Thursday, 27 August 2009-Thursday, 1 October 2009 Outstationed Eligibility Workers Five meetings were held with community health center outstationed eligibility workers, hospital outstationed eligibility workers, and Med-QUEST Eligibility Branch supervisors. Present Hilo (09/11/09): Jeanine Kaninau (Keeau Family Health Center), Barbara Luksch (Hawaii Covering Kids), Catherine Luthe (Hamakua Health Center), Camille Mehau (Pahoa Family Health Center), Susan Taira (Hilo Medical Center), and Oarlene Wingate (Med-QUEST). Kauai (08/27/09): Blaine Akagi (Med-QUEST), Jan Baldwin (Wilcox Hospital), Barbara Luksch (Hawaii Covering Kids), Cassandra Stewart (Kauai Veterans Memorial Hospital and Samuel Mahelona Memorial Hospital), June Munoz (Kauai Community Health Center), and Iris Venzon (Med-QUEST) Kona (09/10/09): Gladys Ablao (Hamakua Health Center), Erika Blake (Kona Community Hospital), Norma Crouch (West Hawaii Community Health Center), Barbara Luksch (Hawaii Covering Kids), Gaylynne Rivera (Med-QUEST), Dean Soares (Kohala Family Health Center), and Jodie Torres (Kohala Family Health Center). Maui (10/01/09): Karin Benz (Maui Memorial Medical Center), Leilani Carlson (Maui Memorial Medical Center), Noe Lecker (Hana Community Health Center), Barbara Luksch (Hawaii Covering Kids), Gail Omura (Med-QUEST), Cassandra Stewart (Outreach Services), and Helen “Gigi” Tavares (Maui Memorial Medical Center). Oahu (08/20/09): Sheryl Atanes (Hawaii Medical Center), Garance Gorman (Waikiki Health Center), Norma Kaunamano (Waimanalo Health Center), Kim Kealoha-Ho (Kalihi-Palama Health Center), Nga Ching Leong (Kalihi-Palama Health Center), Barbara Luksch (Hawaii Covering Kids), Michelle Malufau (Koolau Loa Community Health Center), Fran Mueller (Waimanalo Health Center), Esme Nakamura (Kapiolani Medical Center), Jasmin Nepomuceno (Kokua Kalihi Valley), Teri Roe (Waianae Coast Comprehensive Health Center), Cassandra Stewart (Outreach Services), and Sunny Yee (Med-QUEST). 1. Welcome and Introductions Barbara thanked everyone for attending the meetings and explained the purpose was an informal discussion about current Med-QUEST eligibility topics and collaboration among organizations. 2. Handouts * Hawaii Hospital Emergency Department Visits 2000-2007 (Children 0-18 Years Old) * Application Simplification Workgroup: Med-QUEST Notices * 1100N Draft 08/17/09 * Med-QUEST Offices: Marketing Cit Docs to Customers * Med-QUEST Enrollment Data: Ages 0 Through 18 Years * Number of Applications Registered by Med-QUEST by Unit * MQD PPD Medical Assistance for CFA Citizens * Hawaii Covering Kids Work Plan: June 2009 to May 2011 3. Who Are Uninsured Children and Why Are They Uninsured? We discussed this issue and reasons included: * Work hours cut and can no longer afford dependent coverage through private health insurance. * Parents don’t know they can be employed and kids are still eligible. * Parents recently unemployed. * Parents did not respond to Med-QUEST’s request for income documents so case was closed. * Moved and Med-QUEST cannot locate the family so case was closed. * Newly arrived children from Micronesia, Philippines, and California. * Older parent is retired and won’t provide income information to a government agency to complete Med-QUEST application. * Use sliding scale fee and charity care because it’s easier than applying for Med-QUEST’s programs. * Micronesian children’s parents are not in USA so cannot apply for Social Security numbers. * Homeless youth moving around to live with different families. * Babies added to mother’s case as newborns, but don’t provide birth certificate or Social Security number when case is renewed. * Home births with no birth certificates. 4. Newborns It was requested that community health center OEWs contact the hospital OEW where the baby was born before submitting any paperwork to Med-QUEST. Collaboration between facilities is appreciated by the customers and prevents duplicate applications or add-on requests that create excess work for Med-QUEST staff. Barbara will email an updated list of hospital and community health center outstationed eligibility workers to assist coordination. 5. Updates a. HAWI-Generated Med-QUEST Notices. The Application Simplification Workgroup is revising most common versions. The limits are 34 lines and 70 characters per line. Barbara shared drafts of these pending, approval, and denial notices: M011, M100, M130, M173, M181, M200, M205, M207, M208, and M281. The workgroup will also revise closure notices. The Hilo MQD-OEW group requested a Med-QUEST version of 1293 (BESSD’s free-form pending notice) with checklists so Barbara will follow-up with the Application Simplification Workgroup. b. School Outreach. Barbara requested help in local communities and participants mentioned these successful activities: * Dropping off flyers and contact information with each location’s school health aide, * Coordinating physicals with school athletic directors and verifying these students have health insurance, and * Participating in local school fairs. c. Honolulu Pilot Project: Paperwork Processing. Outreach Services will provide information at a later date. d. Molokai Med-QUEST Office. The eligibility worker recently retired, therefore applications are now processed through the Maui office. e. 1100 Attached to BESSD 1240. Latest version has every other page printed backwards (70,000 copies). One suggestion is to tear apart the pages and staple across the top which makes it easier for the OEW to complete information and EW to process it. f. 1100 Paper Color. Buff-colored paper is no longer available in Hawaii. New color will be canary. 