept or reject the evidence in the target case either manually piece by piece or in bulk at once  When evidence is entered in one case that could be broadcast to the other integrated case, the caseworker will receive a task informing them that they have evidence to accept or reject The Evidence Broker

66 Note: These screens are subject to change Incoming Evidence: Identical

67 Note: These screens are subject to change Incoming Evidence: Non-Identical

68  One Case Worker  Customers will still have the ability to apply for multiple programs at the same time with one caseworker, whether there is a MAGI-based program involved or not.  Reception, Tasks, Work Queues  Other universal worker functionality associated with P2&6 such as work queues, reception, and tasks will remain essential to the NC FAST process.  Potential Multiple Dispositions  After completing the MAGI application, the customer may continue on to the Non-MAGI (and/or FNS) questions to see if he or she is eligible for Medical Assistance (or FNS) prior to 1/1/14. Therefore, a caseworker may have two dispositions to complete.  Potential Multiple Integrated Cases  One caseworker will be able to manage both integrated cases through the use of the evidence broker, which will allow identical information to be shared amongst these cases. Impacts to the Universal Worker

69 North Carolina Department of Health & Human Services 69 Breakout Discussion: Communication Strategies

70  Increased awareness of the Affordable Care Act is expected to bring potential customers out of the woodwork.  Those who are currently eligible but not enrolled: DMA research suggests that 69,683 individuals will gain coverage in  Those who would potentially be eligible under a Medicaid expansion: Approximately ½ million additional applicants who will not be eligible may still want to apply.  Expect an impact, not only to numbers of Medicaid applicants, but to other programs as well. The “Woodwork” Group

71 Estimated Medicaid Expansion Population in 2014

72 North Carolina Department of Health & Human Services 72 Breakout Session Report Out: Communication Strategies Highlights

73 North Carolina Department of Health & Human Services 73 Questions and Answers

74 North Carolina Department of Health & Human Services 74 Thank You for participating today! You will receive an shortly with a link to a survey. Your comments & suggestions will help us plan future workshops.