Thursday, 2 August 2007 Outstationed Eligibility Workers (Cit Docs Team) Present Hawaii: Gladys Ablao, Anna Mehau, and Camille Mehau. Kauai: Charlene Yamamoto and Charlette Manoi. Oahu: Ivy Johnson, Barbara Luksch, Michelle Malufau, Jasmin Nepomuceno, Regina Quimpo, and Teri Roe. 1. Welcome and Introductions The purpose of the conference call was to discuss citizenship, alien status, and photo identification documents for Med-QUEST customers who renewed their benefits in May 2007 and June 2007. 2. X072, X073, and X074 Letters a. Letters were mailed as follows: May 2007 Renewals 04/25/07 (X072) and 06/06/07 (X073) June 2007 Renewals 05/25/07 (X072) and 07/06/07 (X073) b. The Process Simplification Task Force will decide during its 7 August 2007 conference call the X074 closure letter schedule. For previous recipients, X074 was mailed two weeks before the final deadline to submit documents and the OEWs all agreed this was enough time for procrastinators to complete the task. c. OEWs were encouraged to remind recipients who recently renewed in May and June about the blue letters (X072 and X073) and to submit their documents immediately. d. Community health centers appreciated receiving lists from the health plans about patients missing documents. Barbara will request AlohaCare, HMSA, and Summerlin send lists to primary care providers. 4. Hospitals a. We discussed forms that hospitals complete for newborns. If it is an add-on, each hospital sends Med-QUEST information on hospital letterhead with the baby’s name, birth date, sex, mother’s name and case number, and a photo or 8000K. Hospitals complete applications for newborns whose mothers are not Med-QUEST recipients and attach 8000K and hospital record. In both situations, after the birth certificate is issued, the family must send a copy to Med-QUEST. b. For other uninsured patients, the hospitals complete Med-QUEST applications and attach whatever documents are available. If a patient comes to the community health center and does not know if the hospital completed an application and details are not available online, the OEW should call the hospital’s financial counselors. This will help the customer with follow-up on the original application and prevent duplicate applications. c. Barbara will email a list of hospital contacts to community health center OEWS. Note: This was done on 2 August 2007. 5. New Applicants and Lost Birth Certificates Beginning 20 June 2007, Med-QUEST and the OEWs tested a new procedure for applicants who lost birth certificates: * If an applicant is missing a birth certificate, please help her or him get one. * Copies of Hawaii birth certificates can be ordered online at or using a paper application downloaded from Hawaii Covering Kids Library of Forms. * There is a federal agency web page with links to birth certificate information for all U.S. states and territories. * Attach a copy of the money order and paper application or electronic confirmation. * Write the following on 1100A: name of person requesting health insurance who needs a birth certificate, what documentation is attached to prove she/he applied for a birth certificate, and date the birth certificate was requested electronically or by mail. * If these guidelines are followed and the application is only missing a birth certificate, the eligibility worker will wait 45 days to make a determination due to extenuating circumstances. * Please tell the customer that when the birth certificate arrives in the mail to immediately give you a copy to send to Med-QUEST or the application will be denied. OEWs remarked the pilot procedure is working extremely well. Barbara will relay this good news to the Process Simplification Task Force and request revising 8000J to similarly help all applicants. 6. Passive Renewals Barbara requested OEWs help track Med-QUEST customers who move or change telephone numbers and send information using form 1179. Currently, Hawai‘i has passive renewals for cases with children. However if our error rate is greater than 3 percent during Med-QUEST’s random sample follow-up phone calls, Hawaii will lose passive renewals. We don’t want people who do not report household changes to negatively impact children in families who follow the rules. 7. Pregnant Women Applications The OEWs stated in most locations pregnant women applications are taking at least one month to process. Oahu OEWs requested the old Honolulu Med-QUEST office system of specially assigned eligibility workers to process pregnant women and medical emergency applications. It was not only more efficient, but also meant the OEWs knew who to call about these applications. 