6. Med-QUEST and Outstationed Eligibility Worker Partnership a. Outstation Facility Code. It is listed in HAWI according to “Organization Assisting with Application” box on page one of Med-QUEST’s application. We reviewed the code list and suggested changes to distinguish between community health center and hospital sites. b. OEW Submits 1123 with Application. Med-QUEST lists outstationed facility as the authorized representative in the address screen application is registered. c. EW Follow-Up with OEWs. Med-QUEST eligibility workers should contact the outstationed eligibility worker listed on 1100A by telephone or email if documents are missing or other information is needed to process the application. Many OEWs go to customers’ homes or community locations to get documents so this partnership has effectively increased efficiency and cut down on paperwork. 7. Current Issues a. Increasing Pending Notice From Ten to Fifteen Days. Barbara thanked OEWs for their feedback. Ten-day pending is from the date a Med-QUEST eligibility worker inputs information. It is tied to federal adverse action, therefore ten days cannot be increased. Since more documents are now required to determine eligibility, customers should be advised they could request more time. b. Add-On. OEW should find out the case’s EW and send it attention to her/him. This will increase efficiency. c. 1149 Emergency Processing Form. It would be helpful to track health care providers who submit these forms and their reasons. An 1149 request pushes other applications to the back of the queue so it should only be used for emergency medical services listed on the form that will not be treated without health insurance. d. New Med-QUEST Eligibility Branch Voicemail Message. Overall, everyone is grateful for the centralized system diverting general information calls to Med-QUEST’s Customer Service Center. The process was initiated by Med-QUEST Administration effective 07/31/09. It has streamlined Med-QUEST Eligibility Branch’s procedures by giving eligibility workers, secretaries, and clerks more time to process applications and other paperwork. It was suggested the required message is too long and Barbara will ask the Process Simplification Task Force to write a shorter version. Note: This was completed and approved by Med-QUEST administration 10/16/09. e. Citizenship, Alien Status, and Photo ID Documents. This is once in a lifetime requirement, however errors have been found when some customers disenrolled and later enroll again. For example, some BESSD staff input codes without document copies to bypass the HAWI screen and later Med-QUEST must request document copies from customers. If the person’s name on the application is different from the photo identification and/or birth certificate OEWs should put the person’s Social Security number on the document so there aren’t mix-ups. f. Hospitals. If it is inpatient the person or family usually brings documents to complete Med-QUEST application. However, if it is an emergency room situation, follow through with necessary papers by the customer is less likely. g. Customer Email Addresses and Cellphone Numbers. It was suggested during the registration process that an email address and cellphone number be written in HAWI’s medical card address because it has enough space. Med-QUEST requests an email address on the application and some people write cellphone and landline numbers. Follow-up with customers would be more efficient if this information was input into HAWI. 8. Med-QUEST: Marketing Citizenship, Alien Status, and Photo Identification Documents Goal: Increase eligibility worker efficiency by decreasing the percent of applications denied due to “Did Not Provide Information.” Action Steps a. Every time someone from Med-QUEST talks with a customer, she/he tells the person: “You must attach documents to your application.” b. Caller requests a Med-QUEST application in the mail: “Inside the application is a list of documents you must attach to your application.” c. Caller is asking to clarify information: “Please remember when you send your application to attach documents.” d. Person picks up an application at a Med-QUEST office: Pull out 8000J and explain, “Please read this list of documents you must attach to your application when you bring it back to us. If you have questions, please let me know