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NASHP Conference October 4, 2011 Ruchika Bajaj Division of Health Reform and Health Insurance Exchange Integration Office of Health Insurance Programs. Gearing Up for Enrollment in the Digital Age. New York Health Coverage and Enrollment: 2011. Public programs: 5 million - PowerPoint PPT Presentation
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Bajaj
NASHP ConferenceOctober 4, 2011
Ruchika Bajaj
Division of Health Reform and Health Insurance Exchange IntegrationOffice of Health Insurance Programs
Gearing Up for Enrollment in the Digital Age
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Bajaj
Public programs: 5 millionEmployer-based: 10.5 millionUninsured: 2.7 million
New York Health Coverage and Enrollment: 2011
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Increase Medicaid enrollment by about 25%
Add Exchange coverage for over one million more New Yorkers (700,000 subsidized)
New York Health Coverage and Enrollment: 2014
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Planning Grant
Early Innovator Grant
Establishment Grant
Funding for Exchange Build and Rollout
NY-HX
2014 and beyond
MA Eligibility90/10 funding
Business Process
Redesign
Simplify Align Rules
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New York is committed to integrating eligibility and enrollment for all public, subsidized and individual/employee Exchange health coverage through the NY-HX (Medicaid, CHP, Exchange, Basic Health Program, if offered)
Working with funders/consortia to design “customer experience” (web portal)- IDEO
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Simplify, align and integrate HX eligibility and enrollment determination process
Procurement pending-Systems Integrator
Technical infrastructure to support a more uniform, automated, consumer-friendly administration of health coverage programs by 2014
• Qualified Health Plan • Subsidies• Medicaid • CHP• Basic Health Plan
NY-HX System Solution: What is It?
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To design and develop a “best in class” Exchange system
solution, NY has to first specify what the NY-HX will do, and how it will do it (business requirements, business processes).
NY has a number of key policy decisions to make, and design options to choose from, to establish the needed framework and simplify and align the rules governing NY-HX implementation and business operations.
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NY-DOH formed NY-HX EI Project Management Office (PMO) upon Feb 2011 EI Grant Award Adapt NY-HX EI PMO to evolving governance structure
Role of PMO Establish framework to manage project, meet grant
requirements, and oversee Systems Integrator work Develop strategy and schedule to manage external project
dependencies, e.g. User Experience Project, Federal Hub Development Project, Medicaid Eligibility and Enrollment System Project
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Joint efforts - Insurance, Health, other agencies under leadership of Governor’s Office
Insurance Department
Planning Grant Team
DOH Medicaid CHPDOH EI PMO
Governor’s Office
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Multiple, 30+ year old, “horizontal” legacy eligibility and enrollment systems
Shared State/local responsibility for administering Medicaid
Budget and staffing constraints; procurement rules and timelines
Legislative timeline
New York : Key Challenges to Bridging the Gap
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Self declaration of income/ residency at renewal
12 month continuous enrollment for children and most adults
No resource test for most Medicaid beneficiaries
No finger imaging requirement
No face-to-face interview
Automated Eligibility
Elimination of Enrollment Barriers Helps Pave the Way : Key Challenge is Automated Eligibility System
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Statewide Call Center
Telephone Renewal supported by automated tool/rules
Medicaid Redesign Team (MRT) workgroup developing recommendations to align state/local responsibilities- late 2011
New York : Accomplishments to Help Bridge the Gap
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Conduct joint application design sessions on business requirements
Exploring other state, national potential solutions (e.g. SERFF (NAIC/50 state) system for plan management functionality, IDEO user interface project)
New York : Strategies to Help Bridge the Gap
•Eligibility and Enrollment
•Plan Management
•Financial Operations •Customer Service•Communications •Oversight
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Proposed MAGI rules simplify and address much, but not all – work in progress
Robust federal hub, with easy, automated processes for eligibility and verification (e.g. PARIS, death matches, in addition to SSA, HSA and IRS)
Federal support for Exchange systems and tools - (e.g. plan management- use of SERFF? Plan comparison tool? Well designed user experience (IDEO))
Align federal audit standards with ACA
Federal Role In Support of State Exchanges Critical
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Federal funding, guidance critical
State/ Exchange must be able to quickly make decisions and expend funds -- hire, procure, plan and implement new processes and systems
Learn from and involve stakeholders
New York : Lessons Learned
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