Monday, 8 January 2001 Conference Planning Workgroup Present:, Dee Helber, Ruth Ota, Diane Tachera, Mary Rydell, and Barbara Luksch. Regrets: Fay Nakamoto, Pearl Tsuji, Jean Kajikawa, and Ann G. Tam Sing Next meeting: TBA The goal of the meeting was to review the Hawai'i Covering Kids and Boost4Kids 15 September 2000 outreach conference in Hilo and determine the date and purpose of conference number three. 1. Barbara distributed summaries of the conference evaluations. Overall it was a BIG success. 2. Next Conference a. The agenda should be predominantly small groups and we must schedule around Linda Colburn. Her expertise, excellent facilitation, and good humor are keys to our success. b. Participants want to meet with legislators to talk policy issues. It would be a good opportunity, too, for senators and representatives to hear from field workers. We will schedule it in Honolulu when key persons can attend. c. Keep the Med-QUEST question and answer session--possibly expand the time. d. Send a survey to past conference participants to get their ideas: what specific issues (policy or otherwise) are they interested in discussing? 3. Barbara will send an evaluation summary to all participants. Those who submitted a personal goal will get them returned with a friendly reminder. 4. The conference evolution, following conference #3, could be island meetings as follow-up sessions. Wednesday, 10 January 2001 Identification and Outreach Present: Havinne Anderson, Diane Tachera, Sally Hansen, Judy Fraser, Dee Helber, and Barbara Luksch Next meeting: TBA 1. GMMB&A, the Covering Kids marketing firm, sent all grantees an RFP to select eight projects for paid advertising during their 2001 Back-to-School campaign. We reviewed the criteria and noted: * We do not have a huge pool of uninsured children and youth, however we will set the model for Asian and Pacific Islander outreach as well as become the first state to reach 100 percent of our kids insured, * We will highlight our state's process simplification efforts as well as the CHIP and Immigrant Children Program expansions, * Radio, television, and print are all effective utilizing ethnic-specific media, * There was no paid media placement in 2000, * GMMB&A is looking for a major media market so the RFP will be written for the island of Oahu (City and County of Honolulu). However, the materials we develop can also be used on the Neighbor Islands, * The Oahu Med-QUEST Office is an excellent collaborative partner with Hawaii Covering Kids, and * We have a reliable hotline service that collects required data. They can do conference calls in languages other than English using Bilingual Access Line. 2. Havinne gave an Ask Aloha United Way update. They are working with Verizon to add a new feature for people on hold or those calling after hours. There will be an option to press a number for recorded information, including children's health insurance. Barbara suggested it be short and simple. Havinne will email Barbara and Diane the basic message for editing. Note: Diane stated in the editing phase that Med-QUEST does not allow their programs to be called health insurance--the message must say coverage. Since the state also has a subcontract with Ask AUW, they dictate what is said until 31 May 2001. 3. We reviewed and revised the handout "Proposed Expenses for Med-TANF Outreach Funds." 4. Barbara will check on the cost of recorded messages in non-English languages so persons can get basic information on kids health insurance. 5. Sally explained Good Beginning Alliance "Books for Newborns" that are given to every family with a newborn baby will have information in English, Samoan, Marshallese, Tagalog, Ilocano, and Vietnamese. Bilingual Access Line is assisting with translations. 6. Diane said that Pacific Gateway in the Kalihi-Palama area has a subcontract with Med-QUEST to help non-English speaking customers complete applications. Thursday, 22 January 2001 Evaluation Present: Bill Wood, Ruth Ota, Charlene Gaspar, Marcia Hartsock, Andrew Aoki, Supin Wongbusarakum, and Barbara Luksch Next meeting: TBA (when DOE representative can attend) 1. We reviewed school lunch referral forms data from July to December 2000 by city/town and zip code. The next step is comparing this data with school lunch, QUEST/Medicaid Fee-for-Service enrollment data, and the data project's health insurance data. Barbara will check if Med-QUEST has kids enrollment data by census tract. Med-QUEST will take over school lunch outreach because the federal government allows them to link systems with DOE Food Services Branch (similar to unemployment and child support links). 2. Bill suggested meeting with DOE to pursue statewide electronic registration. He will contact Lynn Fallin since it ties into the DOE interest in complex planning using appropriate data. 3. Bill and Supin updated the group on the Hawaii Covering Kids Data Project. a. There are problems hiring a student helper through the UH system. This person will input the data collected by DOH PHN at the public schools, b. They are linking efforts with the Healthy Child Care Hawaii project sponsored by DOH and the American Academy of Pediatrics Hawaii Chapter, c. WIC does not have centralized information on health insurance so they will check with each location (19), d. Head Start requires each participant to have health insurance so enrollment data = number insured. This information is kept at each location, e. Barbara wrote a letter to Louise Wong at the Catholic Schools to arrange a meeting. The purpose is not only to collect data but also get outreach information to families, and f. We are researching using DOE's MacSchools software to include emergency card information. 4. Andrew updated everyone on The Hawaii Uninsured Project. There was very positive feedback on the first assembly and they are continuing the momentum. The next big wave efforts include forming leadership groups to identify policies, continued public awareness, and legislators' support for policy action. Tentatively there will be another assembly in September. 