Tuesday, 21 August 2001 Evaluation Present: Bill Wood, Supin Wongbusarakuum, Andrew Aoki, Piilani Pang, Ruth Ota, and Barbara Luksch Next meeting: 29 November 2001 at 9:00 AM at HPCA Conference Room 1. We brainstormed ideas for Hawaii Covering Kids Phase II * extend profiling process * marketing, similar to Kids Health Insurance Week, should be done every four months * add questions to existing community surveys * organize an immigrant advisory group * become a national model for Asian and Pacific Islander outreach * emphasize HMSAF grant as an example of the original project stimulating community support and the indirect contributions of DOE and DOH. * enrollment drives through businesses; coordinate with health insurance plans 2. Qualitative Questions for Electronic Application Barbara will work with the Maui and Big Island Pilot Projects to use these questions with customers: a. What did you think of the electronic application process? b. Would you recommend it to other persons? 3. Update from 27 July 2001 Meeting Dee Helber (DOE), Ruth, and Barbara met to discuss their plans for emergency card data collection. Dee will call principals at schools that do not have 100% of their emergency cards. Barbara will contract a temporary agency to assist school health aides at larger schools and Ruth will develop the specifications for the temporary assistants. Partners Against Asthma Coalition is researching scanning technology for Form 14 and emergency cards. A suggestion from Bill is to convert documents to barcodes and then scan. 4. Data Mapping UH graduate student Li Zou is mapping our data and preliminary maps will be shown at the next meeting. 5. Hawaii Covering Kids Data Project Update Bill distributed handouts that showed school profile information available on DOE's web site and preliminary health insurance data for school year 2000-2001. The Year 2 report should be completed by mid-September. We discussed the following: * contacting Dee Helber to learn what forms parents/guardians complete when registering a child for school * expanding the DOE profile information in the pilot project areas to include profiles of the uninsured versus insured for the Year 2 report * public health nurses will collect health insurance data on clients they serve Bill and Ruth will present data information at the Governor's Interdepartmental Council Meeting on 14 September 2001 (Barbara is attending the Covering Kids Annual Meeting in Washington, D.C.). Wednesday, 29 August 2001 Oahu Outstationed Eligibility Workers (OEWs) Present: Ann G. Tam Sing, Stephany Vaioleti, Kreaa Miyasaki, Hiro Hara, Gloria Samson, Cassandra Stewart, Regina Quimpo, Lucy Ndirangu, Ronnie Taamu, Alan Takahashi, Teri Roe, and Barbara Luksch 1. Med-QUEST Office Update * The QUEST cap will be reinstated effective 1 September 2001. * QUEST dental will convert to fee-for-service effective 1 October 2001. The rates paid to dentists will increase and MQD will ease up on prior authorization requirements. They are also looking at using ADA claim forms, codes, and processes. An RFP is out to hire a Care Coordinator on each island to assist customers in locating dentists and Cynthia Nishimura (692-8110) will also help kids find dentists. * QUEST II for aged, blind, and disabled persons is scheduled for July 2002. * TANF and Medicaid delinking takes effect 1 November 2001 with MQD eligibility worker training in early October. MQD agreed to present information at the next Hawai'i Covering Kids state coalition meeting on 8 November 2001. * Congratulations to Alan Takahashi who is Med-QUEST's Employee of the Year. 2. Application Simplification and Renewal Simplificaiton Workgroups Barbara gave an update: * The workgroups will meet with Susan Chandler and Aileen Hiramatsu on September 5 to review their progress. * Only one signature will be required on the application. * The application will eliminate forms 1247 and 1247a by including information in the Rights and Responsibilities section. * The renewal form will be different than the application. It will include information already in HAWI and simply ask for updates. * OEWs will be asked to field test draft versions of the new forms before they are finalized. 3. Self-Declaration of Income Med-QUEST does not require income verification at the time of application, however they may request it after the customer is enrolled. Barbara stated this is not self-declaration but "delayed declaration" which is confusing to customers. Until real self-declaration is implemented, OEWs should submit income verifications with the applicant's other forms. 4. The Term: Outstationed Eligibility Workers Med-QUEST's PPDO will not use this phrase because OEWs do not determine eligibility. At one point they suggested calling them application assistants but this title refers to persons in the community who assist applicants with Form 1100 only (e.g. staff from WIC and Head Start). Barbara suggested we continue using outstationed eligibility workers because this is the common title used nationwide by state and community groups. 5. Outstationed Workers Guidebook Ann G. reviewed the first draft of the guidebook. The goal is for all Med-QUEST offices and OEWs to give the same information to customers. * It does not include foster children, prison information, or details on persons who are institutionalized. * We noted that in the past we referred to persons who arrived after 22 August 1996 but as of last week must say "have been in the country five years." * Ann G. asked for suggestions, questions, and clarifications by email attachment no later than 21 September 2001. * We need questions for the Frequently Asked Questions section. * Barbara will mail copies to with instructions to OEWs who could not attend the meeting. * The final version will be in a 3-ring binder so updates can be periodically added. 