Tuesday, 4 January 2005 Renewal Simplification Workgroup Present: Anne Pierce, Maile Aquino, Mary Rydell, Rochelle Sparko, Stephany Vaioleti, Barbara Luksch, Susan Chung, and Kookie Moon-Ng Next meeting: TBA 1. Updates: General a. Susan will submit a modification request for the revised regular renewal form. A copy can be downloaded at Passive Renewal Information. (Update on 27 January 2005: The modification request was assigned and a write-up was created and is being reviewed). b. Anne will check on AlohaCare upgrading its computer system to track renewal dates. c. Benefit, Employment, and Support Services Division (BESSD) issued a request for proposals to upgrade the Hawaii Automated Welfare Information (HAWI) computer system they share with Med-QUEST. The goal is to create computer-accessed Income Eligibility and Verification System (IEVS) reports, however the project is on hold because they are researching a less expensive and better method developed by Utah called eFind. eFind is a single web application that provides eligibility workers with filtered, organized information from many different federal, state, and local data sources to determine eligibility for public assistance programs. 2. Reducing Cases with “Whereabouts Unknown” a. Happening! * Outstationed eligibility workers use revised “Change Report Form” (1179). * Enrollment Call Center staff asks each customer to confirm her/his mailing address and telephone number when she/he calls. * Hawaii Covering Kids created a change form with questions community organizations can review with the customer, write changes, and make sure it gets to the local Med-QUEST office. Note: this suggestion was from a community organization that conducts home visits. * Continued use of reminder postcards (Hawai‘i Covering Kids Kahuku Local Project) and letters (Hawaii Covering Kids Kaua‘i Local Project). b. Down the Road * Revised Med-QUEST forwarded mail policy to be issued in January 2005. (Note: it was distributed to Med-QUEST eligibility supervisors on 01/24/05). * An enrollment call center staff member will have access to HAWI’s address screen (ADDR) using her/his personal logon profile so changes can be efficiently entered directly into the computer. * Med-QUEST Eligibility Branch staff voicemail messages will ask callers for a current address as well as telephone number. * Med-QUEST eligibility workers will check addresses and telephone numbers whenever they talk to a customer. * A one-page form sent to QUEST and Medicaid providers with the headline “Help Us Help You Get Paid.” Most health care providers verify a patient’s address and telephone number during each visit and could fax changes to the local Med-QUEST office. 3. Kahuku Local Project: Renewal Postcards Update Stephany explained data from four months of implementation: * 59 postcards mailed (30 cases with children and 29 adult-only cases) representing 70 customers. * 49 (83%) renewals completed representing 54 customers (32 children and 22 adults). Note: 7 adults not renewed due to excess income, whereabouts unknown, excess assets, and employer-sponsored health insurance. 9 children not renewed because family was over income. * 8 (14%) postcards returned due to address changes; outreach and inreach workers sent “Change Report Form” (1179) to Med-QUEST for each customer. Follow-up telephone calls to customers about the postcards found favorable results. Customers commented that the postcard was easy to understand, it alerted them to expect a renewal form from Med-QUEST, and they knew to contact the Kahuku Local Project for assistance. Also, they found the renewal form simple and easy to complete. 4. Oahu Ongoing Unit III Data a. Table 4: Closures by Reason “Did Not Complete Procedures” is defined as not complying with what Med-QUEST required of the customer so it could determine eligibility. The number for August 2004 (33 cases with children during the renewal process representing 12.8%) appeared high considering the passive renewal process. Jeffrey later reviewed the cases and corrected the total number to 251 and the number of cases closed with children during the renewal process to 25 (10%). We noted the April 2004 and May 2004 data for whereabouts unknown were extremely high (176 and 166 respectively). It was explained health plan change notices were mailed by Med-QUEST on 23 April 2004 so these numbers reflect returned envelopes. b. Table 5: Cases Closed at Renewal We will wait for one full year of data since passive renewals were implemented in June 2004 to analyze this data. 5. Random Sample Follow-Up Results It was noted that Med-QUEST must conduct random sample follow-up for cases with children to monitor quality control for its passive renewal process. a. These cases were added to renewed column: * Child Returned to Mother’s Active Case * Receiving TANF b. What to do about: * No Longer Foster Child: There is a reporting procedure for Social Services Division to alert Med-QUEST when a foster child is removed from this status. Many foster children who are returned to their parent’s custody remain eligible for public health insurance and are added to the active household case. Barbara will organize a meeting with the Process Improvement Collaborative and Amy Tsark from the Social Services Division’s Child Welfare Services Branch. * Child Turned 19: there is an alert in the Hawai‘i Automated Welfare Information (HAWI) computer system when a child turns 19 years old. The eligibility worker sends an application (1100) for completion so a separate case can be opened for the 19 year old who is now an adult. c. Problem: “Did Not Provide” If a customer does not submit requested information to the eligibility worker by the established due date, the case is closed. This also includes “Did Not Respond” to telephone calls and letters and did not want to participate in the random sample interview. d. Other Discussion Points * A computer system that is customer-based rather than case-based would greatly benefit Med-QUEST and its customers. * If someone reapplies and is determined eligible, it should not be an error. * The cost for nursing home cases is very high and therefore skews overall error rates. Wednesday, 26 January 2005 Process Improvement Collaborative Present: Stephany Vaioleti, Barbara Luksch, and Alan Takahashi Next meeting: 12 April 2005 at 11:00 AM We completed the flowchart for applications received by the Honolulu Med-QUEST office, reviewed questions posed by the Renewal Simplification Workgroup to clarify answers, outlined Mälama i nä Keiki 6 training workshops, and discussed children who leave the foster care system. We will invite representatives from the Child Welfare Office to attend our next meeting. Wednesday, 26 January 2005 Evaluation Task Force Present: Charlene Gaspar, Susan Forbes, Laurel Johnston, Ruth Ota, Barbara Luksch, and Marika Ripke Next meeting: 23 February 2005 at 8:00 AM Our goal was to analyze currently available data and decide if the Hawaii Covering Kids home page information should be changed. 