5. Charlene distributed data from the 1998 and 1999 Hawaii Health Surveys. She noted that confidence intervals are missing. The limitations of the survey are that it is a telephone survey and the sample size is small--only 195 uninsured children for 1999. Bill expressed concern that DOH controls their data and will not allow outside experts access to help with analyses. 6. Andrew suggested we peruse the State Coverage Initiatives web site at http://statecoverage.net/about.htm that has a matrix of strategies for all states. Tuesday, 6 February 2001 Application Simplification Workgroup Present: Melba Bantay, Barbara Fabrey, Jeffrey Young, Donna Cohen Ross, Liane Hiramoto, Ruth Ellen Lindenberg, Barbara Luksch, and Gloria Samson. Regrets: Diana Tizard and Bonnie Graham Next Meeting: We will meet one more time as a closed workgroup to complete our major tasks, then meet with the Process Simplification Task Force in May or June. Mahalo to Barbara Fabrey for taking notes! 1. Announcements a. Jeffrey Young is the new ongoing unit representative for the workgroup. Chuck Bayne moved to the state's personnel office. We welcomed Jeffrey and look forward to working with him! b. The Med-TANF Outreach Fund can provide money to simplify the application and upgrade HAWI to be more Medicaid friendly. Barbara distributed a handout and explained several task forces and numerous persons, including Beth Giesting and Susan Chandler discussed a plan and budget to utilize this fund. The state legislature must appropriate matching funds and Med-QUEST must establish a group according to HCFA's delinking guidelines. Donna explained a main purpose of the fund is to fix computer systems to correctly determine eligibility and improve retention. c. Five persons representing Med-QUEST and Hawaii Covering Kids will attend a Covering Kids regional meeting in late March to discuss improving our state's redetermination process. d. We discussed getting away from threatening tones and anti-fraud mantra from the old welfare days and focusing on helping people through Medicaid. A "Dear State Medicaid Director Letter" to this effect, dated 19 January 2001, is found at http://www.cms.hhs.gov/smdl/downloads/smd011901e.pdf. Donna mentioned that states drastically simplifying their processes have a fraud rate of less than two percent. Barbara suggested we think of the honest 98 percent while formulating our new application. 2. Old Business a. EPSDT check-off box can be eliminated as long as EPSDT benefits are highlighted somewhere on the application. Everyone wants complete information explained to all applicants on these benefits, including transportation and appointment assistance. b. Donna explained a SSN and citizenship information can only be required from those requesting benefits. Currently Hawaii application requires everyone on the application to furnish a SSN. According to the Office of Civil Rights, we have three options: * Make it clear that SSNs are not required for people not seeking health insurance for themselves, but say nothing more on the application. The Privacy Act language says that SSNs are used to verify income --so families would get the message that without an SSN they would have to provide some other verification. * After making it clear that SSNs for nonapplicants is optional, add: "SSNs help us to verify your income." * After making it clear that SSNs for nonapplicants is optional, add: "SSNs help us to verify your income. Without an SSN, we may need to ask you for additional information about your income." It is not possible or feasible to check the IEVs system without a SSN therefore the state may request pay stubs or employer furnished income verification. Also, self-declaration is okay for everything except immigration status of a noncitizen applying for benefits (that is the only documentation required by federal law). c. Requiring only one signature is a huge step towards simplification. Donna pointed out that almost all states require only one signature from one adult--the person applying for self or on behalf of others. This would eliminate Med-QUEST wasting time and money by returning incomplete forms to the applicant and increase the use of electronic applications (only the person interviewed signs). Donna will review other state applications for this feature. Liane is inquiring about the signature currently required on the first page since Med-QUEST wants it retained. We discussed who signs the application. The confusion is an 18-year-old adult living at home with parents since or if the person is a 19-year-old tax dependent. The instructions must be very clear to get the correct signature. d. Stepparent: Barbara will review Florida and Pennsylvania applications regarding this question. e. Rights and Responsibilities (R&R): We all want them to be simple and easy to understand. Donna suggested we look at Rhode Island's application EXCEPT how they require SSN. They've broken down the information into subheadings and separated rights and responsibilities. Liane asked the attorney general's office for an opinion on the current R&R but hasn't heard from them. 3. New Business a. HCFA subcontracted to MAXIMUS Center for Health Literacy and Communication Technologies to assist states with their applications and forms. Liane will follow-up with Aileen Hiramatsu to assess Hawai'i's involvement in the project. b. A "Dear State Medicaid Director Letter" from HCFA on paternity was issued 19 December 2000. Barbara distributed copies and we will make sure good cause is properly explained on the simplified application. We will look at North Carolina's application for wording. c. We can eliminate question number one. d. Desktop publisher: Barbara found a person to subcontract for help and a few interested workgroup persons will meet with him to create design options. 