Thursday, 2 November 2000 Identification and Outreach Present: Josephine Chang, Kathy Sthay, Stephany Vaioleti, Dee Helber, Lucy Ndirangu, Beth Giesting, and Barbara Luksch Next meeting: 10 January 2001 at 9:00 AM at HPCA Conference Room The purpose of the meeting was to brainstorm ideas to use the Med-TANF outreach money that is available to Hawaii. The information below will be reviewed at the next meeting. SYSTEMS 1. Expand electronic application capabilities to more outstationed eligibility workers (OEWs). This will also give feedback to OEWs on their applicants' status. 2. Develop and implement recorded telephone information in all languages spoken in Hawaii. 3. Upgrade the HAWI system to meet Med-QUEST's needs. TRAINING 1. Develop and implement a training curriculum for health care providers, including medical and nursing Schools. 2. Train all BESSD workers to properly transition cases to medical only. 3. Train all MQD and BESSD workers to improve customer service skills. 4. Provide annual training for community-based organizations on Medicaid rules. 5. Sponsor annual outstationed eligibility workers meetings. 6. Develop and implement application assistants trainings for WIC, Head Start, school personnel (school health aides, PCNC, counselors, etc.), and community action programs (HCAP, MEO, HCEOC, etc.). OUTREACH 1. Med-QUEST organize a collaborative community task force to: * redesign all pamphlets to improve readability; * develop a campaign to promote utilization of EPSDT services; * create culturally appropriate materials in Hawaii's major languages; and * design and implement an effective statewide media and public information campaign including outreach materials. 2. Translate and record the "Hawaii's Medicaid Programs" and "How to Complete the Med-QUEST Application" videos into all languages used in Hawaii. 3. Provide looped "Hawaii's Medicaid Programs" videotapes to all WIC Local Agencies. 4. Create, produce, and distribute outreach toolkits for community organizations, businesses, faith-based groups, media persons, unions, state agencies, and healthcare providers. APPLICATION 1. Print a simplified application and instructions. 2. Translate and print the simplified application and instructions in all languages used in Hawai'i. EXPAND MED-QUEST APPLICATION UNITS 1. Add a Med-QUEST office in Windward, Oahu 2. Allow the Kapolei office to process all Leeward, Oahu applications INCREASE OEW SUPPORT IN COMMUNITIES 1. OEWs will also be outreach workers to help families enroll in Med-QUEST programs at schools, health fairs, association meetings, faith locations, senior centers, WIC Local Agencies, Head Start programs, immunization clinics, etc. 37 Total * Bay Clinic: Hilo, Pahoa, and Kau * Community Clinic of Maui: Kahului, Wailuku, and Lahaina * Hamakua Health Center * Hana Community Health Center * Kalihi-Palama Health Center: Kalihi-Palama, River of Life Mission, and Safe Haven * Kokua Kalihi Valley: Kuhio Park Terrace, Kalihi Valley Homes, and Hauiki Hale * Waianae Coast Comprehensive Health Center: Waianae, Nanakuli, Waipahu, Kapolei, and Waiola * Waikiki Health Center: Waikiki, Palolo, North Shore * Waimanalo Health Center: Waim"nalo and Kailua * Queen Emma Clinics * Kona Community Clinic * North Shore Community Health Center: Kahuku and Kaneohe * Native Hawaiian Health Care Systems (2 per system): Hawaii, Oahu, Maui, Molokai, and Kauai. 2. Provide additional clerk staff to communicate with OEWs regarding applicants' status: Kapolei (2), Oahu (3), Molokai (1), Maui (1), Hawaii (2), and Kauai (1) Thursday, 2 November 2000 Training and Public Education Present: Alan Takahashi, Cassandra Stewart, Gloria Samson, Med-QUEST Honolulu staff, and Barbara Luksch Next meeting: to be announced We presented the world premiere of our videotape "Hawaii's Medicaid Programs" at Med-QUEST's Dillingham Office. Barbara thanked script writers Alan, Cassandra, and Gloria for making the videotape a reality. Friday, 3 November 2000 Evaluation Present:, Andrew Aoki, Marcia Hartsock, Bill Wood, Supin Wongbusarakum, and Barbara Luksch Next meeting: 22 January 2001at 9:00 AM at HPCA Conference Room 1. We discussed additional people to invite to our next meeting to coordinate data efforts. They are Charlene Gaspar (DOH), Ruth Ota (DOH), and Karl Yoshida (DOE). Barbara will also link data information with Med-QUEST. 2. Andrew explained The Hawaii Uninsured Project sponsored by HMSA Foundation and the first conference on 28 November 2000. A small group session at the conference will focus on data and counting the uninsured. Barbara noted Colorado has a Coalition for the Medically Underserved and their web site address with downloadable reports is http://www.ccmu.org/. 