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Gene Lewit,  The David and Lucile Packard Foundation

Living in Silicon Valley, I am used to reading about new tech wonders every day. In fact, today, we use the internet to do many things we used to do in person, by snailmail or on the telephone. This trend is encouraged by new technology, but has gained popularity because it is often less expensive and more convenient than traditional methods. So, it’s not surprising that states are increasingly using the internet to enroll, and sometimes re-enroll, children and families in their Medicaid and Children’s Health Insurance Programs (CHIP).  A recent survey  by the Kaiser Family Foundation and Georgetown University’s Center for Children and Families found that as of January 2012, 34 Medicaid programs and 30 separate CHIP programs allow for electronically- submitted applications for children and sometimes their parents as well.

California, the home of Silicon Valley, started providing a public access online application option, known as Healthy-e-Application Public Access (HeA PA), for its Medicaid (MediCal) and CHIP (Healthy Families) programs for children and pregnant women in December 2010. Previously, families could only apply for these programs using a paper application or with the help of application assistors and county employees who had exclusive access to HeA and/or One-e-App, an electronic application for a variety of public benefit programs. The positive change HeA PA has made in families’ ability to enroll their eligible children in MediCal and Healthy Families is reported in Healthy-E-Application Public Access:  A New Online Path to Children’s Health Care Coverage in California, An Overview of the First Year, released on March 5th by Mathematica Policy Research.  This report is the first in a series of reports that will examine the impact, functionality and user experience associated with the new online enrollment route.  The work is supported by the David and Lucile Packard Foundation and the California HealthCare Foundation in partnership with California’s Managed Risk Medical Insurance Board.

The current report provides some encouraging information about the potential impact of HeA PA and other online application tools. One piece of good news is that the use of HeA PA was associated with a 14% increase in total applications submitted to the state processing center from 2010 to 2011.  About a quarter of HeA PA applications were submitted outside of regular business hours, which suggests convenience is important in the application process and the use of HeA PA. HeA PA applications were also more likely to be complete, including required documentation, than paper applications but less likely to be complete than assisted online applications.

But the report also raises a number of questions and caveats to be considered as we look for technological solutions to the challenges we face enrolling children and their families in these programs. For example, more than 4,000 HeA PA applications were submitted in the first full month it was available, but before there was an active outreach campaign. This is especially surprising since HeA PA was released at the end of 2010 during the holidays, with very little fanfare. However, the number of HeA PA applications remained at around the same level for the rest of the year, despite an outreach campaign launched in July. These findings suggest that while there may be a demand for online public access applications, that demand may be limited. 

Another interesting finding is the large variation in the use of HeA PA by county. The share of applications accounted for by HeA PA by county ranged from 0 to 48 percent and both heavily-populated urban and sparsely populated rural counties were present at both ends of the range. We need more research to better understand this variation and what it means for the impact HeA PA and other online application systems might have.

The Patient Protection and Affordable Care Act (ACA) calls for states to have enrollment portal systems that provide a high-quality customer experience, reach a high degree of online use, and maximize self service for people applying for health insurance coverage through Medicaid, CHIP or a health insurance exchange. We can learn a lot from the experience of the first year of HeA PA as California, along with other states, strive to implement the consumer-friendly online experience the ACA envisions.  The HeA PA data, and common sense, caution however that we will continue to need to accommodate people who prefer paper applications and/or personal assistance.