4. To Do We will research what to include with the application packet; Gloria brought samples of the current packet. Barbara will send Massachusetts, Oklahoma, and South Carolina applications for us to peruse for layout, wording, and instructions. Monday, 12 February 2001 Process Simplification Present:, Marcia Hartsock, Lynn Fallin, Mary Rydell, Barbara Luksch, and Alan Takahashi Next meeting: May or June with the Application Simplification Workgroup and Dallas 5. 1. Web site statistics are available for July 2000-January 2001. These include total number of requests, visitors, countries, source sites, and which pages are accessed. This group is particularly interested in the last item, for example Library of Forms downloaded, because it assists with our simplification efforts. Barbara will post the data on the web site. 2. We reviewed the status of our outcomes and indicators: * Alan will assist with monthly QUEST/Medicaid data for 1998, 1999, and 2000 (number of applications, number of children and youth enrolled, and average length of time to process applications by island). * Susan Forbes will send Barbara newborns data next week for 1995-1999 and number of emergency room visits by children and youth later this year. * Marcia is researching county level data for child abuse and neglect, teen pregnancy rates, and teen STD rates. It was noted the Evaluation Task Force is trying to get census track data from Med-QUEST for children and youth ages 0 to 19 years enrolled in QUEST and Medicaid Fee-for-Service. 3. We discussed the Application Simplification Workgroup progress (see minutes listed above) and the Dallas 5. The latter is a group attending a Covering Kids regional meeting focused on improving our state's renewal process (AKA redeterminations) and includes Barbara, Ann G. Tam Sing, Beth Giesting, Pearl Tsuji, and Florence Ashihara. 4. Alan gave an update on the Honolulu office: * There are 62 IMW positions: 57 are trained, 2 will be trained in March, 1 is on maternity leave, and 2 vacancies exist. There is currently a clerical shortage, * New supervisor positions were converted from limited term to permanent and Med-QUEST is hiring to fill them, * Ongoing Units are assisting with new applications (400 per week) to handle the backlog, and * Effective April 1 there will be no backlog of applications on Oahu. For all offices, face-to-face interviews are eliminated except for pregnant women, nursing home placements, medical emergencies, and those requesting face-to-face interviews. Note: this does not apply to applications submitted by outstationed eligibility workers. More Simplification: No more 1102 (yeah-one less form!). Once the application reaches the Med-QUEST office, it is logged and the applicant or outstationed eligibility worker can call/fax/mail the new enrollment center with health plan choices. The Kapolei Unit currently handles Leeward Oahu applications except those from outstationed eligibility workers. Eventually, they will handle all Leeward Oahu applications which will greatly assist clients and outstationed eligibility workers. 5. We discussed the simplification effort to get Med-QUEST to refer to their programs as health insurance (not health coverage). It was agreed Barbara should write a letter requesting this change due to the following reasons: * HCFA refers to the programs, including the State Children's Health Insurance Program, as health insurance (a copy of their web site home page was shown), * other states call their Medicaid programs health insurance, * it is less confusing for applicants and participants, * community field tests show that coverage is not understood by the general public, however people do understand health insurance, and * translating the words coverage or health coverage are extremely difficult. 6. Proposed Expenditures for Med-TANF Outreach Funds: Med-QUEST must first implement a mandatory eligibility group separating Medicaid from cash assistance and food stamps before these funds can be utilized. It was agreed a major priority is upgrading the HAWI system to make it Medicaid-friendly. This will also eliminate the serious problem of BESSD illegally closing medical cases. 7. Mary distributed FMAP information for 2000 and 2001. Currently our federal funding is 53.85 percent for Medicaid and 67.7 percent for CHIP. Effective October 1, 2001 it will be 56.34 percent for Medicaid and 69.44 percent for CHIP. 8. Mary reviewed recent State Medicaid Director Letters (SMDL) from HCFA: a. Medicaid simplification and error rates (01-015 on 01/19/01) The objective is to reassure states that simplification and program integrity are not mutually exclusive. For example, it states "It is just as unacceptable to deny eligibility to program benefits as a result of complicated and burdensome application and retention procedures as it is to enroll ineligible individuals." We should not place burdens on applicants. Barbara noted information from Donna Cohen Ross regarding very low fraud rates for states that have simplified their processes (see Application Simplification Workgroup minutes above) and Mary explained that the national average is less than 2 percent error rate for the last ten years. Hawaii could have self-declaration of income due to IEVs access and this would eliminate one more burdensome verification requirement. b. Establishing paternity and pursuing medical support payments (12/19/00). Child eligibility is not dependent on parent cooperation. Our Application Simplification Workgroup is aware the current application does not appropriately explain good cause and will make sure it is properly explained on the new application. c. Enrolling applicants at FQHCs and DSHs (01-008 01/18/01) This letter reviews what is required. Hawaii could also do automated information systems and rolling redeterminations. 9. Med-QUEST and Hawaii Covering Kids sponsored an Oahu outstationed eligibility workers meeting on February 2. The major simplification item discussed was elimination of Form 1102 with the kuwel new enrollment center.