Tuesday, 1 August 2006 Process Simplification Task Force (Cit Docs Team) Present: Tracy Allison, Maile Aquino, Melba Bantay, Frank Chong, Andreas Cravalho, Kris Foster, Charles Greenfield, Jolaine Hao, Barbara Luksch, Ruth Ota, Dawn Reppuhn, Rochelle Sparko, Kathy Sthay, Kathy Swink, Alan Takahashi, Priscilla Thode, and Christine Wong Next Meeting: 22 August 2006 at 9:30 AM Goal: All eligible people who are currently enrolled in QUEST and Medicaid Fee-for Service retain their benefits without going on scavenger hunts. 1. Revising Our Goal We drafted a second goal and will discuss this wording at our next meeting: All eligible applicants will receive their QUEST and Medicaid Fee-for-Service benefits through an efficient process. 2. What’s Happening: Renewals a. Media Specs and Dates: Barbara distributed a detailed list for July 2006 through June 2007 for print and radio advertisements. b. Filter Machine: Barbara distributed an updated diagram that filters out Medicare and SSI recipients. Dee Helber and Kris Foster are working on the photo identification link for kids enrolled in school lunch and A+ programs. c. Affidavit (Children Under 16 Only): We discussed the Draft #2 and will conduct more research to determine if it can apply to all children or just U.S. citizens. We plan to circulate the final draft to state and community agencies as soon as possible. d. A fifty-year-old adult submitted a Keiki ID for herself, however research could not conclude this type of document has also been issued to parents or guardians so it is not acceptable. e. If a parent or guardian brings the child’s photo to a Hawaii State Department of Human Services (DHS) office, she/he is requested to print the child’s name, birth date, and sign it. If there is a group picture, an arrow is used to indicate which child the name and birth date references. f. MQD and BESSD have agreed the office receiving the household’s documents updates the HAWI ETRC (Ethnicity Residency Citizenship Identity) screen and takes care of photo identifications. g. We reviewed the current process for documents sent to the hub. Currently, the hub staff brings up each household in HAWI, prints the PRIP (Program Involvement Person List) screen on orange-colored paper, notes what documents were received, and sends it with documents attached to the appropriate Med-QUEST or BESSD unit. The eligibility workers note and approve each document, update the ETRC screen, and place the papers in the recipient’s case file. It was suggested that having the hub staff and eligibility workers both note the documents could be double work for the hub staff. If Med-QUEST does not receive all required documents from a household, the eligibility worker sends Form M013 requesting missing documents. We discussed if this is confusing to the household and an added state expense because the second reminder letter (073) serves the same purpose. h. If Med-QUEST received original documents, they are making copies and mailing back originals to the household. 3. Helping New Applicants Application Simplification Workgroup members joined our meeting to discuss this issue. a. Revising Application to Include Affidavit Information (Children Under 16): If we add birth place in Question 3 and the affidavit’s required signature notation in the Rights and Responsibilities section, it would meet the photo identification requirement for children under sixteen years old without an additional form. We would like to initiate this process as soon as possible. b. Combined Pending Notice: Currently, Med-QUEST sends a regular pending notice for missing information and a special pending notices for citizenship documents. We reviewed a combined pending notice which would be ideal. However, since it is a HAWI-generated letter there is a maximum number of lines. Barbara and Chris will follow-up. c. Document Sites for New Applicants: Med-QUEST is researching organizations that could assist new applicants with required citizenship documents. The current document sites at community health centers do not have the capacity to handle the additional volume and the funding to reimburse them is limited. d. Babies Born to U.S. Citizen Mothers Enrolled in QUEST/Medicaid Fee-for-Service: Some hospitals send an add-on form to Med-QUEST but do not include a newborn’s photo because it is not required. Therefore, when the case is renewed the household must submit confirmed photo identification. When the affidavit (see 2c) is finalized, Barbara will request the hospitals submit it along with their add-on form. e. Washington is requesting the Centers for Medicare & Medicaid Services (CMS) allow them to approve Medicaid applications that have all required information except citizenship documents and pend for these missing items. f. Med-QUEST includes a list of required documents with its applications (Form 8000J). Chris will send copy to Barbara for the members to review. 4. Resolving Communication Problems: One Voice-One Message Problems continue with DHS offices referring new applicants to 211 and/or document sites. Barbara will collect details about the worker’s name and location and forward them to the appropriate representative. 