Tuesday, 13 March 2001 Renewal Simplification Workgroup Meeting Present: Beth Giesting, Ann G. Tam Sing, Pearl Tsuji, Barbara Luksch, and Florence Ashihara (via telephone) Next meeting: at the Covering Kids Regional meeting A. We reviewed the current renewal process. MQD commonly refers to this as eligibility review (ER): 1. Systems office sends each MQD office a monthly printout with the eligibility worker's (EW) name and number and cases due this month, next month, in two months, and overdue. The list includes case name, case number, program, program status, and review date. The systems office also sends mailing labels although the clients' addresses are not always accurate so they need to be checked by the EWs. 2. The EW (or clerical staff) sends the participant a cover letter, ER checklist, and the 1100 blue application form stamped ER with the upper right corner information completed: Case Name, Case Number, Section/Unit/IMW Code, Worker's Name, and Program (check box). The participant has two to three weeks to respond to the initial mailing. B. Barbara mentioned confusion by participants because they are receiving the 1100 (they consider this an application not renewal form) and are asked for asset information when it's only the child who is enrolled. C. Ideas for Change 1. We looked at what Idaho uses as an example. It is a short form that is printed with information that could be hand written by the EW until there is a systems change. 2. Any changes we come up with should be pilot tested in a small geographic area first to evaluate efficiency and effectiveness. 3. Ex parte would depend on access to systems to verify information with Department of Motor Vehicles, Department of Labor, Child Support, etc. Currently MQD has only a few access logons to these systems due to the limited number of keys allowed by the systems' owners. Most of the time, clerical staff use them, however EWs can also logon. 4. The Application Simplification Workgroup suggestion of more checkboxes and less writing makes it easier for the participant to complete and the EW to read. We can look at the system generated MERF as an example. 5. The Nevada cover letters are very friendly and promote good will between their Medicaid office and the participants. D. Questions to Ask at the Conference 1. How can OEWs help with the renewal process without affecting confidentiality? 2. What will be the effects of HIPAA on the renewal process? Wednesday, 28 March 2001 Renewal Simplification Workgroup Meeting Present: Beth Giesting, Ann G. Tam Sing, Pearl Tsuji, Barbara Luksch, and Florence Ashihara Next meeting: 30 March 2001 We answered questions posed by the Covering Kids Regional meeting organizers. Those not included in the March 13 minutes are: 1. What are the follow-up procedures if there is no response to a notice for Medicaid? None. 2. From our perspective, what are the top three reasons children's Medicaid cases are closed? * no form returned * missing verification (Med-QUEST does follow-up with these cases) * over income * whereabouts unknown 3. If the top reasons for children's cases being closed for Medicaid are not related to excess income, what are some steps Hawai'i can take to reduce the number of children's cases being closed? * new, simple renewal form * self-declaration of income monitored by Department of Labor information * work with authorized representatives: outstationed eligibility workers and health plans 4. What assistance could the federal government provide to help with the steps identified above to reduce the number of children whose cases are closed due to reasons other than excess income? * help upgrade our HAWI system * provide incentives for increasing enrollment * help coordinate systems links: USDA, HCFA, ACF, DOE * provide free postage for participants to return renewal forms Friday, 30 March 2000 Renewal Simplificaiton Workgroup Meeting #3 Present: Beth Giesting, Ann G. Tam Sing, Pearl Tsuji, Barbara Luksch, and Florence Ashihara Next meeting: 5 June 2001 at 9:00 AM with Process Simplification Task Force at HPCA Conference Room 1. Terminology We decided the term renewal is more consistent with assisting people and will help destigmatize Medicaid. We will recommend this change to the Process Simplification Task Force. 2. Next Steps a. Barbara will draft a renewal form for review by the workgroup (us) b. Ann G. and Florence will draft a friendly letter that will eventually be used by all offices c. Pearl will do an ad hoc data report on cases closed for 0-19 year olds (number and reasons) d. Ann G. will poll the MQD offices for an informal data report on cases closed for 0-19 year olds (number and reasons) 3. Our Timeline (So Far) April: meeting notes completed and sent to all process simplification task force members. May: drafts of a renewal form and letter will be reviewed by the Dallas 5; draft of renewal steps written. June: meet with Process Simplification Task Force and present data reports, renewal steps (current and proposed changes), and new form and letter. July: meet with Susan Chandler and Aileen Hiramatsu to discuss our suggested changes; field test a new renewal form and letter with community groups August: pilot test the new form and letter in a small geographic area Tuesday, 10 April 2001 Application Simplification Workgroup Meeting #4 Present: Melba Bantay, Jeffrey Young, Donna Cohen Ross, Liane Hiramoto, Ruth Ellen Lindenberg, Barbara Luksch, and Gloria Samson. HulaFish representatives: Ryan Markus and Matt Paleafei. Regrets: Diana Tizard Notes: Barbara Fabrey moved to the attorney general's office and a new Legal Aid Society representative could be assigned to our workgroup in June. Mahalo to Gloria Samson for taking notes! Next meeting: 5 June 2001 at 9:00 AM with Process Simplification Task Force at HPCA Conference Room 1. Renewal (Redetermination) Conference Covering Kids held a regional conference focused on retention and renewals. The persons representing Hawai'i (Dallas 5) were Ann G. Tam Sing, Florence Ashihara, Pearl Tsuji, Beth Giesting, and Barbara Luksch. They are the workgroup that will present suggestions to the Process Simplification Task Force. 