Oklahoma Health Care Authority Online Enrollment (Easy as 1-2-3) www.mySoonerCare.org

What’s In a Name? What Is Online Enrollment? SoonerCare Comprehensive Web App For For State Sponsored Medical Programs Streamlines Policy, Processes, and Access to Services Real-time Eligibility, Enrollment, and ID Generation SoonerCare Concept submitted to CMS in summer of 2007. Work began after approval December 2007 Launched: Sept. 7, 2010 - www.MySoonercare.org

Why Did We Do It? Over 500,000 Non-Insured Oklahomans 22% Of Uninsured Live In Rural Areas - Limited access to OKDHS offices Oklahomans Are Unsure If They Qualify - It’s Healthcare, Not Welfare - Private, real-time determination available 24/7 Enrollment Process is Broken - Dependency upon Legacy Mainframe - Client Numbering - Streamline enrollment and verification - Intuitive application with editing controls

What Were the Goals? Remove Barriers that Prevent Enrollment Empower and Equip the Members Develop Multiple Program Application Expand Enrollment to Service Locations Remove Barriers that Prevent Enrollment Increase Effectiveness/Efficiency of Process

Was State Policy Affected? Changing the Way We Do Business Date Specific Eligibility Rolling Redetermination Medical Home at Application

Why No Wrong Door? Home View Agency View Paper Application Agency Applying at Home Computer or Community Partner Home View Applying at Agency Partner Agency View Completing Paper Form Mail to HP For Scanning Paper Application Comprehensive Applicant at Welfare Office Agency Electronic Notification of DOS NODOS App Behavioral Health DMH App Newborn Registration e-NB-1 App

Who was Affected? Phase II Phase II.5 Initial Phase Children, Pregnancy, Families Family Planning waiver Behavioral Health Services For the initial phase the online application will be available for the following populations: Low hanging fruit – low cost, high value population Children – 185% FPL Pregnant women – 185% FPL Adults with minor children – 37% FPL Individuals seeking family planning and – 185% FPL Individuals seeking behavioral health services – 200% FPL THIS COVERS nearly 500,000 of the 700,000 unduplicated we serve in a given year. 70% of the population. Next tier: IO & BCC Lower Yield: ABD, Nursing homes, Home community based waivers Phase II Insure Oklahoma (Premium Asst) Oklahoma Cares (BCC) Women, Infants, & Children Nutrition Phase II.5 Affordable Care Act

Where To Start? Unique ID Call Center Other Programs Data Exchange Letters Notices Rules Engine Partners PCP Choice Date Specific Verifications Real-time Enrollment Adding Newborns Rolling Reviews Appeals PERM/MEQC Security

Simplification Is Not Simple OKDHS Agency Electronic OKDHS NON-OE (ABD) ID # Letters ID Cards Agency View Home View MMIS Eligibility Subsystem Rules Engine Yes MMIS Recipient NH, Waiver, BCC, Premium Asst, Custody,….etc Paper Mailed Real Time Scan-Data Entry Reason / Member No Member ID Assigned BH App NODOS Denial Letter E-NB1

What About Verifications? SSN Social Security Administration Agency Partners Pregnancy Function – who we are working with SSN verification – income verification - OSDH pregnancy exchange / WIC eligibility Citizenship / pregnancy verification-validation CSED – TPL info; non-preg adults with children have to play Interfaces NWD will interface with other agencies to verify client data and increase program integrity. Interfaces occur in batch processing or real-time. Results of the interface queries may Be sent to the user via on-line alerts or Trigger automated update to a client's record Require the user to assist in the disposition of the discrepancy. NWD will interface with SSA, OKDHS, OESC, and OSHD, among others. Income OK Employment Securities Commission (OESC) OSDH, Electronic Verification of Vital Events, Systematic Alien Verification for Entitlements Citizenship

Entered into System By Call Center Rep Manual Verifications Coversheet (From Website) Mailed Due Date ATN Name Case # HP Scanned to Workflow Entered into System By Call Center Rep

How Does One Apply? Home View Agency View Paper Application Agency Applying at Home Computer or Community Partner Home View Applying at Agency Partner Agency View Completing Paper Form Mail to HP For Scanning Paper Application Comprehensive Applicant Presents at County Office Agency Electronic

At-Home & Community Partner Options Programs Affected What is Needed FAQ’s Income Guidelines Tell Me More SoonerCare SoonerPlan Apply Now Manage Account Review Benefits Check Status Update Information

Agency Partner Options Search & Submit SoonerCare SoonerPlan View/Update Verifications Pregnancy Citizenship Identity Paper app process- EDS sun guard – entire state ~20000 Eligibility Alerts Certification Ending Domestic Violence Manage Member Review Benefits Check Status Update Information

Paper Application Mail Paper To HP Scan and Data Entry Rules Engine Paper app process- EDS sun guard – entire state ~20000 Rules Engine Letter-Notices-ID

