Self Assessment Toolkit Can Help States Improve Medicaid and CHIP

There is little debate that simplifying and streamlining the application and renewal process makes it easier for both eligibility workers and families applying for coverage. But there’s nothing simple or streamlined about re-engineering the business processes and systems that are used to administer Medicaid and CHIP, so it’s easier to tread water than dive in. Despite the challenges, there are lots of big and little opportunities for states to make improvements. Sometimes it’s hard to know where to start. Now there’s a life vest to keep states from drowning as they swim the distance. 

The Maximizing Enrollment For Kids initiative (funded by the Robert Wood Johnson Foundation and supported by our friends at the National Academy of State Health Policy (NASHP)) has launched a State Self-Assessment Toolkit.  The toolkit was developed through the intensive work of eight states working with technical advisors and the NASHP staff in the Maximizing Enrollment project to conduct a comprehensive diagnostic assessment of each participating state’s strengths and opportunities for improvement. The toolkit consists of four modules:

  • Process Mapping:  Many state agencies (and other organizations for that matter) have found that process mapping can serve as a useful tool in their efforts to understand how their current systems, policies and procedures are working and identify opportunities and concerns.
  • Interactive Diagnostic Assessment Protocol: This Web-based questionnaire helps states better understand their current strengths and diagnose opportunities for improvement in six areas: 1) simplifying the enrollment and renewal process; 2) Interagency Coordinator; 3) Analytic Capacity for Program Management and Decision-Making; 4) Client-Centered Organizational Culture; 5) Community Partnerships and Outreach; and 6) State Leadership.
  • Stakeholder Questionnaires: These sample questionnaires can help states engage stakeholders on their perspectives of the current Medicaid and CHIP enrollment systems, policies and procedures.
  • Improvement Plan Meeting Kit: This kit includes a checklist for convening state agency staff, state leaders and stakeholder partners, as well as improvement and work plan templates to help the project team reflect on lessons learned and prioritize improvement activities.

Engaging in self-assessment and committing to comprehensive, systemic improvement is not for the faint of heart. If you’re the type that prefers to test the water with your big toe rather than diving in, you could find yourself in over your head. This is also not effort that a state can relegate to a single project manager, or that a child health advocacy group could execute on its own.

Nonetheless as states continue to face deficit budgets that reduce resources for administering our critical children’s coverage programs, states must find wants to work smarter and more effectively. As we move toward transforming Medicaid and CHIP from paper-dependent, outdated legacy-based eligibility systems to data-driven, technology-based approaches, states must re-engineer how they do business.  Having a committed group of stakeholders and strong leadership to tackle the fact-finding to support this transformation is key to success. The water may look deep and cold but you might find the effort refreshing and the plunge will certainly help raise the tide on state efforts to maximize enrollment in Medicaid and CHIP.

Tricia Brooks
Tricia Brooks is a Senior Fellow at the Center for Children and Families