Tuesday, 5 December 2006 Oahu Outstationed Eligibility Workers Present: Carina Agpaoa, Ululani Aiana, Marian Bernardino, Hii Campbell, Derrick Chang, Susan Clemente, Fisiipeau Drummundo, Geri Eli, Scott Gardner, Edythe Green, Mele Haunga, Brian Higgins, Jonnette Kamakea, Norma Kaunamano, Airleen Lucero, Michelle Malufau, Nancy Miyake, Wes Mun, Barbara Luksch, Vickie Napuelua, Regina Quimpo, Cassandra Stewart, Jennifer Tehotu, Sean Valencia, and Dorothy Young. 1. Important Information a. Please DO NOT send duplicate applications or other forms to Med-QUEST unless specifically instructed by an eligibility worker. It creates more work for Med-QUEST staff and delays processing. b. If a person is denied due to income, assets, temporary visa, private health insurance coverage, and/or the enrollment cap and their household situation has not changed then reapplying will only delay everyone else’s application and clog Med-QUEST’s system. Furthermore, it would be more helpful for these people to explore other health insurance and health care options. c. Do not fax application pages marked “You May Tear Off and Keep.” d. Med-QUEST Honolulu Office’s New Integrated Units: Applications are assigned randomly and ongoing cases are assigned alphabetically. The eligibility worker list is being revised and Barbara will email a copy to OEWs when it is completed this month. Eligibility workers who previously only worked ongoing cases are still learning the intricacies of processing new applications so OEWs were asked to be patient during the transition phase. e. Barbara reminded participants about the children’s income guidelines effective 1 October 2006. Household income limits for the QUEST and Medicaid Fee-for-Service programs for children and youths ages 0 through 18 years old increased: up to 250% FPL: Free 251-265% FPL: QUEST-Net—premium share is $15 per month per child 266-280% FPL: QUEST-Net—premium share is $30 per month per child 281-300% FPL: QUEST-Net—premium share is $60 per month per child Currently, the gross family income limits for free public insurance (250% FPL) is $57,504 per year for a family of four. The maximum gross income for premium-share public health insurance (300% FPL) is $69,011 for a family of four. f. If an eligibility worker sends a ten-day pending notice and the applicant does not provide the necessary information, the application will not be denied until at least thirty days have elapsed from the date of application. g. OEWs often call Med-QUEST’s Customer Service Section to find out the reason an application was denied. We will research a more efficient way for OEWs to access this information. 2. Med-QUEST Honolulu Office Tour Gina Hidalgo, Unit 110 Clerk, lead a tour and explained the mail sorting process, how applications are registered, where files are stored, and eligibility worker offices. Current assignments are four clerks register, three clerks sort faxes, postal mail, and courier mail, and three clerks assist in the reception area. The Honolulu office has received an average of 2,724 applications monthly in 2006. They also receive renewal forms, add-on requests, responses to pending notices, and other correspondence. Applications from 28 November 2006 will be registered today and applications from 13 November 2006 will be distributed to eligibility workers this week. 3. Medical Emergency (ME) Process and 1149 a. Clerks check the fax machine five times daily then screen, register, and assign MEs. If a coupon is required, the physician must state emergency medications are required and request a coupon be faxed to the pharmacy by indicating the pharmacy name, address, and fax number on 1149 (pharmacies often want the original coupon mailed later, therefore the address is important). b. If an applicant wants to be seen that day, she/he can hand carry the application with 1149. The wait time depends on the number of ME and pregnant women walk-ins. c. The application should be faxed along with 1149, otherwise Med-QUEST staff must track it down. d. A medical emergency means the condition places the person’s health in jeopardy and could result in serious impairment to body functions or serious dysfunction of any body organ or part. However, if the person is currently being treated it is not a ME because the hospital is delivering health care. e. Barbara noted that a few physicians submit 1149 when it is not a ME because they want to get paid sooner and some parents request pediatricians sign 1149 so their children can participate in sports right away. These instances unfairly push everyone else’s application to the back of the queue. Vickie mentioned Med-QUEST’s Policy and Program Development Office is currently reviewing all 1149 forms the eligibility offices receive to help eliminate misuse. f. Form 1149 was last update December 1997 and Barbara suggested it be revised. She will discuss the idea with the Application Simplification Workgroup and they welcome feedback from OEWs. 4. U.S. Citizenship/Alien Status, and Photo Identification Documentation A request was made again by OEWs for Med-QUEST to update its eligibility and enrollment web page by adding recipient information on U.S. citizenship, alien status, and photo identification. This would not only increase their efficiency with applications, but also assist them in proactively calling their customers prior to renewal to alert them to necessary documents. Currently, these details are in the HAWI system, however they are not uploaded to the HPMMIS system viewed by health care providers. 