Tuesday, 11 July 2006 Process Simplification Task Force (Cit Docs Team) Present: Lori-Lei Aponte, Maile Aquino, Natalie Bostrom, Rebecca Delefield, Noe Foster, Jolaine Hao, Barbara Luksch, Rich Melendez, Kookie Moon-Ng, Mary Rydell, Rochelle Sparko, Kathy Swink, and Alan Takahashi. Next Meeting: 17 July 2006 at 11:00 AM 1. Media a. Natalie reviewed a draft of the print advertisement. It was suggested the advertisements be placed in the newspapers’ local news sections to reach our target audience. Noe explained their research concluded island names in Neighbor Island advertisements grabbed people’s attention (e.g., Kaua‘i QUEST and Medicaid Recipients, Big Island QUEST and Medicaid Recipients, etc.). Olomana Marketing will make changes for Barbara to send to the Hawai‘i State Department of Human Services director for approval. The final version will be emailed to QUEST plan representatives for their recipient newsletters. (Note: Attached is the generic final version). b. The first radio campaign from 28 June-9 July 2006 included flights on KCCN (O‘ahu), KSSK (Oahu), KAPA/KBIG (Hawaii), KONG (Kauai), and KNUQ (Maui). Task force members’ who heard the radio advertisement gave very positive feedback! 2. Updates a. BESSD workers are updating the HAWI computer system with household head photo identification details when they work cases. b. Q&A for Health Care Providers: sent to 381 pediatricians (AAP Hawaii), 230 obstetricians and gynecologists (MothersCare), Hawaii Medical Association, Hawaii Association of Family Physicians, AlohaCare, and HMSA. Barbara will also email it to Maile (Kaiser). c. Interfaces with Hawaii State Department of Hawaiian Homelands (DHHL) and Hawai‘i State Department of Health (DOH) Vital Records will be retroactive to 1 July 2006. d. DOH Vital Records is working on a model for real time inquiries for birth certificates through ehawaii.gov, however it won’t begin until around 2008. e. Kookie presented information to DOH administrators from Adult Mental Health, Child and Adolescent Mental Health, Developmental Disabilities Division, STD/AIDS Branch, Communicable Disease Division, and Vital Records. f. Jo presented information to statewide Residential Alternatives Community Care (RACC) case managers. Case managers from other programs will attend the 13 July 2006 public forum. g. Barbara presented information to statewide homeless providers on 6 July 2006. Mahalo to Sandy Miyoshi from Housing and Community Development Corporation of Hawaii for the invitation. h. Hawaii Administrative Rules were effective 10 July 2006. i.Upcoming Letter Schedule: July 26 First Letter August Renewals August 4 Second Letter July Renewals Still Missing Documents August 28 September Renewals September 7 Second Letter August Renewals Still Missing Documents 3. Helping New Applicants a. We will combine two pending notices currently sent to applicants (M011 and X072). b. We cannot use system links because people requesting health insurance benefits are not currently in the HAWI system. c. People who need help with the new requirements will not be referred to 211 because the existing agreement is to help recipients renewing their benefits. Furthermore, they must hire more staff if requested to accommodate new applicants. Also, applicants cannot be referred to the document sites because the outreach workers are overwhelmed helping recipients renewing their benefits and could not handle an increased volume. 4. Affidavits Rochelle reviewed drafts of the four different types of affidavits Legal Aid Society of Hawai‘i created for the task force: a. The Centers for Medicare and Medicaid Services (CMS) Dear State Medicaid Director letter requires one of each of these: * Blood relative affidavit regarding citizenship, * Non-relative affidavit regarding citizenship, and * Applicant/recipient affidavit regarding the lack of availability of other citizenship records. * Affidavit regarding identity (for children under 16 years old). This cannot be used if the child's citizenship was established by affidavit. A parent or legal guardian must complete it. We will discuss them again when we review the new interim final rules with comments. 5. Resolving Communication Problems We commended Rich and his 211 staff for their patience and perseverance during the initial weeks of phone calls. There was some miscommunication with state offices about implementation and occasionally their document demands were stricter than required. A few document sites had new staff or people covering while outreach workers were on vacation, so Barbara and Rich spent many hours troubleshooting. The most common problem was people calling document sites asking about Keiki IDs, which are only issued by police departments, and they were subsequently disappointed or confused. We will add information to the “211 Hotline Questions and Answers” guide about how the document sites assist recipients with photo identifications and handling requests about extensions to mail required documents, 6. Da Kine a. Alan suggested sponsoring Keiki ID events at Med-QUEST offices. Barbara will assist with coordination. b. Some people are sending original documents that are very expensive to replace (e.g., permanent resident cards, naturalization papers, etc.). Med-QUEST is organizing a system to return original documents to recipients. c. If a person walks into a Med-QUEST or BESSD office, the staff will help her/him complete the new requirements. d. The Medicaid waiver and foster children programs receive monthly Med-QUEST reports on client renewals. e. Our next meeting will focus on reviewing the interim final rules with comment. Tuesday, 17 July 2006 Process Simplification Task Force (Cit Docs Team) Present: Lori-Lei Aponte, Andreas Cravalho, Rebecca Delafield, Barbara Luksch, Kookie Moon-Ng, Sandy Morishige, Mary Rydell, Rochelle Sparko, Kathy Swink, Alan Takahashi, and Tessy Yokota. Next Meeting: 