States experiment with electronic Medicaid and SCHIP apps
While conventional wisdom suggests that not many people who receive health care through Medicaid or State Children’s Health Insurance Programs (SCHIPs) are computer literate or have access to computers, states are reporting good results in experiments with on-line applications for the health care programs.
Legislation has been introduced that would give states grants to develop web-based enrollment systems. Brendan Krause, a policy analyst for the Washington, DC-based National Governors Association, tells State Health Watch that development of the electronic applications is consistent with state movement toward a more technological culture in which state web sites are used to provide information about and access to a number of services.
While there may be questions about computer access and literacy, Mr. Krause says, some states are surprised at the number of applications received electronically.
The pioneer state for on-line application process was California, which first made its Health-e-App available for the state’s Medicaid and SCHIP programs in San Diego County.
That on-line application was created by Deloitte Consulting under contract to the California Health Care Foundation. It allows enrollees to apply on-line with the assistance of Certified Application Assistants who work primarily at community-based agencies and help some 60% of Medi-Cal and Healthy Families applicants to enroll.
A statewide rollout of Health-e-App should be completed by the end of the year.
Health-e-App is available in both English and Spanish and takes 20-30 minutes to complete. It has a read-aloud version for use by those with limited vision and uses an electronic signature pad for application authorization.
The system generates a fax cover sheet with a bar code that is used to match faxed income and birth certificate documents with the rest of the application. Those paper documents are turned into digital images so the entire application file is electronic. An initial eligibility determination is made in real time.
Consumers like on-line format
State officials say that Health-e-App is linked to an updated database of participating providers so enrollees can select health plans and primary care providers more efficiently.
"The greatest benefits of the system are just now being realized," Mr. Krause says of Health-e-App. "Administrative efficiency increases could be substantial if fewer applications have to be processed by the mail center, fewer require data entry and paper filing, and if tracking applications is made easier. Based on feedback surveys, consumers prefer the Health-e-App process because they get immediate information on their likely eligibility and confirmation that their application has been received."
The Health-e-App model also is being tested in Pima County, AZ. Deloitte Consulting again worked with Arizona’s Health Care Cost Containment System, the state Department of Economic Security, and Community Health Centers Collaborative Ventures to modify the California version to meet Arizona’s unique requirements.
California Health Care Founda-tion program officer Claudia Page says she was "pleased that our investment is being leveraged by another state to make its enrollment process more efficient for both administrators and consumers."
And Phoenix El Rio Health Center executive director Robert Gomez says that licensing Health-e-App from the foundation "allowed for rapid implementation of an application that will fundamentally change the way we provide services in our communities."
In its first year of operation, the on-line enrollment system for PeachCare for Kids, Georgia’s SCHIP program, processed more than 29,000 applications and won positive feedback from consumers.
The on-line process provides parents with a more convenient mechanism for applying, eliminates mail delays, and gives instant feedback about likely eligibility. Its launch in April 2001 followed funding increases by the governor and legislature to cover children the first day in the month that they apply.
The web-based system coordinates with the program’s eligibility system and was developed in less than four months by PeachCare staff and staff with the program’s third-party administrator. The on-line application is available in English and Spanish and takes 22 minutes to complete. Parents can log in and out, allowing them to work on the application over a period of time.
Mr. Krause reports that parents can use the web site to update their addresses at any time. "Smart" software stops incomplete applications from advancing past key prompts and stops categorically ineligible applicants from submitting an application. The server updates eligibility every two minutes at a minimum, providing application processing in almost real time.
Data submitted through the web site are protected with firewalls and encryption. The server that collects the applications does not retain any income or account information, and confidential information is moved continually to a secured internal server.
Reducing enrollment delays
PeachCare for Kids program director Jana Key tells State Health Watch that the state wanted to reduce the time delay in enrollment, wanted to increase access to health care services, and wanted a system with edit checks to be sure that all applications are complete.
A one-page paper application PeachCare was using was designed to meet literacy standards and the on-line application tracks that form, she says.
About half of the 29,000 on-line applicants completed a feedback survey that praised the new system’s convenience and accessible information. Parents working night shifts or long hours said they appreciated the way the system let them fit applying for benefits into their schedule.
State officials said they were surprised to find that half of the on-line applicants who qualified for benefits were Medicaid eligible, compared to 25% using paper applications who are Medicaid eligible.
Twenty-three percent of parents said they would not have applied for PeachCare that day, if at all, if it were not for the on-line application.
Most on-line applicants were referred to the web site by PeachCare staff, with friends and family providing the second highest number of referrals, and most submitted their applications from a home computer.
Pennsylvania has created its Commonwealth of Pennsylvania Application for Social Services (COMPASS) as part of an initiative to make government services more accessible electronically.
Ultimately, COMPASS will provide on-line applications for most services covered by the state’s Department of Public Welfare, including health insurance, food stamps, cash assistance, day care, Low-Income Energy Assistance Program, long-term care, work supports, and mental health/mental retardation services.
The first element — an on-line application for use with children applying for Medicaid and PaCHIP — was developed and released in fall 2001. The application was developed for the state by Deloitte Consulting.
Department of Public Welfare spokesman Jay Pagni tells State Health Watch that the impetus was primarily to improve customer service by providing an alternative for individuals to use to apply for services for themselves or for others with whom they are working through community-based organizations.
As is typical, the application takes about 30 minutes to complete and families have up to 30 days to complete it, being able to log in and out of the system and not have to finish it in one sitting.
Early analysis indicates that most applications are being submitted by individuals rather than by outreach organizations submitting applications for individual applicants. Administrative cost savings were not a goal and have not been measured. Staff did not expect a significant increase in enrollments and none has occurred.
On-line vs. off
Mr. Krause says an initial evaluation of Texas’ on-line application found a higher number of complete applications submitted using the on-line form, 90% compared to 60% using paper applications. State officials say they are happy with usage of the system, particularly by higher-income SCHIP-eligible applicants, but are hoping to increase system utilization among applicants who are between 100% and 150% of the federal poverty level.
According to Mr. Krause, states interested in pursuing on-line applications should take these steps:
- Form development groups across agencies that have program authority or that must approve information technology projects to determine and address organizational differences.
- If permitted by law, consider an application that either requires no signature or accepts an electronic signature.
- Choose pilot site test populations that represent people who will actually use the system.
- Recognize that people using on-line systems expect a quick response and create a system that can communicate with the state’s eligibility system on an ongoing basis, rather than overnight or with a batch of applications.
- Create a secure system to protect applicants’ privacy.
Meanwhile, U.S. Rep. Adam Schiff (D-CA) introduced legislation that would provide $50 million to help states develop web-based enrollment systems for Medicaid and SCHIP. States also could receive information and technical assistance, including information on Health-e-App. Grants would be paid across five years, starting in 2003.
[Contact Mr. Krause at (202) 624-5367, Ms. Key at (404) 657-9506, and Mr. Pagni at (717) 787-4592]
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