Louisiana
Expansions, Simplifications and Outreach
Program Elements
Louisiana officials identify three prerequisites for increasing enrollment in LaCHIP (the state's combined Medicaid and SCHIP): 1) eligibility expansion; 2) simplification of initial enrollment and renewal procedures; and 3) aggressive outreach.
1. Eligibility Expansion. Louisiana adopted a three-phase plan that gradually raised the eligibility threshold from 133 percent of the federal poverty level (FPL) in the first year, to 150 percent in the second year, to 200 percent by January 1, 2001. The Medicaid expansion model was retained without cost sharing even as new cohorts of children and families became eligible. In October 2007, the state enacted Act 407, Louisiana Children and Youth Health Insurance Program that expanded coverage through a separate program for families earning up to 300 percent of the FPL, with financial participation required on a sliding scale.
However, as a result of the August 17 directive from the Centers for Medicare and Medicaid Services (CMS), which places restrictions on states’ ability to expand coverage using federal funds, Louisiana has had to scale back its initiative. CMS approved an expansion up to 250 percent of the FPL gross income (the state had intended to use the same deductions as their Medicaid and SCHIP programs) with a 12-month waiting period. Approval was received on February 27, 2008. Read more about the August 17 Directive.
For a summary of Louisiana’s proposed expansion see At a Glance.
2. Procedural simplifications and improvements. LaCHIP sought to build on an already-simplified enrollment process by further minimizing paperwork and requirements wherever possible. For example, the state adopted a literacy-tested application, which has been reduced from 14 to three pages, as well as a simplified renewal form. Louisiana also implemented simplification and improvement activities in some key areas.
Changing the eligibility determination culture:
Through intensive “internal marketing” Louisiana shifted the thinking of its eligibility workers—helping them see the integral role they played in reducing the number of uninsured children in the state. Caseworkers were trained on the health and financial consequences of being uninsured, on why families may fail to respond to requests for information, and on barriers to enrollment and retention from the family’s point of view. As a result, the state now puts a premium on enrolling and retaining eligible children, rather than on minimizing enrollment.
Streamlining the eligibility verification process:
- Ex parte reviews are used to verify eligibility at enrollment and renewal by using income, household, residency, citizenship, child support and age data, as well information from other programs such as TANF cash assistance, Food Stamps, and Social Security Income.
- Self-declaration of citizenship and residence is allowed, though curtailed by the passage of the federal Deficit Reduction Act in 2006 which requires applicants to present original and/or certified proof of their citizenship and identity. Louisiana increased Medicaid eligibility staff’s access to online vital records to address the new citizenship documentation requirement.
- 12 months continuous eligibility guarantees a full year of coverage
regardless of changes in family circumstances. This policy also
decreases the number of renewals an eligibility worker must do each
year.
- Social Security cards are not requested if the number is provided and matched against Social Security Administration records.
- Income documentation was reduced from 8 weeks to 4 weeks. In addition, coverage can be retained without paperwork as long as wage information in the Department of Labor’s database verifies eligibility.
- Income verification is sought from employers by phone and/or fax, as opposed to in writing.
Improving general operations to support simplified enrollment and retention:
- New closure and ex parte renewal codes were established so progress and outcomes in the 45 local offices across the state could be closely monitored. State officials believe this data is a prerequisite to improving retention rates.
- Procedures were put in place to track children rather than cases, i.e., to track actual renewal outcomes.
3. Aggressive follow-up and outreach. Outreach has been institutionalized in LaCHIP. Whether conducted by individual eligibility caseworkers, supervisors or managers, or as part of an intensive statewide campaign that involves other stakeholders, the agency focuses on staying connected to participating families.
Standard case management practice includes:
- Multiple follow-up telephone calls when renewal forms are not returned.
- Contact by phone prior to case closure.
- Making calls outside traditional office hours.
- Confirming and updating contact information whenever there is communication with a family.
- Mailing an additional renewal form with advance notice of closure.
- Telephone reviews of eligibility – without the need for a signed renewal form.
- Supervisory review of all procedural closures.
Louisiana’s outreach initiatives have included:
- In partnership with the State Department of Education, an annual “back to school” media blitz and enrollment drive including distribution of more than 900,000 flyers with school lunch applications in all public, parochial, and charter schools.
- Widespread distribution of the LaCHIP application form in community locations such as Community Action Agencies, hospitals, clinics, physician’s offices, churches, WIC Clinics, and Head Start centers.
- Application assistance is available not only in the state’s 45 eligibility offices, but from more than 400 community-based organizations and providers across the state. These partners receive a small state stipend for applications submitted.
- 800+ statewide Medicaid managers, supervisors, eligibility caseworkers, and clerical staff engaged as major players in outreach. Staff brainstorm and implement regional outreach plans, organize and conduct local meetings, tell friends, family, neighbors, and acquaintances about LaCHIP, and distribute application forms.
- Eligibility staff working out in the community use laptops equipped with wireless access to the state’s computerized eligibility system. This enables them to complete applications, check people’s status, and update case information in the community.
- A “24/7” voice response system through which callers can request an application, make status inquiries, complete renewals, and get information about benefits.
- A focus on regions with the highest rate of uninsurance, particualry Northwest Louisiana parishes that have high numbers of eligible but uninsured children and pronounced racial disparities. The state dramatically increased outreach hours and activities there, and out-stationed more eligibility workers.