1 August 2006 at 10:00 AM 1. Updates a. Seven states, including Hawai‘i, implemented the new law on 1 July 2006. b. There were 7,788 letters mailed to recipient households for July renewals. There will be 6,619 letters mailed to recipient households for August renewals (11,158 people must provide information). c. Children born to women enrolled in QUEST or Medicaid Fee-for-Service: * If the mother is a lawful permanent resident who has lived in the United States at least five years or U.S. citizen, the baby can be added to the case. Citizenship/alien status documentation and photo identification will be required when the case is renewed. * If the mother is a non-qualified alien, from the Compact of Free Association states, or lawful permanent resident who has lived in the United States less than five years, a new application with citizenship/alien status documentation and photo identification must be submitted to Med-QUEST. * Interface with Department of Hawaiian Homelands: DHHL does not list citizenship in its database, therefore this system link cannot be used. 2. Interim Final Rules The interim final rules were issued on 6 July 2006. We noted the following: * Medicare and SSI recipients are not required to produce U.S. citizen documents or photo identifications to apply or renew their benefits. This is retroactive to 1 July 2006. * Affidavits for children under sixteen years old are acceptable. A parent or legal guardian can sign an affidavit with specific information in lieu of photo identification. It does not have to be notarized. Legal Aid Society of Hawaii will finalize this document with Med-QUEST for review by task force members. * We can add U.S. Military Record to the list of acceptable citizenship documents. * We cannot add marriage license to our list of acceptable citizenship documents because DOH does not require a birth certificate for someone over 19 years old; it accepts any valid identification. * Foster children are considered recipients not applicants, thereby allowing extra time to gather documents. * Med-QUEST must change HAWI computer system, Hawaii Administrative Rules, and policies and procedures. Task force will update the two letters with new lists of acceptable documents. * We want 1 and 2 in the hierarchy because 3, 4, and 5 are temporary and will require additional documentation later; we will amend letter X073 to call the eligibility worker if the recipient or applicant can only produce items from 3, 4, or 5. * CMS requires a record retention period of three years (see page 33), however Med-QUEST will keep the information forever. 3. Interim Final Rules: Comments Comments must be submitted to the Centers for Medicare and Medicaid Services (CMS) by 11 August 2006. We will encourage community agencies, trade organizations, and health care providers to submit comments. Page 34: Don't limit the number of documents accepted for proof of citizenship and identity. Page 34: Individuals will definitely have difficulty proving citizenship and identity if only primary or secondary level documents are permitted. Page 37: Disagree would take an individual only 10 minutes to acquire and provide acceptable documentation!!!!! Page 37: Disagree will take state only 5 minutes to obtain acceptable documentation, verify citizenship, and maintain current records on each individual!!!!! Page 43: Confusing that if impact is NOT going to generate significant savings why do it? Page 43: Disagree the law will not significantly adversely impact small businesses, nonprofit organizations, and small governmental jurisdictions (including hospitals and suppliers). Page 44: Disagree the law will not significantly impact small rural hospitals. Page 44: Disagree the law will not significantly impact state, local governments, or private sector. Page 45: Disagree added requirements will not overburden the eligibility process. 4. Post Meeting Information Med-QUEST enrollment as of 30 June 2006: QUEST: 144,068 Medicaid Fee-for-Service: 40,459 CHIP: 15,569 Immigrant Children: 3,249 Total: 203,345 Friday, 21 July 2006 Outstationed Eligibility Workers (Cit Docs Team) Hawaii: Jose Macias, Wendy Tamashiro, and Malia Thompson. Kauai: Michelle Martinez , June Munoz, Darline Rita, and Charlene Yamamoto. Maui: Manny Agcolicol and Natasha Andaya Oahu: Hii Campbell, Fisii Drummondo, Geri Eli, Karen Guerrero, Karln Hall, Barbara Luksch, Michelle Malufau, Diana Marriott, Daisy Simeona, Jennifer Tehotu, and Dorothy Young. 1. Welcome and Introductions The purpose of the conference call meeting was to discuss implementation of the new citizenship requirement including updates, what's working, and how we can solve what's not working before letters are mailed to people who renew their QUEST and Medicaid benefits in August. Barbara welcomed the participants and thanked them for their incredible work and patience during the first month of implementation. 2. Time for Recipients to Submit Copies The Renewal Simplification Workgroup has learned over the years that people don't respond to information from Med-QUEST unless the letter or form includes the phrase “your medical assistance may stop” and they have a short period of time to act. Otherwise people put it in a “to do later” pile and it doesn’t get done. The task force doesn’t want people to panic, however they do want them to complete the requirements as soon as possible. Currently, here is information for recipients who need more time: Can I get an extension to submit my copies? Please do not worry and mail whatever you have right now. Med-QUEST is working to extend the deadline for sending documents and photo identifications. They are also connecting with Department of Health Vital Records to get U.S. citizenship information for people born in Hawai‘i so you may not need to produce hard copies. If Med-QUEST cannot find the details through the Department of Health, they will send you another letter. It was explained that for recipients who are renewing their benefits, Med-QUEST will pend as long as the Centers for Medicare and Medicaid Services (CMS) will allow for the new citizenship/alien status and photo identification requirements. The time limit has not officially been determined. 