Thursday, 30 March 2006 Application Simplification Present: Jeffrey Young, Priscilla Thode, Barbara Luksch, Melba Bantay, Mary Rydell, Rebecca Delafied, Fay Nakamoto, Cassandra Stewart, and Waynette Cabral. Next meeting: 12 May 2006 at 11:30 AM 1. Workgroup Goal Med-QUEST will print a simple, easy to complete application that also complies with federal and state laws. Rationale: Med-QUEST will receive complete applications to process efficiently and eligible customers will receive timely public health insurance benefits. 2. Welcome and Introductions a. During the past two years Med-QUEST’s applications were updated via email communication so we welcomed new and veteran members to our workgroup meeting. b. Barbara distributed packets with the most recent versions dated September 2005 and a copy of The Health Literacy Style Manual which is a resource for developing and improving applications and notices. 3. Application Tweaks We agreed at this meeting and through subsequent email correspondence to make these changes: Question 1. Add “This person will receive all mail and phone calls.” Question 2E. Modify the question: “Is anyone who wants medical assistance in a nursing home or applying for nursing home placement, DD/MR, HCC, MFCC, NHWW, PACE, or RACC? (Program names are listed on page 8. You may have to provide more information about your assets.)” Question 3. Modify the bullet points: * We need a social security number and citizenship information for each person who wants medical assistance. * We do not need a social security number or citizenship information if a person does not want medical assistance (non-applicant). However, we may ask for more information if a social security number is not provided. Question 3 A-H. Increase font size and make all caps: SOCIAL SECURITY NUMBER Question 3 A-H. Change “Permanent Resident Alien” to “Lawful Permanent Resident” Question 4B. Add: “If YES, please write information in the boxes.” Question 4B. Modify the employment box by adding “Total for Whole Month” above “1. $”. Question 4B. Modify the following: Pension/Retirement Income (write who pays you) Temporary Disability Insurance (TDI) (write who pays you) Insurance Settlements (write who pays you) School Grants and Scholarships Other Income (please tell us): Question 5. Add: “If YES, please write information in the boxes.” Question 6B. Add: “If YES, please write information in the boxes.” Question 6B. Add a column for bank or company name and modify the instructions to include this information. Question 7. Modify the question: Has anyone who needs medical assistance for nursing home costs, DD/MR, HCC, MFCC, NHWW, PACE, or RACC sold, traded, or given away money, property, other resources, or assets in the past 5 years? (Program names are listed on page 8. You may have to provide more information about your assets. You may not get help if you disposed of your assets for less than fair market value.) Question 8. Add: “If YES, please write information in the boxes.” Question 8A. Does anyone listed in Question 3 have private health insurance, dental insurance, vision insurance, Medicare, TRICARE, VA benefits, or prescription drug coverage? (Other insurance may help pay some medical, dental, vision, or drug bills.) Boxes: Person Covered, Insurance Name/Type/Policy Number, Start Month/Year, and Premium Amount Question 8B. Has an employer offered health insurance to anyone who is employed? (We need to know about employer-sponsored health insurance for the employee only not his or her children or spouse.) Boxes: Person’s Name, Insurance Name/Type/Policy Number, Start Month/Year, and Employer’s Name 8C, 8D, 8E, and 8F: only one box below each question. 9. Change page number: I have read or had read to me the list of rights and responsibilities on page 11 that I may keep for my information. Rights and Responsibilities: * Change fair hearing to administrative appeal * In “SOCIAL SECURITY NUMBER” and “CITIZENSHIP” add: (Pub. L. 93-579) Add Questions and Answers If I have Medicare, will Medicaid pay for my prescription drugs? Some drugs not covered by Medicare may be paid by Medicaid Fee-for-Service. What are the DD/MR, HCC, MFCC, NHWW, PACE, RACC programs? These programs are Developmental Disabilities/Mental Retardation (DD/MR), HIV/AIDS Community Care (HCC), Medically Fragile Community Care (MFCC), Nursing Home Without Walls (NHWW), Program of All Inclusive Care for Elderly (PACE), and Residential Alternatives Community Care (RACC). They provide support services so a person can remain at home or live in a community-based setting. Update Information on MothersCare, SagePLUS, Executive Office on Aging, and federal immigration agency. Addresses Change Maui mailing address to the office’s new location. Thursday, 6 April 2006 Conference Planning Present: Mary Rydell, Dee Helber, Linda Colburn, Ruth Ota, Alan Takahashi, and Barbara Luksch 1. Malama i na Keiki 7 Goal: By working together, we will find, enroll, and retain all eligible children and youth in health insurance. We reviewed the Malama i na Keiki 6 evaluation report, including suggestions for the next conference. Although some participants requested expanding our focus to general health outreach topics, we agreed the emphasis should remain children’s health insurance because that is the focus of Hawaii Covering Kids. We chose Friday, 25 August 2006 at the Best Western Plaza near the Honolulu airport and the theme will be “Building Public-Private Partnerships.” 