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- Summary
- Background/History
- Support/Opposition
- Program Elements
- Funding
- Results
- Lessons Learned
- Contacts
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Last Updated
February 2008
Louisiana
Expansions, Simplifications and Outreach
Program Elements
Louisiana officials identify three prerequisites for increasing enrollment in LaCHIP (the state's combined Medicaid and SCHIP): 1) eligibility expansion; 2) simplification of initial enrollment and renewal procedures; and 3) aggressive outreach.
1. Eligibility Expansion. Louisiana adopted a three-phase plan that gradually raised the eligibility threshold from 133 percent of the federal poverty level (FPL) in the first year, to 150 percent in the second year, to 200 percent by January 1, 2001. The Medicaid expansion model was retained without cost sharing even as new cohorts of children and families became eligible. In October 2007, the state enacted Act 407, Louisiana Children and Youth Health Insurance Program that expanded coverage through a separate program for families earning up to 300 percent of the FPL, with financial participation required on a sliding scale.
However, as a result of the August 17 directive from the Centers for Medicare and Medicaid Services (CMS), which places restrictions on states’ ability to expand coverage using federal funds, Louisiana has had to scale back its initiative. CMS approved an expansion up to 250 percent of the FPL gross income (the state had intended to use the same deductions as their Medicaid and SCHIP programs) with a 12-month waiting period. Approval was received on February 27, 2008. Read more about the August 17 Directive.
For a summary of Louisiana’s proposed expansion see At a Glance.
2. Procedural simplifications and improvements. LaCHIP sought to build on an already-simplified enrollment process by further minimizing paperwork and requirements wherever possible. For example, the state adopted a literacy-tested application, which has been reduced from 14 to three pages, as well as a simplified renewal form. Louisiana also implemented simplification and improvement activities in some key areas.
Changing the eligibility determination culture:
Through intensive “internal marketing” Louisiana shifted the thinking of its eligibility workers—helping them see the integral role they played in reducing the number of uninsured children in the state. Caseworkers were trained on the health and financial consequences of being uninsured, on why families may fail to respond to requests for information, and on barriers to enrollment and retention from the family’s point of view. As a result, the state now puts a premium on enrolling and retaining eligible children, rather than on minimizing enrollment.
Streamlining the eligibility verification process:
- Ex parte reviews are used to verify eligibility at enrollment and renewal by using income, household, residency, citizenship, child support and age data, as well information from other programs such as TANF cash assistance, Food Stamps, and Social Security Income.
- Self-declaration of citizenship and residence is allowed, though curtailed by the passage of the federal Deficit Reduction Act in 2006 which requires applicants to present original and/or certified proof of their citizenship and identity. Louisiana increased Medicaid eligibility staff’s access to online vital records to address the new citizenship documentation requirement.
- 12 months continuous eligibility guarantees a full year of coverage regardless of changes in family circumstances. This policy also decreases the number of renewals an eligibility worker must do each year.
- Social Security cards are not requested if the number is provided and matched against Social Security Administration records.
- Income documentation was reduced from 8 weeks to 4 weeks. In addition, coverage can be retained without paperwork as long as wage information in the Department of Labor’s database verifies eligibility.
- Income verification is sought from employers by phone and/or fax, as opposed to in writing.
Improving general operations to support simplified enrollment and retention:
- New closure and ex parte renewal codes were established so progress and outcomes in the 45 local offices across the state could be closely monitored. State officials believe this data is a prerequisite to improving retention rates.
- Procedures were put in place to track children rather than cases, i.e., to track actual renewal outcomes.
3. Aggressive follow-up and outreach. Outreach has been institutionalized in LaCHIP. Whether conducted by individual eligibility caseworkers, supervisors or managers, or as part of an intensive statewide campaign that involves other stakeholders, the agency focuses on staying connected to participating families.
Standard case management practice includes:
- Multiple follow-up telephone calls when renewal forms are not returned.
- Contact by phone prior to case closure.
- Making calls outside traditional office hours.
- Confirming and updating contact information whenever there is communication with a family.
- Mailing an additional renewal form with advance notice of closure.
- Telephone reviews of eligibility – without the need for a signed renewal form.
- Supervisory review of all procedural closures.
Louisiana’s outreach initiatives have included:
- In partnership with the State Department of Education, an annual “back to school” media blitz and enrollment drive including distribution of more than 900,000 flyers with school lunch applications in all public, parochial, and charter schools.
- Widespread distribution of the LaCHIP application form in community locations such as Community Action Agencies, hospitals, clinics, physician’s offices, churches, WIC Clinics, and Head Start centers.
- Application assistance is available not only in the state’s 45 eligibility offices, but from more than 400 community-based organizations and providers across the state. These partners receive a small state stipend for applications submitted.
- 800+ statewide Medicaid managers, supervisors, eligibility caseworkers, and clerical staff engaged as major players in outreach. Staff brainstorm and implement regional outreach plans, organize and conduct local meetings, tell friends, family, neighbors, and acquaintances about LaCHIP, and distribute application forms.
- Eligibility staff working out in the community use laptops equipped with wireless access to the state’s computerized eligibility system. This enables them to complete applications, check people’s status, and update case information in the community.
- A “24/7” voice response system through which callers can request an application, make status inquiries, complete renewals, and get information about benefits.
- A focus on regions with the highest rate of uninsurance, particualry Northwest Louisiana parishes that have high numbers of eligible but uninsured children and pronounced racial disparities. The state dramatically increased outreach hours and activities there, and out-stationed more eligibility workers.
Browse
- Summary
- Background/History
- Support/Opposition
- Program Elements
- Funding
- Results
- Lessons Learned
- Contacts
View
Download
Last Updated
February 2008