5. Reapplying for Ineligible People a. Some programs have a quota system which could prompt OEWs to reapply for ineligible people. If a person is denied due to income, assets, temporary visa, private health insurance coverage, and/or the enrollment cap and their household situation has not changed then reapplying will only delay everyone else’s application and clog Med-QUEST’s system. Furthermore, it would be more helpful for these people to explore other health insurance and health care options. b. Barbara explained the QUEST cap is set at 125,000 people and there are currently about 150,000 people enrolled. If the cap limit is changed or it is lifted, Med-QUEST will send letters to all of its community partners and Barbara will email OEWs. c. Some patients require a denial letter before they can access charity care, however this is not a problem. The difficulty is continually reapplying for ineligible people. 6. Med-QUEST Eligibility Workers and OEWs Partnering to Help Mutual Customers a. We discussed how Med-QUEST eligibility workers should first contact OEWs regarding questions about applications they submit (those with 1100A attached). This will save eligibility workers time and benefit the customer. b. If an OEW does not get a timely response from an eligibility worker, the OEW should call the supervisor. If the supervisor does not respond, a last resort is to call Vickie. Friday, 8 December 2006 Conference Planning Committee Present: Linda Colburn, Ruth Ota, Mary Rydell, Alan Takahashi, and Barbara Luksch 1. Malama i na Keiki 8 Goal: Working together, we will find, enroll, and retain all eligible children and youths in health insurance. We reviewed the Malama i na Keiki 7 evaluation report, including suggestions for the next conference. It was agreed our presenters will focus on leadership and communication skills. We chose Friday, 16 March 2007 at the Best Western Plaza near the Honolulu airport and the theme will be “Did You Hear What I Think I Said? — Improving Communication Skills.” 2. Ideas for Guest Speakers We brainstormed these ideas: * Arnold Villafuerte: Working with Immigrant Families from the Philippines * Annabel Chotzen: Learning and Using Effective Communication Skills * Barbara: Leadership Our Way * Kim Gennaula and Guy Hagi: Communication Theme with Kid Focus * Med-QUEST Supervisors: Training Workshops Barbara will contact the speakers to organize our agenda. Sanuk activities will be interspersed throughout the day and Barbara will search for appropriate music. 3. Participants The limit is 100 and will include conference planning committee members, sanuk sistahs and braddahs, workers from diverse agencies throughout the state whose full-time responsibility is directly interacting with families, four O‘ahu Med-QUEST supervisors to conduct training workshops, and two Med-QUEST eligibility workers per unit. 4. Travel Barbara will book travel for Med-QUEST’s Neighbor Island eligibility workers through a DHS grant. Partial travel scholarships—approximately $125—will be offered to others who stay the entire day. Participants from Ka‘ü and Häna can be reimbursed for hotel accommodation on 15 March 2007. We will remind people to book early. Thursday, 14 December 2006 Process Simplification Task Force (Cit Docs Team) Present: Curt Barker, Maile Gouvea, Barbara Luksch, Rich Melendez, Sandy Morishige, Kookie Moon-Ng, Lori Naylon, Mary Rydell, Kathy Sthay, Kathy Swink, Alan Takahashi, Tessy Yokota, and Maria Zimmer. Next Meeting: TBA 1. Welcome and Introductions We invited Summerlin to join our task force since they will become a QUEST plan in 2007. Three representatives from their company participated in the conference call. 2. What’s Happening a. Applications: There is serious concern about people denied due to not completing procedures. The Application Simplification Workgroup’s attainable statewide goal is 10%; with new federal documentation barriers 34% of Med-QUEST’s October applications were denied because applicants did not complete procedures. Several states are approving applications for eligible people if everything is complete except U.S. citizenship/alien status and photo identification and allowing extra time for these documents. Hawai‘i decided not to implement this procedure and Barbara will research how it might be possible. b. A request was made again by outstationed eligibility workers for Med-QUEST to update its eligibility and enrollment web page by adding recipient information