3. Barbara and Bill updated everyone on the Hawaii Covering Kids Data Project. * Bill posted a chart listing common fields (and endless uncommon fields!) for emergency forms from the independent schools--there is no common name for the form and not all schools collect health insurance information. The goal for Year 2 is to generate a common data collection form. Also, Barbara will meet with HAIS business managers in January. * There are approximately 600 child care centers and preschools. On Oahu there are 246 sites with 12,000 kids representing 80% of the state. The groups with over 100 kids enrolled are the first priority for data collection. * The error rate of the DOE emergency cards is based on self-declaration by parents/guardians. Question: after we stabilize the data collecting can we match forms and insurance records? * A revised grant budget includes hiring temporary help for school health aides with at large public schools to collect health insurance data from the emergency cards (beginning September 2001) and pilot testing long-term data collection by schools using available hardware and software. * Marcia suggested organizing data by complex: Barbara will do this for the 1998 and 1999 data and Supin and Bill will do it for future data. * Aggregated application and outreach data from the pilot project will be available at the next meeting. * Barbara will try to meet with the head administrator for the Catholic Schools. 4. School lunch outreach forms: the outreach workers did not request parents and guardians to list the child's school on the form but Barbara has them sorted by zip codes and cities/towns. To date, 5735 forms were received. Lucy explained approximately 60-70% of those requesting information need health insurance for their children. Tuesday, 21 November 2000 Application Simplification Workgroup Present: Melba Bantay, Chuck Bayne, Donna Cohen Ross, Bonnie Graham, Liane Hiramoto, Ruth Ellen Lindenberg, Barbara Luksch, Gloria Samson, Diana Tizard 1. Welcome Barbara thanked everyone for their willingness to participate in the meetings and dedicate time and energy to a very important task. A workgroup list circulated for updates and will be distributed to all members with the minutes. Diana volunteered to help with minutes. 2. Introductions We introduced ourselves and explained why we attended the meeting and why a simple application is important: Donna Cohen Ross, Center on Budget and Policy Priorities * involved with the "Start Healthy, Stay Healthy Campaign" to help kids get enrolled in public health insurance * provides training and technical assistance to Covering Kids projects * has done a thorough review of all state applications to assist with simplification and streamlining the process * the application is the first door into health insurance and it should be an open door Liane Hiramoto, Med-QUEST Policy and Program Development Office * in charge of the Aged, Blind, and Disabled program * previously the Med-QUEST Forms Coordinator and helped develop the current 1100 * people often call because they don't know what's expected on the form * simplified form will help customers provide more information for Med-QUEST Chuck Bayne, Med-QUEST Ongoing Unit * simple application will make processing more timely * need a form that will not prevent people from applying because it is intimidating Gloria Samson, Med-QUEST Applications Unit * simple application means it will be more complete and Med-QUEST can make a better and faster determination * approximately 80% of the current applications only have a name and signature Melba Bantay, Catholic Charities Community & Immigrant Services * current form is difficult to understand and not user friendly * would like the application translated into other languages * elderly have problems reading the small font with small spaces * too many questions Barbara Luksch, Hawaii Covering Kids * project brings Med-QUEST and the community together to work on common goals * simple application is win-win for applicants to understand and eligibility workers to process Ruth Ellen Lindenberg, Kokua Council, DHS Financial Assistance Advisory Committee, and AARP Legislative Committee * willing to assist in partnership to help the community * can advise the group as we develop a new application Diana Tizard, State Planning Council on Developmental Disabilities * remembers the old form that was 44 pages * more clear and concise application will make it easier for people to complete and let participants know their rights Bonnie Graham, Children's Community Council * also a consumer * would appreciate a form that has more clarity 3. Tasks to Accomplish a. decide the purpose of the application b. look at forms with more check-offs and less fill in the blanks c. decide a meeting schedule d. look at wording: redundant and difficult to understand e. layout: find what we like from other states, hire a desktop publisher to prepare drafts, larger font, and wider spaces f. rights and responsibilities (R & R): check legality of all those listed on current form, write them so participants understand, and clarify which R & R belong to which program; good cause and Social Security numbers must be clarified g. EPSDT: not a separate program but part of the benefit package; look into eliminating a check-off and include information in the rights section h. field test: does the new application achieve the goal and involve the community in the process; hire consultants if Med-QUEST has money available i. require only one signature 4. Timeline September 6: preliminary meeting to discuss working together November 21: first workgroup meeting February: review rights and responsibilities, review wording, final answer on EPSDT, look at a separate section for child and family on the app, what should be included in an application packet, discuss Med-TANF Outreach and Enrollment money available April: tentatively scheduled April 23 at 10:00 am open the process to interested persons (expand to a task force), present sample form and packet, discuss field testing 5. Programs the Application Covers Liane distributed an informative handout and explained the different programs. 