before you leave our office.” e.Person drops off an application at a Med-QUEST office without documents attached: Give her/him another 8000J copy and explain, “We need these documents to process your application.” Fewer Pending Notices = Mo’ Bettah (Saves Time, Money, and Trees) 9. Retention Best Practices a. Database. Available from Hawaii Covering Kids to track application and renewal dates. Note: Must contact Med-QUEST Customer Service Section for case renewal date. b. Postcards. Barbara showed samples planned by Kahuku Hospital. It is available in Word document format to change the contact information and return address. c. OEWs Follow-Up with Newborn Add-On Documents. Continue requesting birth certificate and Social Security number from baby’s parents. 10. Nonpregnant CFA Adults We discussed Med-QUEST’s policy clarifications. 11. Mahalo Cards The community participants signed thank you cards for Med-QUEST staff to let them know we appreciate their hard work and dedication to helping our mutual customers. Friday, 18 September 2009 and Thursday, 15 October 2009 Application Simplification Workgroup Present: Barbara Luksch (Hawaii Covering Kids), Chris Wong (Med-QUEST Policy and Program Development Office), and Jeffrey Young (Med-QUEST Eligibility Branch) Note: Drafts of all notices and the free-form pending letter were shared with Med-QUEST eligibility staff, outstationed eligibility workers, and all Application Simplification Workgroup members. Their suggested improvements were included in the final versions. 1. We reviewed the most common pending, approval, and denial notices to assure each one has consistent information, is easy to read and understand, and includes information about requesting a free interpreter. Pending Notice M011: Need More Information: HAWI Pending Form DHS 1109: Need More Information: Free Form Approval Notices M100: Medical Emergency and ABD M130: 1931 Program M173: QUEST-ACE M181: Regular QUEST Denial Notices M200: Did Not Provide Information M205: Over Income ABD M207: Over Assets M208: Other Reasons M281: Over Income QUEST Closure Notices M600: Did Not Provide Information M685: Over Income: PW and Kids M687: Over Assets M690: Did Not Return Form 1110 (Election and Enrollment) M698: Over Income: Non-Pregnant Adult X620: Did Not Return Form 1100B-2 (Renewal) 2. Information from notice M688 (Excess Assets QExA) was added to M687. There is now only one “Over Assets” closure notice. 3. We created a Med-QUEST free-form pending letter (DHS 1109). Chris is writing instructions so it can be released to Med-QUEST eligibility staff and outstationed eligibility workers. 4. We created an automatic notice to be sent to the primary informant (person listed in Question 1 on 1100 and 1108) when the application is registered. Monday, 26 October 2009 Conference Planning Committee Present: Lori Bianchin, Linda Colburn, Michelle Kaaihue, Barbara Luksch, Mary Rydell, and Alan Takahashi. 1. Malama i na Keiki 11 Goal: We will work together to find, enroll, and retain all eligible children and youths in health insurance. We reviewed the Malama i na Keiki 10 evaluation report, including suggestions for the next conference. It was agreed presenters will focus on organization skills. We chose Friday, 26 February 2010 at the Best Western Plaza Hotel near the Honolulu airport. Usually we host the event in March, however all Fridays those months are either designated for state furloughs or a holiday. The theme will be “Being Organized in a Frenetic Work Environment.” 2. Agenda (8:00 AM - 4:00 PM) We brainstormed these ideas for guest speakers: * Welcome: Mary Rydell, Centers for Medicare & Medicaid Services * Sanuk Braddahs and Sistahs Song: “I’m Coming Out” by Diana Ross * Guest Speaker: Peter Kay, CyberCom, Inc. * Med-QUEST Supervisors: Training Workshops * Kim Gennaula and Guy Hagi: After Lunch Presentation Focused on Our Theme * Linda: Team-Building Activity That Requires Being Organized in a Frenetic Environment Barbara will contact the speakers and organize specific times. There will be a morning small group interaction among participants assigned to tables; discussion will focus on children’s health insurance outreach and enrollment strategies. Sanuk activities will be interspersed throughout the day. Cellphones will be banned from 8:00 AM to 4:00 PM. 3. Participants The limit is 100 and will include conference planning committee members and four Oahu Med-QUEST supervisors to conduct training workshops. All other participants must be agency staff whose full-time responsibility is directly interacting with families, such as community outreach workers, outstationed eligibility workers, public health nurses, Head Start educators, and social workers. We will also invite 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. Travel scholarships will be offered to others who stay the entire day. Participants from Kau and Hana can be reimbursed for hotel accommodation on 25 February 2010. Participants will be reminded to book early.