Louisiana has done an incredible job of reducing the number of children who lose coverage for LaCHIP (Louisiana’s Medicaid or SCHIP) at renewal. What’s the secret to success? Ruth Kennedy, LaCHIP’s director, provides us with the answers. (Additional resources on Louisiana’s renewal processes are also available at the end of the interview.)
CCF
It is really terrific what you have been able to accomplish in cutting red tape and improving health coverage for Louisiana’s children. What I found most impressive is how you have completely turned around losses at renewal in your LaCHIP program. Now, only one child out of 100 children coming up for renewal loses coverage for paperwork reasons. How did you do it?
Ruth
We did it by being aggressive and innovative, but in the end the procedures that we adopted are pretty simple and logical. Here’s our basic “recipe.” First, when someone comes up for renewal, before even sending out a renewal notice, we check to see if the child can be renewed by relying on information we already have on hand, such as that available through food stamps, child support, and labor tax records. If they are eligible, we let them know. Nothing more needs to happen. Second, we follow up with the families that we can not renew based on existing information to renew as many of them as possible by telephone. We successfully renew about 3 out of 4 families through one of these two steps.
CCF
How do you reach families that you cannot renew with those three steps?
Ruth
Once we had these systems in place, we improved our renewal rate even more by allowing families to renew anytime through a toll-free hot line and allowing families to renew online. Our most recent improvement to the renewal process is the implementation of streamlined procedures for families with low and very stable income, for example, where a grandparent on a fixed income is caring for a child. These families are sent a letter and told to contact the state if their situation has changed. If they do not report a change, eligibility is automatically extended.
CCF
So, let me be sure I have this right. Louisiana renews most of its Medicaid/SCHIP cases without ever sending the family a renewal form?
Ruth
That’s right—in a recent month, we renewed about 88 out of every 100 families without sending them a renewal form.
CCF
What have your agency’s employees thought about all of this? Doesn’t this shift more of the burden on to them?
Ruth
Well, that’s the first thing they thought when we asked them to do it! But, we’ve been doing it for several years now and they really like the changes—in part because even though they have some new responsibilities, overall the changes have saved them time because they no longer have to process multiple forms and collect duplicate paperwork. But the bigger issue is that these changes have been part of a major transformation of our workplace and our eligibility workers have been deeply involved in designing the changes, and thus, are committed to making it work.
CCF
How are they involved?
Ruth
For one thing, they are involved in outreach and marketing, which helps them connect more to the community and to our coverage goals. But also, they bring their ideas for simplifying the process to the table. We test out the ideas and if they work, we adopt them.
CCF
What kind of ideas have they had?
Ruth
One idea was to stop requiring pay stubs from families if their income was not more than 75% of the upper eligibility level. Let me give you an example. We cover children up to 250% of the federal poverty line. If a family reports income that is only at 180% of the poverty line and we can verify that through our databases, we don’t ask for pay stubs. We found, through our testing, that there are very few errors in the wage reporting and if there are errors, they are slight. So if a child is well below the upper eligibility level, a small difference isn’t going to matter. Why ask for the paper work if it won’t affect eligibility?
CCF
What advice do you have for other states that might want to put these kinds of practices in place?
Ruth
The first bit of advice is more of a reassurance—if we can do it, you can do it! We don’t have fancy computer systems here in Louisiana; and we have parish offices that operate much like county or regional offices in other states. We have faced cutbacks in staffing like many other states. But we set our sights on getting our procedural closings as low as possible and have been successful—99% of families can be found if you try hard enough. It takes time—we have added to our repertoire of strategies over the years and did not do it all at once—but it can be done. Transforming the workplace so that managers and front line employees have explicit goals and expectations, the data to measure renewal results, and a place at the table is really the key to our success.
CCF
What are the three most important points your colleagues in other states should remember when trying to reduce their renewal losses due to paperwork?
Ruth
1) Don’t require new paperwork unless it is absolutely necessary—that means renewal forms as well as verification. Our caseworkers believe they get better quality and more accurate information through the telephone renewal process. As an added bonus, it’s great for Green Government!
2) Use the telephone and online technology to make the process accessible to families in different situations. We make major use of both to verify income so that we don’t have to ask the family for documentation.
3) Empower managers and front line employees by setting goals, allow them to use their common sense to achieve those goals, and listen to their suggestions for improvements.
