Tuesday, 1 July 2003 Application Simplification Workgroup Present: Maile Shimabukuro, Eiko Cusick, Jeffrey Young, Cassandra Stewart, Liane Hiramoto, Melba Bantay, Sharon Gibson, and Barbara Luksch Next meetings: 26 August 2003 at 9:00 AM (topic: passive renewals) and 3 September 2003 at 10:30 AM (topics: children and pregnant women application field test results and final draft and correcting Rights and Responsibilities sections) 1. Med-QUEST issued a memo that allows acceptance of faxed and electronic signatures without an original signed application delivered to their eligibility offices. 2. Liane has kept Lee-Ann Brewer from the AG's office informed of our progress with the separate application for children and pregnant women (form 1108). 3. Field test procedures for the children and pregnant women application: a. Dates are 21 July to 22 August and locations are Kahuku, Kauai, and Waianae. b. Liane will write the letters and surveys for the outstationed eligibility workers (OEWs); Barbara will meet with OEWs in each location to explain the new application and implementation. c. Cassandra's unit will process the applications received on Oahu. d. We will review the test results at our September 3 meeting and it will be published for general public use by November 2003. 4. Electronic application programming: Phase 2 is postponed until the children and pregnant women application is official. 5. We reviewed and rewrote information on page 6 of form 1108. It includes common questions and answers for pregnant women and children about the application process and a list of important resources. Melba explained the new name for the federal immigration office is Bureau of Citizenship and Immigration Services and their telephone number is 1-800-375-5283. We also added a section to Question 1: "What language do you speak best?" 6. Rights and Responsibilities a. Pat McManaman of Na Loio sent corrected wording for citizenship: Those persons applying for assistance in my household are U.S. citizens, U.S. nationals, lawful resident aliens, citizens of the Federated States of Micronesia, Marshall Islands, or Palau, refugees, asylees, persons granted withholding of removal or paroled for at least one year, battered children or children of battered spouses with a pending or approved spousal visa or petition for relief under the Violence Against Women Act when the need for benefits is substantially connected to the battery or cruelty, dependant children of active duty military, Cuban, Haitian, or Amerasian entrants, persons permanently residing under color of law, or otherwise authorized by law to receive assistance. b. Sharon questioned wording of the last sentence in the EPSDT section. Note: following the meeting, Med-QUEST agreed to change the wording to: "If requested, I may also receive help with scheduling appointments and transportation for EPSDT services." 7. Renewals Passive renewals will be discussed more in-depth at our 26 August meeting. However, we talked about the need for a renewal form that is computer generated and automatically mailed (currently labels are computer generated but Med-QUEST workers manually stuff envelopes and mail forms), and possible follow-up by the health plans to assure preventive services are used. We will request updated data from Med-QUEST on the number of 2003 cases closed with children due to "failure to provide information" (2001 data average was 482). Tuesday, 29 July 2003 Training and Public Education Task Force Present: Mary Jane Jacinto, Adrienne Dillard, Kimberly Mokuahi, Po Kwan Wong, Cassandra Stewart, Gwen Palmer, Jacqueline Rose, Barbara Luksch, and Melanie Migvar. Next meeting: TBA The purpose of the meeting was to plan community training workshops for workers who interact with families. The goals of the workshops will be: 1) Teach community members how to help customers complete Med-QUEST's application with a focus on enrolling children and youth and 2) Identify barriers and possible solutions to enrollment. The trainers will be local Med-QUEST supervisors and Linda Colburn. Barbara will organize and facilitate the sessions. 1. Barbara explained The Samuel N. and Mary Castle Foundation and DHS are providing funding to conduct the workshops. We did similar trainings at the Malama i na Keiki 4 conference in June and will subsequently take our show on the road. Information from other states, including Maine, West Virginia, Arizona, and Washington, were discussed and handbooks perused. 2. We watched the video on Med-QUEST's programs and completing the application. The latter was recently updated for the simplified 1100. Each workshop participant will receive a copy. 3. Participant packets will include a flyer, sample applications (1100 and 1108) and other forms mentioned in the video, reapplication form (1100B), Hawaii Covering Kids application cover letter, video scripts, and Med-QUEST's brochure with information on the health plans. We will use different colored paper to distinguish photocopied handouts. 