2. Ideas for Guest Speakers * Morning: QUEST plans (AlohaCare, HMSA, and Kaiser) and Aloha United Way 211 * Workshops: outreach to homeless families, media outreach, outreach to Filipinos, customer service, and Med-QUEST eligibility information and issues * Afternoon (our usual magic formula): Kim Gennaula and Guy Hagi followed by Linda’s skill-building activity Sanuk activities will be interspersed throughout the day and we will search for appropriate music and wigs. 3. Participants The limit will be 100 and our list includes: Conference Planning Committee members, two Med-QUEST eligibility workers per unit, four Oahu Med-QUEST supervisors (workshop trainers), outstationed eligibility workers, and outreach workers (frontline staff who interact directly with families full-time). 4. Lunch Mixer We discussed ways to encourage more participants to network with people from other organizations and islands during the buffet lunch. The committee members will devise a game with prizes to achieve this aim. 5. Travel Barbara will purchase coupons for Neighbor Island eligibility workers through a DHS grant. Partial travel scholarships--approximately $100--will be offered to others who stay the entire day. We will remind people to book their flights early. Tuesday, 11 April 2006 Process Simplification Present: Christine Akau, Andreas Cravalho, Rebecca Delafield, Janice Fernandez, Kris Foster, Noe Foster, Dee Helber, Barbara Luksch, Rich Melendez, Kookie Moon-Ng, Ruth Ota, Gwen Palmer, Madi Silverman, Rochelle Sparko, Kathy Swink, Alan Takahashi, Alan Tang, Jennifer Tehotu, Ethel Yamane, and Tessy Yokota. Next meeting: 25 April 2006 at 10:00 AM 1. Welcome and Introductions Organizations invited to participate included AlohaCare, Aloha United Way 211, American Academy of Pediatrics Hawaii Chapter, Centers for Medicare and Medicaid Services, DHS Adult and Community Care Services Branch, DHS BESSD, DHS Child Welfare Office, DHS Med-QUEST Customer Service Section, DHS Med-QUEST Eligibility Branch, DHS Med-QUEST Policy and Program Development Office, DOE Student Support Section, DOH Office of Bilingual Health Services, DOH Child Wellness Program, DOH Public Health Nursing Branch, DOH WIC Services Branch, Hawaii Association of Family Physicians, Hawaii Covering Kids, Hawaii Medical Association, Hawaii Medical Service Association, Head Start, Healthcare Association of Hawaii, Kaiser Permanente, Kalihi-Palama Health Center Homeless Outreach, Ke Ola Mamo, Legal Aid Society, MothersCare for Tomorrow’s Children, National Association of Social Workers Hawaii Chapter, Olomana Marketing, SagePlus, Social Security Administration, and State Planning Council on Developmental Disabilities. Barbara thanked everyone for coming to the meeting on short notice and concurred that participants care about our community and the people we serve. We will work together as a team to focus on our goal: All eligible people who are currently enrolled in QUEST and Medicaid Fee-for Service retain their benefits without going on scavenger hunts. We don’t want organizations or Med-QUEST’s customers to panic, therefore we will not initiate news releases, publish news articles, or send general announcements to people currently enrolled in QUEST and Medicaid. Our message to inquiries will explain we have a team developing an action plan to implement the new citizenship law and iterate our goal (above). Questions can be directed to Barbara. 2. Notes The DHS computer system will mail prepopulated renewal forms for July 2006 to Med-QUEST’s customers on 27 June 2006 (fourth business day before the end of the prior month). Med-QUEST enrollment as of 31 January 2006 is 204,142. 3. Brainstorming (Group Ideas) a. Where are copies of birth certificates currently located? People have them, Med-QUEST offices (if people submitted them voluntarily), DOE student files, DOH Vital Records (birth and marriage), Child Welfare Services, hospital medical records, private schools, and churches. b. What agencies require a birth certificate? Benefit, Employment, and Support Services Division (anyone who is/was Financial Assistance or Food Stamp recipient), Social Security Administration, Department of the Attorney General (Hawaii State Identification Cards), Housing and Development Corporation of Hawaii (HCDCH) and Section 8 Housing, DOL work permits for youth under 15 years old, U.S. Department of Veterans Affairs, Hawaiian Homelands, driver license, voter registration, adoption services, and Head Start. c. Where are photo identifications currently located? People have them, U. S. Department of State (passport), Department of the Attorney General (Hawaii State Identification Cards), County Departments of Motor Vehicles (driver license), schools, work, police departments (Keiki ID and Kupuna ID), Hawaii State Department of Public Safety (prisoner), U.S. Citizen and Immigration Services (permanent resident card), physicians’ offices, Costco, Sam’s Club, credit cards, and bus passes. d. What is our action plan for system links to these documents? Social Security Administration Database (people requesting a social security number show a birth certificate; information is entered in Numident Electronic Record about birth date, place of birth, and citizenship code), Social Security Administration SDX and Bendex interfaces (Medicare and SSI recipients), Hawaii State Department of Health Vital Records (weekly for a flat fee), Hawaii State Department of Health online access, and Hawaii State Department of Labor and Industrial Relations. 