6. Common Fields for All Programs Applicant's name, birthdate, telephone number, address where he/she lives, mailing address, and social security number if applying for self. 7. Layout Designs from Other States Pennsylvania: checklist Delaware: large spaces South Carolina: wording Massachusetts: color coded supplements District of Columbia 8. Other Information * Requiring a signature twice is a huge problem: if an applicant only signs once the application is photocopied, mailed back, and must be returned within 10 days or it is denied. * If the applicant is a parent of a minor child or a spouse of a needy husband/wife (even if they are legally responsible) and is not requesting coverage and therefore does not furnish a Social Security number, there are registration and IEVS check problems with the HAWI system. Note: IEVS is used for income verification and HAWI is Med-QUEST's computer program. * We need a declaration of citizenship only for those applying for benefits. * When Med-QUEST adopts a new application, BESSD must reprint their cash and food stamp forms packets. because the Med-QUEST application is included in the BESSD packet. 9. Assignments for Next Meeting Liane: research rewriting R & R so participants understand them; review simplified R & R samples from other states; can we require only one signature? review stepparent question: how to identify this; relationship; is it possible to eliminate question #1 Barbara: EPSDT from other states; find a desktop publisher Diana: check on EPSDT concerns; call Sue Reyes Donna: email Marty on Social Security numbers and IEVS Monday, 4 December 2000 Process Simplification Present:, Marcia Hartsock, Helene Cannella, Lei Lee, LaVerne Lucero, Toddy Hagans, Bob Hashimoto, Diane Tachera, Gwen Palmer, Beth Giesting, Alan Takahashi, Con Hogan, and Barbara Luksch Next meeting: 12 February 2001 at 1:00 PM. 1. Updates * Beth explained a group organized by DHS and ACLU meets regularly to work on MQD process problems. Community participants include Healthy Mothers Healthy Babies Coalition, MothersCare for Tomorrow's Children, HPCA, Wai'anae Coast Comprehensive Health Center, and others and their effort results in simplifying Med-QUEST's documentation and verification requirements, improving TANF letters sent to participants so they understand their health insurance is not terminated, and 46th day presumptive eligibility. The next meeting is early January. * Barbara explained the newborns law on verbally adding a baby born to a mother who is a Med-QUEST participant and a letter from Steve Kawada was distributed. Note: if the mother is a TANF recipient a new application is still needed. * The Application Simplification Workgroup began meeting in November (minutes are listed above). It will continue working as a small, closed group-to work efficiently-until April when it expands to a task force and more persons can join. * Med-QUEST is researching linking their system with school lunch lists to establish long-term outreach to eligible children and youth. The collaborative effort by Hawai'i Covering Kids and the DOE this year was very successful and is perceived as an excellent outreach strategy for parents/guardians. 2. We reviewed the status of our barriers and solutions list formulated at a December 1999 meeting and will present the status chart at our next state coalition meeting. 3. We discussed ways to enhance Hawaii Covering Kids and Med-QUEST partnerships at the pilot and state levels. Hawaii Covering Kids * meet in person with MQD supervisors monthly * BRING FOOD! * talk story, learn who the workers are, and make friends * submit complete paperwork for each applicant * support the supervisors * offer mobility to reach clients outside the Med-QUEST office * collaborate on projects: conferences, videos, application simplification Med-QUEST * view outstationed eligibility workers as helpers in the process * send monthly applications data to outreach workers so they can help clients and document their success * collaborate on projects: conferences, videos, application simplification 4. HAWI System Problems a. HAWI is BESSD's system b. If BESSD denies cash and food stamps it can take two to three months for the case to be forwarded to Med-QUEST c. BESSD sometimes closes medical cases even if the child is still eligible for medical d. available Med-TANF money can be used to delink the HAWI system and make it more Med-QUEST friendly; this should be a high priority since December 2001 is fast approaching when 1600 families will be affected e. Con noted our state did not apply for a RWJF Supporting Families grant that would help fix system problems f. relationships across systems are very important to help families 5. Con suggested we establish a Department of Labor connection.