4. Additional Information for Presentations a. Which form to complete--explain buff (1100), pink (1108), and green (1100B) b. Self-declaration for income and assets c. Review income questions d. Choosing a health plan e. Compile common questions and answers from Hawaii Covering Kids application cover letter, form 1108, and Malama i na Keiki 4 f. Explain forms to complete in special cases such as when someone is released from incarceration and when a child in foster care returns to a parent's home 5. Adrienne of Papakolea Community Center offered to help organize our first workshop in early November. A full schedule in locations statewide will be developed after we test the curriculum by conducting a few sessions. We will also train staff at agency meetings. Tuesday, 26 August 2003 Renewal Simplification Workgroup Present: Jean Kohashi, Noe Foster, Diane Taira, Cassandra Stewart, Jeffrey Young, Barbara Luksch, Mary Rydell, Aileen Hiramatsu, Michelle Malufau, Lillian Koller, and Charlette Resinto. Next meetings: 3 September 2003 at 10:30 AM (topics: children and pregnant women application and "Rights and Responsibilities" section on all applications) and 22 September 2003 at 2:00 PM (topic: implementing passive renewals) 1. Our outcome is that all eligible children and youth enrolled in QUEST and Medicaid will maintain their benefits without interruption. Our indicators are: 1) Number of Med-QUEST (MQD) cases with children and youth that are closed per month due to failure to provide information is 0 and 2) Customers must only renew their Med-QUEST health insurance every 12 months. 2. Work on this outcome began in March 2001 and was initiated by a Covering Kids & Families regional conference attended by three Med-QUEST representatives (Ann G. Tam Sing, Pearl Tsuji, and Florence Ashihara), Barbara Luksch, and Beth Giesting. The conference highlighted retention work done in other states, including self-declaration, preprinted forms, and friendly letters sent by Medicaid offices. There were seven workgroup meetings held, including one on 5 September 2001 with the previous DHS director, MQD administrator, and Process Simplification Task Force members explaining a recommended passive renewal procedure. Med-QUEST decided passive renewals were not possible with the current computer system and they published a reapplication form in February 2003. The reapplication process also requires copies of all income and asset documentation accompanies the reapplication. 3. It is important for children to retain health insurance because to keep them connected to their health plans and primary pediatricians and continued access to preventive health care. Also, outreach workers and eligibility workers work extensively to initially enroll them in the programs, therefore it is cost effective for the state to prevent churning (disenroll and enroll again). 4. Lillian emphasized the administration's philosophy is to find, enroll, and retain all eligible people in MQD's programs. They do not mind enrollment numbers increasing because cost containment can be achieved through alternative methods. 5. The most recent data available to the workgroup on cases closed with at least one child under 19 years old participating in QUEST or Medicaid are May 2001 through February 2002. An average of 469 cases were closed monthly due to failure to provide information which means approximately 11,000 children and youth are disenrolled yearly due to procedures. Application Process 6. Med-QUEST currently uses delayed declaration for income and assets. They do not request the information when an application is submitted, however they perform "backend verification." This means customers must keep all pertinent statements in case a MQD worker contacts them. This procedure is confusing to customers, therefore it was suggested that MQD either use self-declaration or require complete documentation with an application. Lillian said Med-QUEST should pilot test self-declaration with random sample follow-up through existing databases (Department of Labor, IRS, Social Security Administration, etc.) to determine if it adversely affects error rates. Barbara will research other states that use self-declaration including the number of new enrollees and error rates. Renewal Process 7. Jeffrey explained that statewide ongoing units send out approximately 6,000 reapplications per month. Aileen will research how many Med-QUEST cases are children only, adults only, and children plus adults as well as inform the workgroup on the current error rates for QUEST and Medicaid programs. The health plans will check on the number of children and youth they re-enroll yearly. 8. We discussed a simplified renewal procedure for all children and youth in QUEST and Medicaid. Ideally it will be a computer-generated form with current customer details. If there are changes, the parent or guardian writes the information, signs it, and returns the form to Med-QUEST. If there are no changes then no action needs to be taken. This would also allow time for Med-QUEST to perform more quality work on IEVS reports. States requiring signatures on renewal forms must do very aggressive follow-up including a postcard sent two months prior to the renewal date explaining the upcoming procedure, a renewal form with a self-addressed stamped envelope sent one month prior to the renewal date, a call from the Medicaid office ten days after the renewal form was sent if the form had not been returned, and a home visit/final call/email reminder before the case is closed. 9. Noe explained that through AlohaCare focus groups on Oahu and the Neighbor Islands, members commented that often families do not immediately open their notices because they know they are covered and it is not a current priority.