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OHA MAGI Medicaid
System Transfer Project
Oregon Eligibility (ONE)
Oregon CIOs Conference
Presented By: Julie Bozzi
11/17/2015
2
Table of Contents
Project Overview 3
Eligibility and Enrollment 4
Project Mission and Key Benefits 5
Median Household Income Benefits 6
System Functionality 7
Project Approach 8
Project Milestones and Status 9
ONE System Go-Live Dates 10
What to Expect: Worker and Applicant Processes 11 – 13
Team Contact Information 14
Appendix 15
3
Project Overview
• Kentucky system exists in production and works correctly
• Minimum necessary system customizations were planned and made
• Policy and business processes will change wherever feasible
Kentucky’s Affordable Care Act-compliant system (called kynect),
was transferred and configured to meet Oregon’s MAGI
Medicaid/CHIP eligibility determination needs.
Oregon’s system is called Oregon Eligibility (ONE) or just ONE.
4
Oregon’s Medicaid Eligibility & Enrollment
• Applicants apply for Oregon Health Plan (OHP) coverage via ONE (Medicaid
Eligibility Determination)
• Applicants eligibility information is passed from ONE to MMIS to enroll in OHP and
get a coverage card (Medicaid Enrollment)
• MMIS sends CCO enrollment files to enroll OHP members in particular CCOs
Medicaid eligibility will be completed in the ONE System.
The Medicaid enrollment system of record is Oregon’s MMIS.
Oregon MMIS Oregon CCOs
Project Mission and Key Benefits
5
Improve Oregonians’ access to health care by providing a simplified process
for eligibility determination and enrollment in Oregon Health Plan (OHP)
The Mission
• Better coordination of care for mixed household families because applicants complete a
single application through the HealthCare.gov website or within the ONE system to receive
an eligibility determination for MAGI Medicaid/CHIP or private health insurance
• Oregonians can set-up an account, report changes and receive real-time eligibility
determinations via the user-friendly Applicant Portal
• Simplified OHA eligibility workload via automated process that generates tasks for case
management
• Centralized and verified enrollment data available for Coordinated Care Organizations
• Consistent quality data source for reporting CMS-mandated operational statistics
Key Benefits
Median Household Income Key Benefit
6
100%
200%
300%
400%
QHP
APTC
OHP
Pregnant
Woman
Child
APTC
QHP
OHP
QHP
APTC
OHP
Adult
% o
f F
PL
The Median
Household Income in
Oregon often results
in mixed eligibility
households. A key
benefit of the ONE
system will be the
ability to track these
households and
service each member
of the family.
Median Household Income in Oregon =
Between 200-300% FPL
Applicants complete a single application through the HealthCare.gov website or within
the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP
190%
138%
305%
7
Benefit Programs
Capabilities
Ap
pli
ca
nt
Po
rta
l &
Co
mm
un
ity
Pa
rtn
ers
Ch
an
ne
ls
Wo
rke
r P
ort
al
(Ma
il /
Fa
x /
Ph
on
e)
Screening
MEC Check
for Adult
Advanced Premium
Tax Credit (APTC)
(Disabled)
Continuous
Eligibility
MAGI
Account
Registration
Non-MAGI
Referral
CAWEM /
CAWEM Plus
(Emergency
Medicaid)
Former Foster
Care Children
New Existing
Emergency
Medicaid
Federal
Healthcare.gov
ONE System Functionality
Check
Benefits
Document
Management
Reasonable
Compatibility
Case
Maintenance
Verification Real Time
Eligibility
Manage Tasks
Inquiry
Hospitalized
Inmate
Application
Bi-directional
Account Transfer
Correspondence
& Reports Renewals
Eligibility
Override
Public
Assistance
Reporting
Information System
Medicaid
Management
Information
System
Oregon
Employment
Dept.