2. Application Layout a. Barbara, Liane, and Gloria met with Ryan on March 23 to discuss general ideas and review other state applications. The following items from the current application should be together on the new application: * numbers 5, 12, and 13 (ABD questions) * numbers 9, 10, and 14 (QUESTions) Gloria will research exactly what must be in the "official use" box and Barbara will draft rights and responsibilities in categories (similar to Rhode Island). b. Ryan presented basic samples and we noted the following: * "Official Use" box should be bigger * we prefer portrait layout * use as many checkboxes as possible * use pastel colors to avoid problems when the application is faxed * a cover page will have basic instructions that will be repeated in each heading (close to where the applicant is filling out information) 3. Self-Declaration of Income Liane noted Hawa'i is looking at income self-declaration for applicants. Donna explained self-declaration means the burden is not on the family to produce papers to justify what they write on a form. Regarding income, the information can be verified through computer links with the Department of Labor (this is how Georgia checks their information). Donna will give Liane a contact person in Ohio for reference and Barbara mentioned the Medicaid persons from Idaho who presented at the renewal conference stated "Go for it because it is a lot less scary than you think!" Furthermore, their error rates based on a random sample of 100 cases-they went to self-declaration in November 1999-were 0.5% wrongly approved and 3% wrongly denied. The Center on Budget and Policy Priorities will soon publish a study on ten states using self-declaration and their results. 4. SSN SSN are only required for those applying for health insurance, however most persons list it. Explaining it is optional protects people without one. Donna suggested the workgroup look at Mississippi's application that explains a choice: you can self-declare income with a SSN or provide income verification without a SSN. 5. Instructions Group Barbara, Gloria, and Cassandra Stewart will work on headings and instructions. 6. Rights and Responsibilities a. Amy Murakami left the attorney general's office, however she stated the current wording on the blue 1100 application form could stand up in court. b. The current wording is hard for applicants to understand. When we go to self-declaration applicants must comprehend their rights and responsibilities. c. Review of Barbara's draft * the SSN section is worded from the Office of Civil Rights information provided by Donna * Barbara will check on good cause for pregnant women * need to add citizenship information * Barbara and Liane will continue to work on this part of the application 7. Next Step We will meet with the Process Simplification Task Force to review a draft application. Tuesday, 24 April 2001 Evaluation Task Force Present: Bill Wood, Ruth Ota, Charlene Gaspar, Marcia Hartsock, Andrew Aoki, Piilani Pang, Supin Wongbusarakum, Karl Yoshida, and Barbara Luksch Next meeting: 21 August 2001 at 9:00 AM at HPCA Conference Room 1. Karl presented information on DOE data systems. Student Information System pertaining to our project includes: * Mac/Win Schools software used at the school level. Daily enrollment and demographic data exported to central VAX database for 200,000+ students by all schools. Keeps schedules, report cards, and attendance for middle, intermediate, and high schools. * Separate section for home schools but due to home school association objections the regulations are sparse on what demographic data is required. * Does not include charter schools. * Emergency card information not currently entered at school level. This will be a good way to establish a long-term system of data collection and prevent delays when a child moves to another school (no wait for the paper emergency card to arrive). The Hawai'i Covering Kids Project will help principals link emergency data with their computer system. * There are possible scanning input capabilities. * There can be duplicates if the child did not register with a birth certificate correctly stating her/his first and last name and he/she changes schools using a different name; we need to encourage all agencies to enter legal names to coordinate services for kids. 2. Supin reported there are approximately 6005 home schooled children and youth in Hawaii. 3. Electronic Application The system has been functional since August 2000 and we need to develop quantitative and qualitative evaluation components. The Big Island has not yet implemented the system so we are not behind in this effort. The group will email ideas to Barbara and we can review them together via cyberspace. 4. Emergency Services Ruth explained there is a subcommittee researching what information EMS needs when their medical staff take a child to the emergency room. 5. The Hawaii Uninsured Project Andrew updated everyone on recent events: * Piilani was hired as the full-time program specialist * HMSA Foundation will continue funding the effort * work will be done on public policy development * there will be community forums to get public input and involvement He noted the overall data component is difficult to track, especially for adults. 6. The Hawaii Covering Kids Data Project The quarterly report was distributed and Bill gave this recent information: * DOE schools: data is entered and they are fixing error problems * Day Care Centers and Preschools: there are approximately 500 and many are requesting a survey tool; Bill will send questions to Barbara by May 31 * Independent Schools: they need to be convinced a common collection form is helpful * WIC: data will be collected next year using their database system * Head Start: collects data on all children * Good Beginnings Alliance: is helping with data on their 400 kids Areas to be covered in the next five weeks are profiling uninsured children and youth in the pilot project areas and hiring a consulting firm to do qualitative assessments. For the later, a method of rewarding parent/guardian participants must be established.