Keeping Eligible Families Enrolled in Medi-Cal: Promising Practices for Counties Prepared for: CALIFORNIA HEALTHCARE FOUNDATION Prepared by: Dana Hughes UCSF Institute for Health Policy Studies September 2004
Examples of Promising Practices Objective: Enhancing Staff Communication with Clients Size Calaveras began offering group redeterminations in late 2003. After clients sign up for the group meeting, the county confirms meeting time and lists needed verifications in a letter. At the meetings, clients review their own previously submitted information, note changes, and return forms. Workers check forms and verifications on the spot and, if necessary, describe what else the client needs to provide. Calaveras Small Contra Costa uses county-paid advocacy workers (CalWORKs recipients) to follow up with clients. Caseworkers notify advocacy workers if a client is in danger of being discontinued and also when the ten-day notice is sent; advocacy workers contact clients by phone, visit the home, or arrange an in-office appointment. In February 2003, Santa Clara conducted an outreach effort (5-8 pm) to phone clients who were discontinued on January 31 for not completing the annual redetermination and to identify the reason(s) why they were not completed. A bilingual group of staff was able to reach 143 clients out of 500 who had not contacted the county but were still in the 30-day eligibility window. The majority still wanted Medi-Cal. Contra Costa Santa Clara Large 2 CALIFORNIA HEALTHCARE FOUNDATION
Size In 2003, Santa Clara piloted an effort to increase the number of redetermination forms returned through focused client contact. The redetermination packets were centrally distributed and accompanied by a standardized speed letter (automated notice) listing the requested verifications and due date, as well as a self-addressed stamped envelope. Multiple follow-up phone calls were made if necessary. Labels with the case number were placed on the forms before mailing for ease in the identification of returned packets. Amador offers clients three ways to handle redetermination: mail back completed form; telephone caseworker who will enter changes on computer; or come to a county office for an in-person meeting. Yuba staff call clients and complete redetermination statement of facts over the phone, then send to clients for confirmation. Clients may also come in to the office to renew. In Santa Cruz, phone or office interviews are available at clients request. Home visits are also offered to clients who are unable to come to the county office. Los Angeles developed a one-page glossary of words your worker might use that provides easy-to-understand explanations of terms used in Medi-Cal forms and letters. Available in six languages, the glossaries are included in initial enrollment packets, but can also be used as a resource for redetermination cases. Santa Clara Large Low Amador Small Yuba Small Santa Cruz Los Angeles Large Keeping Eligible Families Enrolled in Medi-Cal: Promising Practices for Counties 3
Size Alameda has developed Medi-Cal and You, a 40-page booklet that contains important information about Medi-Cal and includes a Steps to Keep Your Medi-Cal Active flow chart describing the renewal process. The resource guide will be pilot tested with Medi-Cal continuing cases. Alameda Large Objective: Training Medi-Cal Workers Size Merced staff receive small printed SNAP cards reminding them to verify key information every time they speak with clients. The acronym SNAP helps staff remember to check: (S) Social Security number; (N) name; (A) address; and (P) phone number. To help eliminate workers, requests for verifications that are not required, Los Angeles developed a two-sided page called Medi-Cal Verification Guide, which features more than 30 eligibility factors identified as mandatory, declaration sufficient, and not required. In addition, Los Angeles has issued Medi-Cal Verification Q&A Newsletters to remind workers how to handle various verification issues. Staff notes that asking for unnecessary verifications makes both worker and client work harder. Low Merced Los Angeles Large 4 CALIFORNIA HEALTHCARE FOUNDATION
Size San Bernardino has also developed a one-page Quick Verification Chart (QVC) for Medi- Cal staff, modeled in part after Los Angeles s verification guide. The QVC is used in both intake and redetermination. Los Angeles has prepared Tips for Processing Medi-Cal Redeterminations, a one-page guide that encourages staff to retain Medi-Cal coverage for clients at time of redetermination. Santa Cruz provides Medi-Cal staff with a one-page flow chart that serves as a reminder of the steps in the redetermination process. Low San Bernardino Large Low Los Angeles Large Santa Cruz In multiple counties, staff are divided into specialized units, either for intake/enrollment or for ongoing/renewal, or assigned to specific groups of Medi-Cal clients. This approach is designed to address concerns that when the same staff do enrollment and renewal, renewal can suffer. Alameda, Butte, Lake, Madera, Merced, Monterey, Tehama, Santa Cruz Varies Santa Cruz is piloting a project in which ongoing Medi-Cal and food stamps cases are handled by one worker. This may help the client because the client interacts with only one worker for both programs. Santa Cruz Workers are trained to know CCS, WIC, AIM, Healthy Families, Medi-Cal, food stamps and CalWORKs. This crosstraining increases the likelihood that clients will be referred/enrolled in appropriate programs. Modoc, San Luis Obispo Small and Keeping Eligible Families Enrolled in Medi-Cal: Promising Practices for Counties 5
