By Stephanie Brooks, Colorado Covering Kids and Families

Colorado Covering Kids and Families’ (CKF) new report, Colorado’s Health Insurance Affordability Programs: Goals to Prioritize and Options to Consider to Create a More Direct Pathway to Health Coverage, is the first in Colorado to document and examine the eligibility and enrollment process in health coverage programs since the implementation of the Affordable Care Act (ACA).

Based on data collected through 11 focus groups and two surveys, and research conducted by CKF staff, our new report outlines the current process individuals and families go through when applying for Colorado’s health insurance affordability programs. These programs include Health First Colorado (Colorado’s Medicaid Program), Child Health Plan Plus (the state Children’s Health Insurance Program), and premium tax credits and cost sharing reductions available through the state-based marketplace, Connect for Health Colorado.

The report describes the multiple steps that Coloradans take to enroll in health insurance affordability programs and visualizes the process with an in-depth flow chart. In addition, the report proposes nine goals for the state to prioritize as it works to further simplify, streamline, and coordinate the eligibility and enrollment process and health insurance affordability programs. Within each over-arching goal, the report also suggests legislative, regulatory, and administrative options that decision makers may consider to implement improvements.

In the coming months, CKF will use the goals and options outlined in the report as part of our advocacy strategy to encourage decision makers to implement the most feasible options to have a positive impact on individuals and families applying for health coverage. The nine goals and corresponding options are summarized in this chart.

Although CKF plans to work with the state Medicaid agency and the state-based marketplace to implement the majority of these suggestions over time, we are focusing our initial efforts on six options that could be adopted in the short-term that would have an immediate positive impact on our eligibility and enrollment processes. These short-term, high impact options are:

• Improve the transfer of information between systems and entities. Although Colorado has significantly improved its online application, the Colorado Program Eligibility and Application Kit (PEAK), errors can occur in transfers of information and data between the online application, the state-based marketplace, the eligibility system, and the state’s claims payment system.
• Continue to simplify PEAK to decrease errors, improve client satisfaction with the application process, and increase client autonomy. Despite the success of Colorado’s online application and shared eligibility system, assisters note that the application length is a barrier, the questions are not always clear, the Spanish version of the application is less clear than the English version, and the help text is not always accurate.
•  Prioritize improvements to client correspondence to increase readability, clarity, accuracy, and timeliness. The letters Coloradans receive about their health coverage are consistently cited as a barrier to enrollment in health insurance affordability programs. Clients and assisters stress that notices generated by the eligibility system often contain incorrect information and are difficult to understand.
• Prioritize the implementation of the integrated support model to streamline and improve customer service support for clients and assisters. The overwhelming number of program call centers in Colorado causes frustration, barriers to enrolling in health coverage, and delays in accessing needed health care. The agency that manages the eligibility system is beginning to develop an improved and integrated customer support model with stakeholder input.
• Allow assisters to have access to additional information on a client’s case. Assisters have expressed a desire to have, at a minimum, read-only access to client case information within the eligibility system so they can see details of a case, explain the details to clients, and more effectively troubleshoot issues if they arise.
• Improve and integrate training for assisters, including call center staff. Assisters consistently identify the need for integrated training on all health insurance affordability programs, rather than the disjointed training opportunities currently offered which either focus on public programs or marketplace programs, but rarely both.

Substantial steps have been taken since the implementation of the ACA to get more eligible Coloradans enrolled in health coverage, and we are proud that Colorado has prioritized many reforms aimed at increasing enrollment, including expanding Medicaid and creating a state-based marketplace. In order to ensure that Colorado continues to be a leader in health care reform and achieves its goal of being the healthiest state in the nation, we will continue to work with decision makers, state agencies, funders, and other advocates to prioritize changes that protect our advances and further improve health insurance affordability programs, and the application and enrollment process.

We continue to work toward our vision that every eligible Coloradan can easily enroll, and stay enrolled, in high quality, affordable health coverage.

The full report and accompanying handouts, including an executive summary and fact sheets on the six short-term options, are available on the CKF website here: ckf.cchn.org/publications/the-maze/.

CKF is a statewide, coalition-based project with a mission to increase access to affordable health coverage and high quality health care by ensuring that Health First Colorado, Child Health Plan Plus, and subsidized private insurance through Colorado’s state-based marketplace consistently meet the needs of low-income Coloradans. For more information about CKF, please visit ckf.cchn.org.