January 19, 2012 California’s Experience: Designing a Streamlined User-Friendly Enrollment System Kristen Golden Testa Health Director The Children’s Partnership Families USA Conference Washington DC

Overview California Experience What we have to work from Partnering agencies/governance State legislation Draft design Stakeholder input RFP TCP’s Enrollment roadmap Lessons Learned

What California Has Now 58 counties determine Medicaid eligibility 3 county Medicaid IT systems 1 private vendor for centralized CHIP eligibility A “single point of entry” for joint applications Health e app Express Lane for pilot school lunch programs Separate Exchange board up and running

What California Has Now Negative: Previous attempts to consolidate/privatize/centralize left mistrust Negative: Enormous structural budget deficit Positive: ACA requirements and new federal funding in the short term Positive: Strong political energy and talent behind the California Health Benefit Exchange (HBEX)

California Experience: Governance DHCS and counties for Medicaid (Medi-Cal) CHHSA (overseeing Medicaid and CHIP) MRMIB for CHIP (Healthy Families) New California Health Benefits Exchange (HBEX) ??? Who is ultimately responsible for the California Health Eligibility, Enrollment and Retention System (CalHEERS)

California Experience: State Legislation AB 1296 (2011) creates CalHEERS to: Streamline eligibility rules among Medi-Cal, premium subsidies in the Exchange, and Healthy Families; Coordinate and simplify citizenship and identity verification at application and renewal; Require a single statewide application used at all entry points; Adopt rules for “no wrong door” to ensure consistent determinations from one system Require real-time determination Establish consumer protections and transparency requirements Establishes stakeholder planning and design process

Enrollment IT Design

California Experience: Stakeholder Process Advocates’ own coalition Slow agency coordination HBEX stakeholder workgroups HBEX state tour: input on marketing, enrollment and retention Joint agency process

California IT RFP Goals “No Wrong Door” service system with consistent consumer experience through all entry points Culturally and linguistically appropriate oral and written communications, access for persons with disabilities Seamless and timely transition among health programs Minimal eligibility burden for consumers Security and privacy of consumer information Real-time eligibility determination Transparency and accountability No gaps in coverage Consumers to make informed choices

California RFP Functionality Single rules engine for MAGI ‐ related eligibility determination Coordination with county systems for non ‐ MAGI eligibility Single application On ‐ line verification Support for selecting among offered health plans, such as qualified health plans levels, premium/cost sharing,enrollee satisfaction survey, quality ratings, medical loss ratio information, and provider directories ƒ Plan management, including certification of issuers ƒ Financial management, ƒ Consumer assistance online, over the phone, and by mail ƒ On ‐ line support and financial transactions for navigators

Our Enrollment Roadmap 1. Smart connections through multiple doorways and accessible consumer assistance. 2. Integrated eligibility criteria and processes across programs. 3. Real-time, immediate, and ongoing enrollment. 4. Easy navigation of coverage

Roadmap: Multiple doorways Target harder-to-reach populations who need live connections and assistance Consumer assistance and call center provide real- time (either automated and live human) assistance Web portal to support the full coverage experience Use express lane strategies and technology to prepare for large-scale pre-enrollment. Leverage enrollment gateways to reach more uninsured consumers

Roadmap: Integrated Process Single shared eligibility system for all insurance programs, regardless of program entry point Conform income and other eligibility criteria Continue essential health services and coverage pathways with insurance program Integrate eligibility and enrollment for other human service programs

Roadmap: Real-time Enrollment Modernized IT system and state verification hub Data hierarchy to resolve inconsistencies in eligibility data to reduces need for follow-up When real-time not possible, provide immediate coverage to eligible consumers Establish consumer-protection policies to govern the use of data

Roadmap: Easy Navigation Enrollment UX project Integrated health plan enrollment with eligibility process and real-time Coordinated premium payment across programs Consumer-friendly procedures for those facing changing circumstances Easy navigation through multiple programs for mixed-coverage families Connecting employees/dependents of SHOP employers with Exchange subsidies, if eligible

California Lessons Learned Stakeholder input and coordination Clear governance Thinking through the details Don’t forget SHOP as linkage opportunity Best practices from other states (and UX project) Federally funding essential

Contact Kristen Golden Testa (415) For CA HBEX information: