Friday, 20 February 2009 Oahu Outstationed Eligibility Workers
Present: Sherry Baclaan, Chez Black, Karen Gardner, Garance Gorman, Norma Kaunamano, Barbara Luksch, Michelle Malufau, Kookie Moon-Ng, Esme Nakamura, Jasmin Nepomuceno, Teri Roe, Cassandra Stewart, and Alan Takahashi.
1. CHIP Reauthorization
President Obama signed the law on 4 February 2009 and it is effective 1 April 2009 to 30 September 2013. The overall goals are to continue public health insurance benefits for current recipients and cover an additional four million children and youths who are eligible but not enrolled. Three process simplification provisions that affect eligibility are:
a. States can verify citizenship through an electronic link with the Social Security Administration.
b. Eligible kids can be enrolled in public health insurance while citizenship documents are forthcoming.
c. Newborns in U.S. hospitals are no longer required to provide citizenship and photo identification documents.
Furthermore, Hawaii will receive an annual performance bonus for enrolling more children and youths in its regular Med-QUEST programs. This fiscal incentive is designed to encourage states to reach more low-income kids and is also based on implementing five of eight enrollment simplification measures. Hawaii currently qualifies because it has already implemented these simplification measures: (1) no asset test, (2) no face-to-face interview, (3) joint application and verification processes for all public health insurance programs, (4) administrative or ex parte renewals, and (5) express lane eligibility through BESSD.
More details are on our CHIP Reauthorization web page.
2. Kapiolani Medical Center for Women and Children: Health Insurance Process
Esme explained there are five financial counselors and the department operates seven days a week. Every mother is visited in her room and asked about health insurance for the newborn. Most who have private coverage cannot afford to add the baby so a Med-QUEST application is completed. A hospital form is attached with information required by Med-QUEST and a photo is attached. This form is also used to add a baby to a mother’s Med-QUEST case. Financial counselors also request pay stubs from parents to attach to the application. Other information included:
* A messenger delivers Med-QUEST applications to the Honolulu office, however if the primary informant’s home address is another island then paperwork is faxed to the local Med-QUEST office.
* If the baby is ineligible for QUEST or QExA, there is a financial assistance program discount if the bill is paid within 30 days. Hospital costs are about $12,000-15,000 without complications. She noted some Japanese tourists come her to give birth, pay cash, and go home.
* Physicians encourage parents to preregister online and allows financial counselors to contact the family about health insurance options prior to hospitalization.
* If the parents have not decided the baby’s name, birth details are not transmitted to the Hawaii State Department of Health and the parents must apply later for a birth certificate.
We discussed the updated “Hospital Outstationed Eligibility Workers” handout that helps community health center OEWs and hospital OEWs coordinate paperwork for mutual customers.
3. Updates from 5 December 2008 Meeting
a. Recommendations to Med-QUEST Honolulu Office on 11/20/08
Based on information shared at the 5 September 2008 meeting, Oahu OEWs suggested three actions to better assist mutual customers. Alan gave an update on each action:
When an application with 1100A is registered, list outstationed facility as the authorized representative in the address screen. Next require all eligibility workers call the OEW if documents are missing or other information is needed to process the application. Positive Outcome: Overall it will save the eligibility worker time if she/he uses the OEW to get paperwork or details rather than sending a pending notice. Status: Alan said clerical staff will be informed to list the outstationed facility in the authorized representative field and eligibility workers will be instructed to contact the OEW if documents are missing or anything else is needed.
Assign two eligibility workers to process pregnant women (PW) and medical emergency (ME) applications. This system was extremely efficient and inexplicably disappeared. Positive Outcome: PW and ME applications will be processed on time (5 business days and 2 business days respectively). Also, OEWs and customers know exactly who to call with questions about these applications. Status: Each unit has oversight for PW and ME applications. Supervisors send Alan weekly reports so he can monitor their progress. OEWs are requested to follow the procedure that began in 2007 if their PW or ME applications are not processed timely.
Allow all community health center OEWs to send applications to the Kapolei office. Positive Outcome: More efficient process. Overall it will build a positive public-private partnership and provide better customer service. Status: A pilot project began 12/15/08 (see 3c below).
b. Med-QUEST Honolulu Office Pilot Project
The initial pilot for Unit 117 and The Queen’s Medical Center applications was very successful because it enabled a more efficient processing method. An RFP was issued 01/26/09 to expand the service to all five units at the Honolulu office for one year:
* Receipt and processing of daily applications and verifications by mail, fax, or electronic means,
* Screening applications and requesting for verifications,
* Data entry of application information,
* Data query and registration into HAWI,
* Initiation and retrieval of physical case records,
* Contacting and assisting application to secure verifications,
* Submit to Med-QUEST verifications to Med-QUEST within 10 days, and
* Process acceptable verifications
During the one-year contract, Med-QUEST Eligibility Branch will also eliminate ineffective policies and procedures, establish clear lines of accountability and authority, perfect standards, and make appropriate changes to HAWI computer system.