1. Medicaid and CHIP Eligibility Review Pilot – Round 1
Robert Sugawara, Chief Program Review Branch California Department of Health Care Services August 20, 2014

2. BACKGROUND
The Department of Health Care Services is the Medicaid Agency in California
California chose to develop its own State-based marketplace – California Healthcare Eligibility, Enrollment and Retention System (CalHEERS)
Pre-ACA – approximately 7.5 million beneficiaries
Current – approximately 10.9 million beneficiaries

3. BACKGROUND (CONT.)
California has three county-based eligibility systems collectively referred to as the Statewide Automated Welfare System (SAWS)
LEADER
CalWIN
C-IV
The Medi-Cal Eligibility Data System (MEDS) is California’s data repository for all Medicaid, APTC/CSR and other public assistance programs

4. KEY ASPECTS OF ROUND 1 PILOT
Title 19
Title 21
Active: 8
Negative: 8
Total:16
Active: 43
Negative: 43
Total: 86
Total Sample Size Per Quarter: 102
December 2013 and March 2014

5. KEY ASPECTS OF ROUND 1 PILOT (Cont.)
Eligibility
Liability
Pertinent Information
Error Types
Reviews were performed at the individual vs. case level

6. STAFFING
19 full-time staff statewide performing reviews * * * * * *

7. TIMELINE Round 1 Template Approval Pulled Sample Ongoing Training
March 25, 2014
Round 1 Template Approval
April 11, 2014
Pulled Sample
April 2014
Ongoing Training
May 2014
Reviews Began
June 2014
Reviews Completed

8. KEY CHALLENGES CalHEERS and E-HIT Functionality Policy Changes
Staff Training
Covered California and County Consensus

9. PRELIMINARY ROUND 1 RESULTS
Error Rate
Errors by Type
Causes of Errors

10. LESSONS LEARNED Lesson Learned Define Errors Differently
Greater Internal Quality Controls
Better Coordination with Business Partners
Intensify Staff Training

11. QUESTIONS?