4. Next Steps Barbara and Kookie will meet on Thursday to review the brainstorming information and draft reasonable options. At the next meeting, our team will also discuss funding needs as well as a media outreach campaign for new Med-QUEST applicants. Tuesday, 25 April 2006 Process Simplification Present: Christine Akau, Andreas Cravalho, Rebecca Delafield, Jolaine Hao, Barbara Luksch, Rich Melendez, Kookie Moon-Ng, Ruth Ota, Mary Rydell, Rochelle Sparko, Kathy Swink, Alan Takahashi, Alan Tang, Arnold Villafuerte, and Tessy Yokota. Next meeting: 11 May 2006 at 10:00 AM 1. Our Goal All eligible people who are currently enrolled in QUEST and Medicaid Fee-for Service retain their benefits without going on scavenger hunts. 2. Notes It was suggested we invite representatives from DOH Adult Mental Health Division and Hawai‘i Long-Term Care Association to join our citizenship team. Barbara will contact them. Barbara distributed Kookie’s Med-QUEST work plan and an article from the Congressional Quarterly HEALTHBEAT NEWS on the Centers for Medicare and Medicaid issuing its guidance to state Medicaid directors. We decided not to launch a media campaign focused on the new enrollment barrier because applicants will not be required to submit documents that Med-QUEST can obtain through system links (see #4). Furthermore, it may discourage people from applying because they cannot locate birth certificates and/or photo identifications. 3. Research Updates * DHS Benefit, Employment, and Support Services Division: conducts DOH Vital Records link for paternity; Med-QUEST could arrange similar link for birth certificates * Voter Registration: citizenship is self-declared * WIC: does not record citizenship in database * Head Start: birth certificate for each child; record birth certificate’s state or foreign country in database, however each island has a separate database * Marriage License: under 18 years old certified copy of birth certificate; 19+ valid ID or driver license. * Driver License: county offices; under 18 years old certified birth certificate; 19+ alternative is state ID, certified marriage license, certified decree of name change, or certified divorce decree * Community Health Centers: many have each patient’s picture identification on file * Private Physicians: some use Electronic Medical Record programs to store photos 4. Kookie’s Razzle-Dazzle Filter Machine (Patent-Pending) We discussed an illustration of potential system links: Filter 1: Lawful Permanent Residents and Pacific Migrants -> Department of Human Services Child Welfare Services past and present children -> Department of Attorney General state identifications -> U.S. State Department passports Filter 2A (Birth Certificates): Department of Human Services Med-QUEST Division voluntarily submitted by customers -> Department of Human Services Benefit, Employment, and Support Services Division past and present customers -> Social Security Administration -> Department of Health Vital Records -> Department of Hawaiian Homelands -> Head Start -> Community Health Center patients (outstationed eligibility workers send to Med-QUEST) Filter 2B (Photo Identifications): Department of Human Services Benefit, Employment, and Support Services Division head of household -> Department of Transportation/County Services driver licenses -> Department of Public Safety Corrections Division former inmates -> Community Health Center patients (outstationed eligibility workers send to Med-QUEST) 5. Brainstorming (Funding Needs) MQD = Med-QUEST BESSD = Benefit, Employment, and Support Services Division (Financial Assistance and Food Stamps) OEW = Outstationed Eligibility Worker (Community Health Center) * HAWI Computer System Modifications: photo IDs and citizenship documents * MQD Documentation Hub: contract with agency for temporary workers, office space, computer hardware and software, email addresses, internet access, telephones * DHS Link with DOH Vital Records and Other Agencies * MQD/BESSD Offices (Reception Areas): photocopy machines with scanners. If people apply in-person and have a birth certificate and/or photo identification, staff can copy the documents and email/upload to MQD Documentation Hub and/or other MQD offices. The photocopy option can be used for other paperwork. * OEWs: scanners. When a person applies and has a birth certificate and/or photo identification, OEWs can scan the documents and email/upload to MQD Documentation Hub and/or other MQD offices * Printing and Mailing: letters, postcard reminders, information to outreach workers * Polaroid Cameras and Film: MQD and BESSD Offices, OEWs, Legal Aid Society Offices, Hawai‘i State Department of Health Bilingual Health Service Offices * Photography Contracts: OEWs (non-patient pictures), some MQD waiver programs, long-term care facilities * Hawaii Covering Kids: coordinate outreach efforts, link 211, design fact sheets (Q & A), and provide media information * Neighbor Island MQD Staff and OEW Trainings: air fare, car rental, and hotel (if necessary) to discuss implementation procedures 6. Next Steps Barbara and Kookie will meet with Lillian Koller on 1 May 2006 to discuss our task force’s ideas and request interagency links. Our team will discuss the identification requirement (photo and alternatives), information from the National Association of State Medicaid Directors, and the revised Hawaii Administrative Rules at the next meeting.