Size Most San Mateo eligibility workers are crosstrained to enroll people in Medi-Cal, Healthy Families, and Healthy Kids. All Madera staff can enroll people in Medi- Cal, Healthy Families, CalWORKs, food stamps, and CMSP. Alameda s colorful flow chart of easy steps to redetermination is used as a training tool (and it is sent to clients with redetermination packets). San Mateo Madera Small Alameda Large Objective: Modifying Program Design/Major Program Additions Size Humboldt s main Medi-Cal office is not easily accessible to many people due to the geography of the county. To improve the situation, the county established two small, satellite offices with one or two staff. Each satellite office features free phone access to the main office, so clients questions can be answered promptly and so clients can call case workers for free. In November 2003, San Mateo launched a call center focused on Medi-Cal redeterminations and status reports. The call center is staffed by 35 benefit analysts who handle between 2,000 and 3,000 cases per month; they resolve address changes, refer people to internal/external resources, and flag cases for caseworkers, etc. High Humboldt High San Mateo 6 CALIFORNIA HEALTHCARE FOUNDATION
Objective: Improving Mid-year Status Reports (MSR) Process Size Santa Clara developed several onepage guides to help train staff on the MSR process. The materials include: a Media Advisory notifying staff about the MSR requirement; an MSR Reference Guide; an MSR Reporting Cycle table; and a Due Date chart. San Bernardino has updated its Medi-Cal handbook to include MSR procedures. Los Angeles created a one-page Medi-Cal Mid-year Status Report Guide that helps eligibility workers by clarifying the regulations and describing exemptions from MSR requirements. San Mateo designed a cover flyer to get clients attention about the new MSR requirement. The flyer is available in English and Spanish. Los Angeles developed a Don t lose your health benefits! cover letter for MSRs that provides brief instructions, reminds clients to return the MSR form by the due date, and notes that a postage-paid envelope is enclosed. Los Angeles has also prepared a (draft) version of an MSR cover flyer that explains who is exempt from the MSR filing requirement. Santa Clara and Sacramento Counties have adapted Los Angeles s MSR flyer for their counties. The flyers are based on a sample shared at the Retention Workgroup and are available in English and Spanish. Low Santa Clara Large Low - San Bernardino Large Low Los Angeles Large Low San Mateo Low Los Angeles Large Low Santa Clara Large Keeping Eligible Families Enrolled in Medi-Cal: Promising Practices for Counties 7
Objective: Explore Selected Programs from Other States Source: Retaining Eligible Children and Families in Medicaid and SCHIP: What We Know So Far, Lake Snell Perry & Associates, 2003. of Effort Required State Michigan allows families to self-declare income (without need for documentation) and has found that this policy has improved caseworker productivity. Florida has lowered disenrollment rates through its system of passive renewal that assumes continuous eligibility for children until families provide information regarding a change in circumstances. Rhode Island created Medicaid Self-Help Areas in hospitals and doctors offices that feature renewal forms, free use of a copy machine, and a drop box. Washington state has 12-month continuous eligibility, has allowed self-declaration of since 1998, and has established automatic Medicaid renewal through the food stamps program. Massachusetts has addressed its retention challenge through an express renewal process that allows families with no change in income to renew their eligibility during a visit to a community clinic or provider before their renewal date. Maryland has developed an electronic database system that interfaces with TANF, food stamps, and Medicaid. The link permits automatic updates of families information for all programs when a change is reported to any of the programs. New York state funds community-based outreach workers, called facilitated enrollers, who assist families in completing renewal paperwork. New York City has hired and trained 23 people to call and send letters to families before the families renewal dates. This demonstration project resulted in a drop in disenrollment rates. Low High High High Michigan Florida Rhode Island Washington Massachusetts Maryland New York New York 8 CALIFORNIA HEALTHCARE FOUNDATION