8. OEW Statewide Meeting Barbara is organizing a statewide OEW meeting. Airfare will be reimbursed for Neighbor Island participants. Tentative details are: * Open to outstationed eligibility workers whose full-time job is completing Med-QUEST applications. Unfortunately, capacity and funding do not allow participation by supervisors, case managers, or other staff. * Approximately three hours, including free lunch, with presentations by QUEST health plans, hospital financial counselors, and Med-QUEST eligibility staff. OEWs who attend must commit to the entire three hours. * Subsequent to the conference call, these logistics were decided: Friday, October 5 from 11:00 AM to 2:00 PM at the Honolulu YWCA. 9. Other Business a. Form 8000M was mailed with the second blue letter (X073). People who needed help with United States birth certificates could return it in the self-addressed stamped envelope and a special Med-QUEST administrative team provided assistance. People do not need to use 8000M if they prefer to get help through a document site. b. It was suggested the Honolulu Med-QUEST office have a designated fax number for OEWs. c. Barbara will email O‘ahu OEWs the process to use if eligibility workers do not return phone calls within twenty-four hours. Note: this was done on 9 August 2007. d. Funding may be available to reimburse document sites for assistance with new applicant birth certificates. Barbara will research the feasibility and procedure. Tuesday, 7 August 2007 Process Simplification (Cit Docs Team) Present: Chris Akau, Frank Chong, Andreas Cravalho, Carol Ganiron, Liane Hiramoto, Donnie Kamiya, Barbara Luksch, Sandy Morishige, Vickie Napuelua, Joy Soares, Alan Takahashi, and Julie Thomas. Next Meeting: 28 August 2007 1. Welcome and Introductions The purpose of the meeting was to discuss Med-QUEST customers who renewed their benefits in May 2007 and June 2007 as well as new applicants. Details below include additional information gathered following the meeting. 2. April-July Hub Data Chris reported on most recent data. The tally for July 2006-July 2007 is: 51,929 X072 Letters Mailed 19,552 X073 Letters Mailed 35,641 Mail Processed 2,965 Mail Returned 3,027 Calls Received 3. Interim Med-QUEST Data (Kookie) The following data reflects 1 July 2006 to 30 April 2007 and does not include exempted recipients (children in foster care and individuals enrolled in Medicare, receiving Supplemental Security Income, and/or receiving Social Security Disability Insurance): 101,276 Total Cases: Required to Submit Documents 51, 466 Total Cases: System Links Located Documents 49,810 Total Cases: Need Hard Copies; Sent X072 79,853 Total Individuals: Need Hard Copies 14,402 Individuals Scheduled for Closure; Sent X074 5,806 Individuals Lost Benefits Due to Citizenship, Alien Status, and Photo ID Documents (7,139 Individuals Terminated, 975 Individuals Reinstated, and 358 Individuals Requested Voluntary Termination) 3,302 HMSA Participants Sent Documents Note: The actual number of documents received is greater, however multiple documents were submitted by some individuals. 4. QUEST Plan Activities a. During the previous campaign, telephone calls were not very effective because either the customer was not home, no longer lived at the location, or the line was disconnected. b. Kaiser, HMSA, and AlohaCare will send letters with self-addressed stamped envelopes urging participants to send their documents. The letter will contain the Med-QUEST Section which signifies the eligibility branch unit and worker and 8000K including the form’s header and footer. c. Barbara explained the PCPs appreciated receiving patient lists so they could also follow-up, therefore Kaiser, HMSA, and AlohaCare will share details with them. 5. May 2007 and June 2007 Renewals Our timeline will be: 15 August 2007: Med-QUEST gives lists to QUEST plans of participants missing documents 20 September 2007: Deadline for QUEST plans to drop off documents at hub 5 October 2007: Case Closure Letter (X074) generated for customers still missing documents 19 October 2007: Case Closure Letter (X074) mailed 31 October 2007: Last date Med-QUEST offices can receive documents from customers 1 November 2007: Cases closed Med-QUEST Customer Service Branch will continue as the hub. Donnie explained it takes a maximum of two days to process the documents. 