6. Electronic Application Update The Hawaii Covering Kids Maui Pilot Project outreach worker, Amy Rosenberg, is working with Barbara and CyberCom to fix minor bugs. Also, when the simplified application is complete, the e-app will be reprogrammed and other forms will be updated. 7. Sending Applications by Mail Regina was concerned about Med-QUEST receiving mailed applications and eliminating the health center's expense of sending them certified return receipt. It was suggested the original be faxed and the fax confirmation saved. Also, the OEWs should work with the MQD eligibility workers to preserve the first date. 8. Foreign Students' Children Unfortunately, due to their visa status, these children are not eligible for public health insurance and their health needs are impacting the North Shore Community Health Center's finances. The group suggested a community meeting be held to devise solutions to the problem and find health insurance options for these families. 9. Mahalo Applications are being processed faster and communication between MQD eligibility workers and OEWs has improved tremendously. We thanked each other for great teamwork! Wednesday, 5 September 2001 Application Simplification and Renewal Simplification Present: Susan Chandler, Aileen Hiramatsu, Beth Giesting, Ann G. Tam Sing, Pearl Tsuji, Barbara Luksch, Ruth Ellen Lindenberg, Liane Hiramoto, and Melba Bantay Next Meetings: Rights and Responsibilities Committee 9 October 2001 at 2:00 PM at HPCA Conference Room; Renewal Simplification Workgroup 16 October 2001 at 2:00 PM at HPCA Conference Room 1. Purpose The meeting was organized to review work done by the Application Simplification Workgroup and Renewal Simplification Workgroup with Susan Chandler, Director of the Hawaii State Department of Human Services and Aileen Hiramatsu, Med-QUEST Division Administrator. 2. Renewal Workgroup a. The workgroup has met four times since March and attended a Covering Kids Regional Meeting together to garner ideas for producing a simplified form. b. The process has been renamed from redetermination to renewal to be consistent with assisting people and help destigmatize Medicaid. The person is renewing a health insurance plan. c. Barbara noted data received from Med-QUEST on cases closed for children and youth ages 0 to 19 years. The major reasons were eligibility requirements not met (average 369 cases per month) and failure to provide required information (average 334 cases per month). We focused on solving these problems when designing the simplified renewal form. d. Ann G. explained that after 2-3 days the case is closed and a new application must be submitted for the person(s) to be reinstated. Not only does this result in a break in health services for the customer, but also extra work by MQD's eligibility branch due to churning. e. We reviewed Draft #3 of the simplified renewal form. The goal is to eventually generate the form from a computer. Highlights of the new form include: * friendly letter * easy to understand information * current information provided by Med-QUEST * no signature required (CMS does not require this because a signature is on the original application) MQD is concerned that there is no record of signing and an eligibility worker has not talked to the customer, therefore a signature will be required. 3. Application Simplification Workgroup a. The workgroup has met five times since September 2000 and there were several committee meetings inbetween to work on specific aspects of the new application. b. We reviewed Draft #9 of the simplified application form. Highlights of the new form include: * fifth grade reading level with easy to understand questions * easy to translate into other languages * larger font size and bigger boxes * checkboxes wherever possible * only one signature (the applicant) * Rights and Responsibilities written in simple language on a separate page that the customer will keep for reference * eliminate EPSDT checkbox because it is a benefit not a choice; information included in Rights and Responsibilities * eliminate the car insurance question because it is only required after the applicant is enrolled and if there is an accident involving a motor vehicle; CMS recommended deleting this section and using a process similar to Medicare * eliminate forms 1247 and 1247a; put the information in the Rights and Responsibilities section. c. There is still a problem: it is too long if the application is for a child or pregnant woman only. We must address this issue. d. Med-QUEST suggested eliminating question #11. Many states include this to better understand what outreach methods work but there is no way to currently track outreach data on the HAWI system. e. The group decided questions #2 and #4 should be combined-this was mentioned at the last Application Simplification Workgroup meeting and will be done in Draft #10. Also, birthdates should be written like the current 1100. 4. Next Steps a. Renewal Form: MQD will write comments and submit them to Barbara within two weeks, the workgroup will meet to review the comments and make changes, the Kona Med-QUEST office will field test the new form, and eventually it will be implemented statewide. b. Application Form: MQD will write comments and submit them to Barbara within two weeks, the workgroup will meet to review the comments and make changes, and Hawaii Covering Kids Pilot Project outreach workers will field test the new form. Also, the Rights and Responsibilities Committee will meet to write a chart that customers can understand and is acceptable to the Attorney General's office. Finally, instructions must be written and field tested before it can be implemented statewide. 5. Barbara's Biggest Fear Barbara expressed concern that after long hours spent by the workgroups' members, the application and renewal forms might go to Med-QUEST's Policy and Program Development Office and be completely revised. The members hope the group process will be respected and their time and energy not dismissed.