Processing Continues for Additional Benefits Agency Electronic OKDHS Interface DHS Mainframe Rules Engine HTML Data Gathered Demographics gathered in Mainframe HTML transaction sent to OHCA OE Rules Engine Eligibility decision made and Enrollment completed Approval or denial reason returned Processing continues for additional benefits No Denial Reason Eligible? Processing Continues for Additional Benefits Yes Update Recipient Approval Welcome Letter

Electronic Notification of DOS Certify For Date of NODOS –5 days ID # Rules Engine Application NODOS Certify For Date of App No Patient on App? Yes Certify For Date of NODOS –5 days No 15 days NODOS? Yes

What Got Better? OLD WAY NEW WAY Apply 24hrs/7days Available: M/F, 8am-5pm Apply 24hrs/7days 20-30 Days For Results Real Time Eligibility Individual Policy Interpret Policy Uniformly Applied No Primary Care Provider Medical Home - Enrollment Process Differs By County Streamline Business Process Imprecise data Normalized data

Yeah…We’re Kickin’ Apps 232,527 Applications Received & Takin’ Names April – September 2011 232,527 Applications Received Opened/Extended 196,597 New Application 108,795 Recertification 87,802 Denied 35,930 New Application 33,805 Recertification 2,125

Source Average (6 months) April – September 2011

Source Trend (6 months) April – September 2011

Blizzard In Oklahoma Application Status Feb 1st Feb 2nd Total Denied 33 29 62 Opened 198 239 437 Total 231 268 499 Health Program New Apps Recert Total STBS 4 0 4 SoonerCare 354 378 732 SoonerPlan 32 12 44 Total 390 390 780 HOME INTERNET 87% Agency Electronic 10% Agency Internet 3%

“The Days the State Stood Still” February 3, 2011 Blizzard in Oklahoma! THE DAYS THE STATE STOOD STILL (Or Did It?) OE Enrolls 780 in SoonerCare with Virtually Every County Office in the State Closed! Governor Fallin declares Online Enrollment Days!

Be Careful What You Wish For eMPI – Client Numbering and Normalization Confusion – Applicants/Members/Partners/Co-workers Human Services – County Coordination is Imperative Call Centers – Staff Up! Organization – Enrollment Operation Structure Automation – Data Driven System (the good, the bad & the ugly) Conversion – Auto-populate what you don’t have Compatibility – Browsers and Pop-up Blockers Staffing – You’re going to need some experts! Design Outside Box – Generic Family & Optional Denial Letter

We Got Some Phone Calls

Online Enrollment -- Answer Rates

Online Enrollment Effect on Total Calls

Where Do We Go From Here? Phase II – Additional Populations Insure Oklahoma (Premium Asst) Oklahoma Cares (BCC) WIC Phase III - Health Insurance Exchange Affordable Care Act Partnership with Insurance & Health Department Rules Engine Modifications Phase IV – Enrollment Data Exchanges Other Agencies and Programs Interfaces with Welfare Programs, WIC,

Future – Gather and Verify Data, Rules Gather Family Demographics

Future – Apply Rules, Evaluate, Enroll Real-time Decision and Enroll Rules Engine Function – who we are working with SSN verification – income verification - OSDH pregnancy exchange / WIC eligibility Citizenship / pregnancy verification-validation CSED – TPL info; non-preg adults with children have to play Interfaces NWD will interface with other agencies to verify client data and increase program integrity. Interfaces occur in batch processing or real-time. Results of the interface queries may Be sent to the user via on-line alerts or Trigger automated update to a client's record Require the user to assist in the disposition of the discrepancy. NWD will interface with SSA, OKDHS, OESC, and OSHD, among others. Numbering Client

Future – Enroll, Distribute OKDHS Community Partners Real-time Decision and Enroll Recipient Database Insurance Exchange Function – who we are working with SSN verification – income verification - OSDH pregnancy exchange / WIC eligibility Citizenship / pregnancy verification-validation CSED – TPL info; non-preg adults with children have to play Interfaces NWD will interface with other agencies to verify client data and increase program integrity. Interfaces occur in batch processing or real-time. Results of the interface queries may Be sent to the user via on-line alerts or Trigger automated update to a client's record Require the user to assist in the disposition of the discrepancy. NWD will interface with SSA, OKDHS, OESC, and OSHD, among others. State Dept Of Health Native American Tribes

Did We Learn Any Lessons? As A Matter of Fact…We Did! It Really Does Take a Village Build Partnerships Keep Them Alive Design Tool – HP Wireframe Focus Groups/Application Flow A Variety of Approaches Are Critical Like “Esurance”, technology when you want it… people when you don’t.

Dustin Oxford Enrollment Automation Oklahoma Healthcare Authority 405-522-7141 Dustin.Oxford@okhca.org