Tuesday, 8 August 2002 Evaluation Present: Ruth Ota, Charlene Gaspar, Piilani Pang, Marcia Hartsock, Liz Ahana, and Barbara Luksch Next meeting: TBA The purpose of the meeting was to review the report by Market Trends Pacific, Inc. and Dr. D. William Wood, "A Focus Group Study of Uninsured Children in Hawaii," and clarify technical language prior to publication. 1. Background Information The Hawaii Covering Kids Evaluation Task Force designed the focus group questions after reviewing similar studies done by other states and the Covering Kids national program office. The task force members believe that customers affected by the programs should be involved in critiquing them and it would be helpful to the project's statewide outreach and simplification efforts to gather information from a first person's perspective. 2. What Parents and Guardians Are Trying to Tell Us We reviewed the report and listed the following: a. Health insurance for their children is extremely important to them. b. They feel severe financial stress, especially when choosing between basic needs and health insurance. c. If a child does not have health insurance, it can impact her/his development because the child is often not allowed to participate in activities that could cause injuries. d. Some feel shame in applying for Med-QUEST's programs and come to the process with preconceived notions. e. The application and renewal processes are barriers to obtaining and retaining health insurance for their children. f. When applying for QUEST or Medicaid, they appreciate workers who are caring and sincere about wanting to help them. 3. Report Review We discussed technical wording that should be clarified. For example, since dental benefits are covered by public health insurance, we assumed a parent's quote was referring to private health insurance and inserted this in parentheses. Barbara will send the recommended changes to the researchers for their review. 4. Med-QUEST's Comments Aileen Hiramatsu submitted a letter and suggested comments from Med-QUEST. These were forwarded to the researchers. Tuesday, 20 August 2002 Process Simplification Present: Charlette Resinto, Ui Nakagawa, Joanna Fong, Eiko Cusick, Hiro Hara, Piilani Pang, Lynn Fallin, Wanda Kakugawa, Barbara Luksch, Tiffany Gomes, John Ishoda, Tugalei Soa, Airleen Lucero, Bill Wood, Lisa Kahahane, Michael Epp, Beth Giesting, Mary Rydell, Jason Sanders, Alice Fares, Michelle Malufau, Suzanne Chun Oakland, Susan Chandler, Joele Alameida, Dennis Arakaki, Dee Helber, Will Maauga, and Stephany Vaioleti. Next meeting: TBA 1. Welcome and Introductions Barbara welcomed everyone to the meeting and participants introduced themselves. Handouts available included background information on the qualitative assessment study, process simplification matrix, and a report by Center on Budget and Policy Priorities titled "Allowing Families to Self-Report Income: A Promising Strategy for Simplifying Enrollment in Children's Health Coverage Programs." 2. Presentation: "A Focus Group Study of Uninsured Children in Hawaii" Wanda Kakugawa, president of Market Trends Pacific, Inc. and Dr. D. William Wood, University of Hawaii at M"noa researcher, presented their findings. 3. Discussion Participants made the following points regarding the study and recommendations: a. The study's findings are consistent with community workers' experiences. b. Med-QUEST's goal should be the same as Hawaii Covering Kids: find, enroll, and retain eligible persons in QUEST and Medicaid. c. Families need help with application and renewal forms because they are too complex and only in English. d. Customers develop a relationship with outreach workers, therefore they feel comfortable working with them. e. The number of applications received by Med-QUEST has increased dramatically the past two years, however the number of eligibility workers has not kept pace. Too many cases and not enough staff affect customer service. f. CMS allows states to implement self-declaration of income and assets. The federal government does not reward states for quality control rates because the state's role should be to help applicants. g. Kaua'i outreach workers who field tested the new simplified application form in May and June found it much easier to help applicants complete. h. Med-TANF Delinking money--approximately $10 million with 75-90% matched by the federal government--is available for community organizations to hire outreach workers. Many states have taken advantage of this excellent resource and it not only helped families, but also eligibility workers' efficiency because more complete applications were submitted to Medicaid offices. i. DOH's bilingual aides are helping many families with applications due to language barriers. However, this is not their primary responsibility and money should be allocated to hire bilingual community workers to assist customers in completing Med-QUEST's forms. j. Some outstationed eligibility workers focus their time and energy on systematic compliance by Med-QUEST workers. They work within the bureaucracy to get applications processed using simplified procedures. k. Budget issues should be brought to the attention of the legislature rather than allow them to dictate procedures. 4. Urgent Priorities The matrix handout lists process simplification activities that must be completed by this task force: a. Develop a simplified application form. (Note: the Application Simplification Workgroup has been meeting and advocating for two years to get a new form). b. Eliminate unnecessary documentation and verification requirements. c. Eliminate requirement that a newborn be added to an existing case by completion of a new application. d. Reduce income verification requirements. e. Eliminate forms 1247 and 1247A by including this information in the "Rights and Responsibilities" section. f. Develop a simplified renewal form. (Note: the Renewal Workgroup has been meeting since March 2001). g. Implement an electronic application. h. Eliminate automatic referrals to Child Support Enforcement Agency. i. Med-QUEST accepting DOH's "Voluntary Establishment of Paternity by Parents" form in place of Form 1301. Monday, 26 August 2002 Application Simplification Workgroup Present: Waynette Cabral, Jeffrey Young, Diana Tizard, Liane Hiramoto, Barbara Luksch, and Cassandra Stewart 1. Kauai Field Test Report Field testing was held during May and June. Med-QUEST eligibility workers and staff from community agencies submitted responses to the simplified application questionnaire. There were 196 completed applications sent to the Kauai Med-QUEST office. The most frequent favorable comments were: "more spaces provided," easier to complete," "less cluttered," print is bigger," "checkboxes made it easy," and "questions were simple and easy to understand." Suggestions for improvement included: "too many pages," "repetitive questions," "could not identify household members who need to be on the form," and "income and asset questions are confusing." 2. DHHS Office for Civil Rights (OCR) Comments a. Social security numbers and citizenship information should specifically state in each area that they are not required for non-applicants. b. There should be information on why these questions are asked: 2, 5, 7, and 8. c. Applicants should be informed of their right to file a complaint with DHHS OCR with an address and telephone numbers. 3. Cover Letter Information must be included so the applicant knows where to mail the form and who to contact for help. It was decided that the back of the "Rights and Responsibilities" page will include a list of all Med-QUEST offices and telephone numbers. This page will be printed as a tear off section so the applicant can keep it for reference. 4. Color Med-QUEST decided to use buff because it can be read when faxed and can be distinguished from other forms. 5. Final Draft We revised questions according to field tests and DHHS OCR. Med-QUEST's planned implementation date is October 1. Monday, 30 September 2002 Training and Public Education Present: Jeffrey Young, Barbara Luksch, Cassandra Stewart, Liz Ahana, Pearl Tsuji, Dawn Reppuhn, Alan Takahashi, and Arnold Villafuerte Next Meeting: TBA 1. Review Current Video We watched the video "Completing the Med-QUEST Application" that was produced in 2000 to see the format. 2. Discuss Revisions for the New Application Barbara distributed copies of the new simplified application and we discussed changes to the script. 3. Next Steps Barbara will email a draft to the task force members for their review, a final script will be given to Leah Kihara for the new production, and copies will be distributed to state and community organizations. Note: those who previously bought a videotape will get a new copy for free. Others can purchase them for $6.00.