Federal Data
Services Hub
Inte
rfa
ce
s
Qualified Health Plan/
Employee Sponsored Insurance
(Disabled)
Project Approach
8
Status Phase What We’re Doing
Design • Finalize requirements
• Define future-state business processes supporting new capabilities
• Capture all changes occurring as a result of the new technology and processes
• Planning to move data from existing systems into the new tool, known as the “cutover
strategy”
• Communicating with staff and stakeholders about the project
Build • Build technology, integrating and “talking to” current systems not being replaced
• Write scenarios that simulate how the system is used
• Develop detailed training courses
• Communicate specifics about changes and benefits that ONE will bring
Test • Extensively test the system to confirm it is running correctly and works with other systems
OHA currently uses
• Make final adjustments to technology and processes as necessary, based on the results of
tests
Implement • Conduct training to help staff and others learn new technology and processes
• “Turn on” the system to perform business processes
• Conduct additional training as needed
Support • Continuous support with help of “Local Experts”, or staff highly trained on the system
• Encourage continued momentum among staff to use the system, ask questions, and raise
concerns
We are
here
Project Status Summary
9
2015 2016
Phase Aug Sep Oct Nov Dec Jan Feb Mar
Test
Implementation
Planning
Training
Go-Live
Support
Worker Portal
Go-Live
Applicant Portal
Go-Live
Milestone Date
User Acceptance Testing (UAT) Begins 9/15/15
Worker Portal Training Materials Complete 9/30/15
Submit Authority to Connect Packet to CMS 10/15/15
Worker Portal End User Training begins 10/19/15
Milestone (cont.) Date
Applicant Portal End User Training begins 11/30/15
CMS Operational Review 11/4/15 -
11/5/15
Worker Portal Go-Live 12/15/15
Applicant Portal Go-Live 2/6/16
User Acceptance Testing Begins
On Track for On-time Go-Live, Tight Schedule Creates Risk
ONE System Go-Live Dates
10
Worker Portal Go-Live
December 15, 2015
• Used for eligibility determinations
• Read only access for DHS staff as needed to
review status of client applications
Applicant Portal Go-Live
February 6, 2016
• Community Partners/Assisters and public
use for self-servicing new eligibility
determinations and enrollments
• Current Medicaid enrollees will need to
have an eligibility determination completed
in ONE by a worker before they can use the
Applicant Portal
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 16 17 18 19
20 21 22 23 24 25 26
27 28 29 30 31
December
February
S M T W T F S
1 2 3 4 5
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29
15
6
11
A Day in the Life of an Eligibility Worker
11
Applicant provides verification
documents
Receive
Verification
Documents
Eligibility Worker
Other OHA / DHS
System
generates
correspondence
Request for
Information
Data needed to run
verification is received
and entered
Re-run
Verification
Reassign applicant to
appropriate queue
Non-MAGI
Referral
Applicant is handed off to DHS
and processed outside of the
ONE system
DHS
Dashboard
Pull appropriate task
from queue. Manage
from your dashboard
Log In
Single Sign On Verification
successful?
Verification
Complete Applicant
Registration and data
collection
Data Entry Authorize Benefits
Authorize the
appropriate benefits
Authorize Benefits
Authorize the
appropriate benefits
Yes
No
Report Results
The eligibility results will be
reported to the ONE System
Application Lifecycle for Applicants and Workers
General New Applicant — Does not have Medicaid
Existing Applicant — Has Medicaid
Worker Log In
Single Sign On
Worker Dashboard
Pull appropriate task
from cue. Manage
from your dashboard
Verification
successful
Verification
Applicant Applies
Applicant Portal
(On-Line)
Community Partner Assistance in
Applicant Portal
Complete Applicant
Registration and data
collection
Data Collection
Eligibility Determined
Applicant not previously
known to the Oregon system
has their eligibility
determined
CCO Selection
Applicant or Community
Partner selects a
preference, MMIS assigns
CCO finally
Complete Applicant Registration
and data collection
*Applicant known to Oregon
Systems?
Data Collection
Eligibility Determined
Applicant not previously
known to the Oregon system
has their eligibility
determined
Verification
successful.