on U.S. citizenship, alien status, and photo identification. This would not only increase their efficiency with applications, but also assist them in proactively calling their customers prior to renewal to alert them to necessary documents. Currently, these details are in the HAWI system, however they are not uploaded to the HPMMIS system viewed by health care providers. Kookie will discuss this task with Wes Mun. c. It was agreed we should delete hospital record and religious record from 8000J. These U.S. citizenship documents can only be used when no other evidence is available (e.g., does not exist or cannot be obtained) and Med-QUEST eligibility worker must get more details before allowing these documents for U.S. citizenship. Therefore, we do not want to encourage applicants to submit hospital records or religious records. d. DHS’ contract with the Hawaii Primary Care Association (HPCA) for document sites has finally been approved by the Attorney General’s office and signed by DHS. HPCA will sign memorandums of agreement with the document sites and get their data on people receiving help with documents. 3. Newborns a. Barbara, Rochelle, and Kookie have almost completed the citizenship affidavits. Our primary target group is newborns, although they can be used in other rare circumstances, too. There have been discussions with CMS and Center on Budget and Policy Priorities regarding who can sign the affidavits. Barbara will send the final version to everyone when it is approved by Med-QUEST. b. We are concerned about “no-option newborns” who don’t have U.S. citizen relatives and therefore cannot submit required affidavits. Alan will assess through his eligibility units how many potential newborns are affected by this problem and report back to the task force. c. Kathy Sthay informed us the American Medical Association adopted the American Academy of Pediatrics’s resolution to use state Medicaid agency's record of payment for the birth of an individual in a U. S. hospital as satisfactory documentary evidence of both identity and citizenship. 4. First (XO72) and Second (XO73) Letters to Current Recipients 10/26/06 X072 November renewals 11/06/06 X073 October renewals missing items 11/12/06 X073 July, August, and September renewals missing items 11/27/06 X072 December renewals 12/06/06 X073 November renewals missing items 12/26/06 X072 January renewals 5. October 2006 Hub Data from Lori-Lei and Non-Responders X072 Mailed: 5,581 Mail processed: 5,636 Return Mail: 329 (5.9%) Calls Received: 140 Call Reasons: Document Site (18%), Clarify Notice (37%), Verify Documents Received (15%), Request Extension (30%) We discussed what to do with recipients who have not responded to notices. This accounts for approximately 10,000 cases for July through October (18% of total cases): * Barbara explained that prior to passive renewals for cases with children, which began June 2004, Med-QUEST’s monthly case closure average for renewals was 38.4%. Subsequently, it has been 21.8%. Therefore, 18% non-responsive rate is within an expected range. * Anecdotal information from Med-QUEST eligibility workers and outstationed eligibility workers emphasizes some people use a closure notice as impetus to take action and provide necessary information. * Following a closure notice, recipients still have thirty days to comply before the case is closed. It was decided to recommend Med-QUEST begin closing cases in February 2007. Due to the potential workload impact on Med-QUEST eligibility staff, outstationed eligibility workers, and 211 operators, it should be done in monthly increments. Also, Kathy Swink and Kookie will work on a solution for foster children who are still missing U.S. citizenship and alien status documents. 6. AUW 211 Data (September-November 2006) Calls: 2,920 Honolulu County: 67% Hawaii County: 18% Maui County: 9% Kauai County: 6% Rich noted there are spikes for about one week after letters are mailed. 8. Defining Health Plans’ Role The QUEST RFP stated the health plans will assist DHS with meeting all citizenship documentation requirements. Barbara suggested our task force define the health plans’ activities so they complement current implementation steps and do not interfere with smooth-running procedures. We referred to minutes from the conference call on 31 May 2006 with the QUEST health plans explaining how they currently assist with citizenship and photo identification document requirements. The QUEST plans had requested a list of members’ renewal dates to use existing phone line services to contact recipients and for Med-QUEST to update its eligibility and enrollment web page by adding recipient information on U.S. citizenship, alien status, and photo identification. Kookie clarified Leslie Tawata at Med-QUEST is coordinating with health plans on the mandatory re-enrollment process. Barbara will email Maria from Summerlin the “Open Your Mail” print advertisement appearing in newspapers throughout the state and also in health plan newsletters.