5. Other Da Kine a. Our next public forum is the legislative briefing on 08/03/06 at 1:00 PM. State and community agencies are welcome to attend. b. WIC staff has received requests from some clients to sign photos. The task force has continually invited WIC to attend our meetings and public forums because if they assist their families, it will help the parents and children retain public health insurance benefits. c. It was suggested Med-QUEST send information to all of its health care providers. We decided after the federal government issues its final rules, the question and answer guide for health care providers will be a good resource to distribute. d. We were invited to staff booths set up by DHS at various locations statewide. Our task would distribute information on the new citizenship requirements and take pictures. However, task force members do not believe this is an effective outreach activity for our target audience. e. Hawaii State IDs are not available for children under three years old. The Attorney General’s office may change the age limit, however we prefer recommending the free photo identification affidavit for children when it becomes available. Tuesday, 22 August 2006 Process Simplification Task Force (Cit Docs Team) Tuesday, 22 August 2006 Process Simplification Task Force Meeting (Cit Docs Team) Present: Liane Hiramoto, Andreas Cravalho, Alan Takahashi, Rebecca Delafield, Barbara Luksch, Kris Foster, Frank Chong, and Kathy Swink Next Meeting: 5 October 2006 at 9:00 AM via conference call 1. Revising Our Goal We added a second sentence as our additional goal. 2. What’s Happening a. Removing Keiki IDs from lists. There have been many problems associated with listing Keiki ID on the photo document list. The Honolulu Police Department (HPD) averages 100 requests per day, document sites must continuously explain they do not issue Keiki IDs, and some Hawai‘i State Department of Human Services (DHS) offices are telling parents and guardians their kids are required to have Keiki IDs or lose public health insurance benefits and referring them to 211. We decided a Keiki ID is still acceptable as “Other Official Photo Identification,” however we must remove it from lists on 072 and 073 (first and second blue letters) to end the frenzy. b. Revised 8000K (Photo ID Affidavit for Children Under 16 Years Old). The final version has been approved and emailed to community resources. Barbara encouraged task force members to distribute it to their statewide contacts. It will also be mailed with 073 letters. c. Revised 072 and 073 Letters. We updated lists according to documents referenced in the interim final rules. The revised letters will be mailed after system modifications are completed. Note: 073 letters have not yet been mailed due to system glitches. d. Revised 8000J (Citizenship, Alien Status, and Photo ID Lists for Applicants). We updated lists and revised the wording. The new edition will be inserted in Med-QUEST applications. e. 8000M (Request to Confirm USA Birth). Med-QUEST will help people who have problems with birth certificates. This form will be mailed with 073 and give Med-QUEST permission to search Hawaii State Department of Health (DOH) Vital Records using a recipient’s birth name that may be different from her/his case record name or birth records in other states. f. One Voice-One Message: Med-QUEST and BESSD Communication to Units: There were still problems with inappropriate DHS staff referrals to 211, HPD, and document sites, however our task force members have been working hard to eliminate them. A joint Med-QUEST and BESSD memo will be issued this week. 3. July 2006 Hub Data 072 letters mailed to 7,788 households. 564 returned mail (7%), 3,036 mail processed (39% of letters mailed), and 227 calls received (self-referred). 4. Newborns Approximately 6,420 newborns are enrolled in Med-QUEST programs annually. We outlined information from the interim final rules about newborns: a. For 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 mother becomes ineligible or the case is renewed. b. If the mother is not enrolled in QUEST or Medicaid Fee-for-Service, 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 must be submitted to Med-QUEST. Photo Identification: Our task force will ask all hospital staff and outstationed eligibility workers submitting Med-QUEST documents to attach a completed 8000K (Photo ID Affidavit for Children Under 16 Years Old) or official photo identification to each add-on form and new application. This will fulfill the photo identification requirement forever. Acceptable Temporary Citizenship Document: We discussed an appropriate hospital birth record to attach with each add-on form and new application until Med-QUEST can interface with DOH Vital Records or, if it paid for the birth, Med-QUEST’s claims system. The interim final rules are unclear what is acceptable (e.g., is it a crib card, admission report, medical record, progress notes, hospital bill with newborn charges listed, information on official hospital letterhead, etc.?). Med-QUEST has been trying to clarify hospital record details with the Centers for Medicare & Medicaid Services (CMS). Note: Barbara and Liane researched information after the meeting. All details from hospitals to DOH Vital Records and from DOH Vital Records to Social Security Administration (SSA) are sent electronically. No hard copies are available. Also, if the process is not completed through a hospital interface with DOH Vital Records and the parent or guardian later applies for a social security number using an official birth certificate, SSA must confirm with the vital records office in the state where the child was born that the birth certificate is authentic. This takes about two weeks. SSA also requires a hospital or physician statement attesting to the child’s birth or a hospital bill with the child’s name listed. We agreed to urgently resolve this problem to assure all eligible newborns can enroll and retain their health insurance benefits. Barbara will follow-up with Kookie to identify acceptable temporary citizenship documents. Next, Barbara, Alan, and Kris will ensure outstationed eligibility workers, Med-QUEST eligibility workers, and BESSD staff has accurate details (one voice-one message). Barbara will also organize a conference call with all Hawai‘i hospitals that deliver babies to alert them to the task force’s photo identification request and share information about acceptable temporary citizenship documents.