1. Information on Hawaii Covering Kids Web Site These Hawaii statistics are listed on the home page: * approximately 7% of our children and youth are uninsured statewide... * that means over 22,000 children and youth do not have health insurance... * and 14,000 of those who are uninsured are eligible for free public health insurance. We noted that according to U. S. Census Bureau 2000 data there are 327,251 children and youth under 19 years old in Hawaii. 2. Public Health Insurance: Children and Youth Not Eligible/Not Interested Children not eligible for public health insurance include: students (F1 visas), dependents of students (F2 visas), nonimmigrant visas (V, K, H4, and others), illegal immigrants, and tourists. Families who are not interested in public health insurance for their children include hippie lifestyles and Kingdom of Hawai‘i citizens. 3. Employers Dropping Free Dependent Coverage Outreach workers from throughout the state have told Barbara this isn’t a problem in Hawai‘i. Children they help enroll in QUEST and Medicaid have parents who are offered health insurance by employers for the dependents for a monthly fee they cannot afford. It was suggested that Laurel contact the Hawaii Employers Council and the state’s Rapid Response Program to get qualitative data on employers who previously paid for dependent children’s health insurance but now ask the employee to pay the premium. 4. Hawaii Covering Kids Data Source It was suggested we continue using three-year aggregated Current Population Survey (CPS) data. It is consistent with emergency room data, uses face-to-face-interviews, and is available annually. Marika explained the 2004 Kids Count Data Book lists Hawaii with 8% uninsured (26,180) as the 2000, 2001, and 2002 average CPS number for children and youth 0-18 years old. It was noted that to improve the reliability of state estimates for children’s health insurance coverage the Census Bureau in 2001 increased the CPS Annual Social and Economic Supplement (ASEC) sample size from 50,000 to 78,000 households. Barbara explained that in 2004 over 9,000 more children and youth ages 0 to 19 years old were enrolled and retained in QUEST and Medicaid due to extensive outreach and simplification efforts. Last January, the children and pregnant women application was launched and in June a new passive renewal process for cases with children started. These simplification efforts were complemented by the new Outreach and Assistance Project, funded by the Centers for Medicare & Medicaid Services and Med-QUEST, which placed additional outreach workers in various communities to help families with applications and renewals. The new enrollment data should be reflected in future CPS reports. Barbara suggested that data from the Hawaii Covering Kids Local Projects in Kahuku and on Kauai be used for sampling data. Outreach and inreach workers conduct extensive outreach in their geographic areas and their aggregated enrollment in QUEST and Medicaid averages 38 children and youth per month. Furthermore, annual data on uninsured children and youth from 1999-2002 is available through research conducted for the Hawaii Covering Kids Data Project with reasonable sample sizes. 5. The Hawaii Uninsured Project Data The Hawaii Uninsured Project’s January 2005 policy brief lists this information: 25,669 children and youth are uninsured and 19,548 are below 200% of the poverty level. This would mean 7.8% of Hawaii’s children and youth are uninsured and 76% of them are eligible for QUEST and Medicaid. Information from outreach efforts dispute the latter so we suggested Laurel request this information from The Hawai‘i Uninsured Project researchers: * Rolling averages by income levels over three year periods, beginning with your first complete year of data and through your most recent year (e.g., 1994, 1995, and 1996; 1995, 1996, and 1997 through 2001, 2002, and 2003). * Make sure the analysis reflects Hawaii’s federal poverty levels that are different than the continental United States. * Are there were other adjustments after the Children’s Health Insurance Program and Immigrant Children’s Program expansions started in July 2000 that might explain changes in data. * What are the specific questions that CPS uses to define the child’s insurance status? There was discussion regarding the definition of "uninsured." For example, are our estimates based on uninsured for a day, month, or year? There may be some confusion among different groups reporting the total numbers of uninsured and it would be good to reinforce the official definition based on CPS. 6. Other Information Susan explained that the Hawaii Health Information Corporation has dynamic maps on its web site and UH Center on the Family has excellent data and information on children and families at http://uhfamily.hawaii.edu/Cof_Data/datacenter.asp. An informal follow-up meeting was held on 02/23/05 with Jerry Russo, Laurel Johnston, Gladys Quinto from The Hawaii Uninsured Project, Susan Forbes, and Barbara Luksch. Jerry tabulates numbers from the raw CPS source for his data. He explained the question asked annually in March: “In the preceding year, did you have a health plan?” therefore any insurance at any point means insured. According to a Congressional Budget Office report, "How Many People Lack Health Insurance and For How Long?" (May 2003), “The CPS estimate is intended to measure the number of people who are uninsured for the entire year. However, there is considerable evidence that the CPS estimate overstates the number of people who are uninsured all year and is closer to the number of people who are uninsured at a point in time.”