6. New Applicants a. The pilot with outstationed eligibility workers is working very well. We will expand the process to all applicants with this note on 8000J: Lost U.S. Birth Certificates If someone who needs medical assistance must get a new birth certificate, attach a copy of the birth certificate application or electronic confirmation and money order. The Med-QUEST eligibility worker will wait 45 days from the date Med-QUEST received the application to determine eligibility. When the birth certificate arrives in the mail, immediately send a COPY to Med-QUEST or the person will be denied. b. It was also noted that outstationed eligibility workers and Med-QUEST Eligibility Branch do not support expanded pending for citizenship, alien status, and photo identification documents. Forty-five days is sufficient and extending pending will wreak havoc on priority applications (e.g., pregnant women applications, medical emergencies, etc.). Tuesday, 28 August 2007 Process Simplification (Cit Docs Team) Present: Lori-Lei Aponte, Natalie Cook, Andreas Cravalho, Joelaine Hao, Dee Helber, Susan Jackson, Barbara Luksch, Richard Melendez, Kookie Moon-Ng, Sandy Morishige, Ruth Ota, Mary Rydell, Rochelle Sparko, Kathy Swink, and Alan Takahashi. Task force members described the reality of implementing the federal government’s citizenship, alien status, and photo identification requirement as brutal. They believed Hawaii’s overall success was attributed to the following: 1. Welcome and Mahalo * Everyone came together for the greater good * Task force members focused on what was best for Med-QUEST’s customers * We cut through obfuscation and barriers * We relied on each other’s strengths and expertise * Each task force member checked her or his ego at the door * Everyone tried to be of service * There was very little time to plan, however we were flexible so when problems arose we found immediate solutions * System links eliminated unnecessary hard copies * There was a strong spirit of cooperation * The state did not want eligible people disenrolled from Med-QUEST programs * Public forums and conference calls gathered ideas and explained processes to collaborative partners * We organized a free statewide hotline service through 211 and central document hub at Med-QUEST’s Customer Service Branch * The “Open Your Mail” media campaign worked because the message was easy to understand, advertising covered all islands, dates were set for the entire year, and it caught people’s attention. * The extra effort by Hawaii State Department of Human Services employees to call people before their cases were closed helped ultimate procrastinators submit documents. * The team leaders kept everyone informed and ran a smooth operation by providing up-to-date details when federal guidance regularly changed, preparing key agencies with appropriate information, organizing meetings and activities, and writing detailed minutes and memos to track our progress. 2. Suggestions for Improvement These three areas were mentioned: * Hospitals: We worked extremely hard to interest these institutions in our efforts, however we were not successful * QUEST Plans: Get them more integrally involved * Invite appropriate trade associations to participate 3. Updates a. Rich explained 211 quarterly call data by zip code from June 2006-August 2007. Total was 11,369 from: Hawaii: 1,898 Kauai: 596 Lanai: 17 Maui: 896 Molokai: 67 Oahu: 7,858 Other States: 34 b. Lori-Lei highlighted the hub data from July 2006-July 2007, including these totals: X072 Mailed: 51,929 X073 Mailed: 19,552 Mail Processed: 35,641 Mail Returned: 2,965 Calls Received: 3,027 4. Next Steps a. Med-QUEST Eligibility and Enrollment Web Page This web page must be updated so people who reapply do not have to resubmit documents all over again. Document sites, outstationed eligibility workers and health care providers know will what documents are required and Med-QUEST customers aren’t required to go on unnecessary scavenger hunts. b. Helping Children Leaving Foster Care Children need citizenship, alien status, and photo identification documents to continue Med-QUEST benefits. We discussed a possible Child Welfare Services-Med-QUEST interface to help eligible children retain their public health insurance benefits when they leave foster care. Note: Following the meeting it was decided two YES/NO checkboxes should be on Form 1106 sent from Child Welfare Services to Med-QUEST: Photo Identification in CWS file and U.S. Birth Certificate in CWS File. Barbara will follow-up with Irvette Henley (Med-QUEST) and Kathy Swink. c. Med-QUEST Customers: Address and Telephone Number Changes It was suggested the task force field test a health care provider—“Help Us Help You Get Paid!”—that could be faxed to a local Med-QUEST office with customer address and/or telephone number changes. 5. Med-QUEST Enrollment Data 30 June 2006 QUEST: 144,068 Medicaid Fee-for-Service: 40,459 CHIP: 15,569 Immigrant Children: 3,249 30 November 2007 QUEST: 138,209 Medicaid Fee-for-Service: 40,875 CHIP: 17,772 Immigrant Children: 3,205