3. Major Updates from Federal Interim Final Rules with Comment CMS issued a letter to state Medicaid directors on 9 June 2006 and subsequently issued their interim final rules with comment on 6 July 2006. Our task force is working on implementing these recent changes: a. SSI and Medicare Recipients Are Exempt They are not required to produce U.S. citizen documents or photo identifications to apply or renew their benefits. This is retroactive to 1 July 2006. b. Affidavits for Children Under Age 16 A parent or legal guardian can sign an affidavit with specific information in lieu of photo identification. Legal Aid Society of Hawai‘i is finalizing this document with Med-QUEST and it will be issued as soon as possible. c. Children born to women enrolled in QUEST or Medicaid Fee-for-Service: * If the mother is a lawful permanent resident who has lived in the United States at least five years or U.S. citizen, the baby can be added to the case (Form 1179). Citizenship/ alien status documentation and photo identification are not required until the case is renewed. However, we highly recommend submitting the documents at birth to avoid future problems. * If the mother is a lawful permanent resident who has lived in the United States less than five years, non-qualified alien, or from the Compact of Free Association states, a new application with citizenship/alien status documentation and photo identification must be submitted to Med-QUEST. 4. Update on System Links (“Filter Machine”) a. DOH Vital Records: this interface has been established. However, if the person’s name in Med-QUEST’s HAWI system is different from the birth name, there won’t be a match. b. County Driver License Offices: DHS is working on this. c. DOE School Lunch and A+ Programs: BESSD and DOE are helping with this. d. Department of Hawaiian Homelands: DHHL does not list citizenship in its database, therefore this system link cannot be used. 5. Schedule for Letters Mailed to Recipients July 26 First Letter August Renewals August 4 Second Letter July Renewals Still Missing Documents August 28 First Letter September Renewals September 7 Second Letter August Renewals Still Missing Documents 6. Memorandum of Agreement (MOA) for Document Site Reimbursement The Hawaii Primary Care Association (HPCA) is waiting for DHS to finalize the contract so it can be signed. When this is completed, MOAs will be sent to the executive directors. Note: The MOA is for people renewing their benefits. There is currently no agreement with DHS to also refer new applicants. Barbara will solve this problem immediately. 7. What Document Sites Are Doing That's Working a.Waikiki Health Center: They photocopied the letters on light blue paper and posted them with a note, “If you get this letter in the mail, please come to us for help.” b. Pahoa Family Health Center: They are using a Polaroid camera if the family doesn’t have photographs of their children. The outstationed eligibility worker makes a photocopy of the picture to send to the hub and gives the original to the parent or guardian. c. Kalihi-Palama Health Care for the Homeless Project: The outstationed eligibility worker set up dates and times she will be in the clinics and the receptionists schedule people who have received blue letters. Only a few people needed their pictures taken, so she used a digital camera and printed them. 8. Questions and Answers a. When I photocopy the photo identification, the photo appears black, fuzzy, or blank. What should I do? Next to the photo identification write, “I viewed the original photo” with your signature or initials. b. Is there a time limit for photos? No. A copy of any photo regardless of age is okay. c. Are all household members obligated to be with the recipient for the picture to be confirmed? No. It is NOT necessary for household members to be present to confirm their photos. For example, if a parent has a picture of his spouse and three children, the spouse and children are not required to come with him to a location to complete the photo identification requirement. d. What kind of photos can be sent? Recipients can send a copy of any photo with an organization's name on it. They can also send a copy of a photo that an organization or health care provider (community health center, school, child care center, WIC, Head Start, pediatrician, nurse, hospital, etc.) confirms by signing and clearly writing the organization’s or health care provider’s name, address, and telephone number. 9. Other Da Kine * The Kapolei hub was set up for people who are renewing their benefits and must submit citizenship/alien status and picture identification documents. The task force did not want this paperwork getting lost amidst the applications, renewals, add-ons, pending notice responses, and other mail that local Med-QUEST eligibility offices receive. Please send all citizenship/alien status and picture identification documents for people renewing their benefits to the hub. * If an outstationed eligibility worker helps someone complete a Med-QUEST application, submit citizenship/alien status documents and photo identifications with the application. Do not send them to the hub; the hub only verifies documents for recipients who are renewing and have a current case listed in HAWI. * The Child Welfare Office is taking care of requirements for all foster children. Please let Barbara know if these offices have questions and she will refer them to the appropriate task force representative. * If people do not have their postage-paid envelopes, postage costs can be reimbursed. Please save receipts to send HPCA after the MOAs are signed.