Verification
Yes
No
Application Lifecycle for Applicants and Workers
Applicant Applies
Completes their
application via Paper,
Fax, Fillable PDF
IRMS
Scans the
application into
the Worker Portal
Worker Dashboard
Pull appropriate task
from cue, Manage
from your dashboard
Verification
successful
Verification
Worker Log In
Single Sign On
Applicant without Computer or Access to a Community Partner
Complete Applicant
Registration and data
collection
Data Collection Eligibility Determined
Applicant not previously
known to the Oregon system
has their eligibility
determined
Project Team Contact Information
14
For additional information regarding the OHA MAGI Medicaid System
Transfer Project or the ONE System, email the project team:
Appendix
10 Things to Know About the ONE Project
l. Oregon has elected to transfer and implement the Kentucky eligibility and enrollment system (called
KYNECT) – meaning we are bringing a system that already works, to Oregon for use by OHA.
2. The project is minimizing changes to the KYNECT system and limiting them to the ones needed for
Medicaid policies in Oregon that don’t exist in Kentucky (like emergency Medicaid for non-citizens) or
are necessary to support a Supported State Based Marketplace – (like Account Transfer with the Federal
Marketplace (FFM) or Medicaid Coverage Check (MEC)).
3. OHA is using a system integrator on the project – Deloitte Consulting – who built the original system in
Kentucky.
4. The system will be hosted in the Oregon DAS Enterprise Technology Services State Data Center –
under control of state resources to support it.
5. There are some technical changes that need to be made to the Kentucky system to make it work in
Oregon, including integration with an existing Document Management Solution and a new security COTS
software product (Kentucky had a custom developed application) for their specific needs.
6. The ONE system will have interfaces with Oregon’s MMIS (5 total), with the FFM (10 total) and with a few Oregon
specific data sources (like Employment Department). Interface development is on-track based on the project schedule.
7. There is a phased implementation schedule planned for the ONE system:
• Worker Portal & integration with FFM (i.e. Bi-Directional Account Transfer) – December 15, 2015
• Applicant Portal for client self-service – February 6, 2016 (after open enrollment finishes)
10 Things to Know About the ONE Project
8. OHA is convening a group of external advisors – including Legislators, Coordinated Care Organization
representatives, as well as Community Partner representatives – to advise on implementation planning for
the ONE system. First meeting will be held in July 2015.
9. When the system goes live, each current Medicaid enrollee will need to have an eligibility
determination completed in the ONE system by a worker before they can use the Applicant Portal for
inquiries or reporting changes in circumstance, via self-service.
10. Nothing about the new ONE system makes the problem of Medicaid clients wanting to choose a CCO
based on participating providers better (or worse). The ONE system will provide a webpage with links to
CCO provider directories, maintained by CCOs so that Oregonians can search to see if their provider is in
a particular organization. The ONE system does provide applicants (accessing the system through the
online Applicant Portal) the ability to choose a preferred CCO based on residential zip code should the
applicant be found eligible. The ONE system will NOT interface with OHA Office of Health IT (OHIT)
Provider Directory at initial implementation.
• OHIT is currently working on a statewide provider directory project that will leverage data from
existing, authoritative, and accurate provider data sources, such as common credentialing. The
provider directory is not anticipated to be consumer-facing but instead will be a resource for
provider directory systems (potentially including MAGI) to validate their own directories and
improve the accuracy of their data they provide.
See attached PDF for useful information regarding the MAGI Medicaid System Transfer project.
Updated ONE System Experience
18
After December 15th internal OHA Staff will access the Worker Portal to complete all eligibility
determinations, each current Medicaid eligible will have to have a redetermination completed
through Worker Portal before using Applicant Portal to self-service.
Worker
Portal
Updated ONE System Experience
19
After February 6th new and returning applicants who have had an initial redetermination completed within Worker Portal will initiate their application or renewal by way of the Applicant Portal
Applicant
Portal
