Eligible children and families losing Medicaid or CHIP coverage at renewal for procedural or paperwork reasons has been a persistent problem. As Harvard researcher Dr. Benjamin Sommers has aptly noted, poor retention rather than poor take-up is the main reason why millions of children eligible for Medicaid and CHIP are uninsured. Dr. Sommers’ research has shown that it’s not uncommon for upwards of 40% of uninsured, eligible children to have been enrolled at some point in the past year. No successful business would allow that many customers to “get away” after investing in marketing, sales and customer service (outreach, enrollment, and consumer assistance in the health coverage world).
Importantly, the ACA seeks to improve both retention and administrative efficiency by streamlining the renewal process and requiring states to conduct ex parte reviews of ongoing eligibility at renewal. If you’re a regular reader of Say Ahhh!, you’ll know that I’m excited about the ACA’s prospects of improving retention and eliminating gaps in coverage for eligible kids.
Ex parte renewals access reliable sources of electronic data, such as the state wage database, to check for current income or other eligibility information. Although states have long been required to use ex parte processes before terminating Medicaid coverage, the ACA requires states to be proactive in using ex parte to automatically determine eligibility whenever possible before asking enrollees to return a renewal form with paper documentation. While many states use electronic data to confirm eligibility reported by individuals, the key distinction for ex parte is that it happens without an enrollee taking action.
When we compiled the data with our colleagues from the Kaiser Family Foundation for the 2016 annual 50-state survey on Medicaid and CHIP policies and procedures, I was pleasantly surprised to see that two-thirds of the states indicated they able to conduct ex parte renewals, although not all of them were able to report the share of renewals that were determined through the ex parte process. Of the states that were able to provide these data, it was clear that several states are achieving high rates of ex parte renewals – in some cases exceeding 75%. So Dr. Gene Lewit and I decided to take a closer look at state experiences in implementing ex parte renewals.
This new brief highlights some of the challenges that states have faced and offers tips in overcoming them. Much of the advice that State officials offered can apply generally to the use of technology to streamline eligibility and enrollment. It is clear that there are differences in state perspectives in both defining ex parte renewals and in state philosophy toward using federal flexibility to achieve high rates of automated renewals. We also found evidence that states have learned much since the days of patching up their legacy-based mainframe eligibility systems. These lessons include hiring IT professionals who can aptly manage vendor contracts, getting the design right on paper before starting to build the system, phasing in system functionality, fixing problems rather than using workarounds, and making a concerted effort to facilitate agency culture change.
Government has often lagged behind the corporate world in using technology to enhance operational efficiency and effectiveness. This was often due to the high cost of implementing sophisticated, high-performing systems. But the federal government has removed this barrier for states by making 90% federal funding for system development and implementation and 75% funding for ongoing operations and maintenance permanent.
The annual 50-state survey on Medicaid and CHIP shows that states can be successful is harnessing technology with several states Now that the dust has settled on many of the ACA’s numerous implementation tasks, states can focus on how to maximize those systems in automating the eligibility and renewal processes to achieve high rates of real-time determinations and ex parte renewals. What this can mean for children and families is getting enrolled faster and staying covered continuously without the hassle of paperwork.
