As Say Ahhh! readers know, in May, we released a comprehensive report showing that child enrollment dropped by nearly 1 million children in 38 states in 2018 and we have continued to track the growing enrollment decline in Medicaid and CHIP. Data recently released by the U.S Census Bureau underscores the need to for policymakers to focus on this alarming trend for children’s health coverage showing the number of uninsured children increased for the second year after a decade of gains.
In addition to discussing various factors contributing to the decline in our report, we summarized a number of strategies and steps that states can take to reverse the negative enrollment trend. In this blog series, we are taking a closer look at the policies and actions that are proven to promote enrollment and retention. This fourth installment focuses on ways to maximize the use of technology to promote enrollment and retention, while increasing state administrative efficiency.
Everyone knows how technology has evolved over the two to three decades. In efforts to grow and prosper, businesses have increasingly relied on technology to automate many of tasks that otherwise require significant human resources and are prone to human error. Today, many consumers conduct personal business in a paperless environment, no longer getting bills in the mail and writing checks to pay them. For too long, both government and the health care sector have lagged in adopting technology to create efficiencies, eliminate human error, and streamline processes. In particular, state Medicaid eligibility enterprises were hindered by decades-old mainframe-based computers in a world of cloud-based, high-performing technology, in a large part due to the cost of technology. That all changed with the Affordable Care Act and an adjustment in the federal financing structure of Medicaid eligibility systems from a 50:50 federal match to a 90:10 match with the goals of accelerating automated, data-driven enrollment and renewal and providing consumer tools to promote self-service.
- Web-based and Mobile Consumer Tools – Ensuring that online applications and online accounts are mobile friendly is increasingly important given that smart phones have rapidly become a preference for many consumers over computers. Earlier this year, Tennessee became the final state to launch a state-based online application but only 42 states offer online accounts. Online accounts allow enrollees to perform a number of useful tasks – like updating their mailing address – that would otherwise require manual data entry. Other online account functions include reporting income changes, uploading needed documents to verify eligibility, and going paperless all offer conveniences to enrollees and efficiencies to states. Some states are taking steps beyond ensuring mobile accessibility by designing apps specifically designed for mobile devices. To see what states are doing, check out Tables 8 and 9 in the annual 50-state survey on Medicaid and CHIP policies.
- Automated Renewals – States are expected to use trusted data sources to assess eligibility at renewal before asking families to complete forms or submit documents. Some states have achieved levels of automated renewals greater than 75 percent. But states have different approaches depending on which data sources they use and how they determine what constitutes a match between what the individual reported and what the data source reflects. States should work to expand the sources of data and perfect system capabilities to confirm ongoing eligibility at renewal.
- Community-Assister Portals – Portals allow community assisters to facilitate the application or renewal process, thereby expanding the state’s capacity to provide consumer assistance. Health care providers have a vested interest in helping families maintain continuity of coverage but many community-based organizations are also willing to help connect families with services. While these portals may be limited to simply tracking the submission of the regular application by assister, they can also be built to provide additional functions. For example, if assisters are alerted to upcoming renewal dates, they can reach out to assist families. If families are confused about a notice they received, the assister can access it online to help the enrollee understand what it means. Moreover, these portals give states important tools to monitor community-based assister performance and, though audit trails, to discern if information that was entered or changed was made by a third party as an added beneficiary protection.
- Data Collection for Informed Decision Making – Technology makes it easier for states to track key performance indicator data. Too often we don’t know why applications are denied or enrollees lose coverage. While CMS performance indicators require states to track whether a denial or disenrollment was the result of ineligibility or due to missing paperwork or other procedural reasons, these data have yet to be publicly reported. States should strive to implement more explicit reason codes, which can help identify when denials or disenrollments reflect barriers to enrollment that can be addressed through additional action by the state. Another example is for states to track data on call center performance such as call volume, wait times, and abandoned calls can help states better assess how well their call centers are performing to meet beneficiary needs. Of note, tracking data alone is not sufficient. States should use the data to improve performance over time.
This is fourth in our blog series on opportunities for states to regain enrollment momentum and reduce the number of uninsured children. There’s a lot more that could be said about using technology to maximize enrollment. If you want to dig deeper, check out this brief that discusses consumer assistance in the digital age. While a bit dated, it offers a number of ideas on supporting consumers through digital tools. And stay tuned for our final installment in this series where we will explore ways states can enhance procedures and processes to ensure that all eligible children and families are enrolled and able to retain coverage.