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Tricia Brooks National Covering Kids and Families Webinar December 15, 2011

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Countdown to 2014. Technology and the Vision for Paperless, Simplified Eligibility and Enrollment under the Affordable Care Act. Tricia Brooks National Covering Kids and Families Webinar December 15, 2011. The Vision of the ACA. Robust website

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Countdown to 2014

Technology and the Vision for Paperless, Simplified Eligibility and Enrollment under the Affordable Care Act

Tricia Brooks

National Covering Kids and Families Webinar

December 15, 2011

the vision of the aca
The Vision of the ACA

Robust website

Electronic application with electronic signature

Verification through electronic data sources

Real or near-real time eligibility decision

woe is the state s eligibility system
Woe is the State’s Eligibility System

Sick of hearing what the state can’t do because of its aging systems?

State budgets got you feeling under the weather – no money to upgrade systems

help has arrived
Help Has Arrived

Unprecedented federal funding opportunity

90% system development

75% system operating costs

Expires at end of 2015

expedited it funding approval
Expedited IT Funding Approval
  • Waiver of certain cost-allocation rules in integrated systems (e.g. SNAP)
    • Don’t have to allocate costs for functions/process needed for Medicaid (even if other programs benefit)
    • Only the incremental cost of integrating other programs are charged to them
  • Expedited process for funding approval
  • Sharing system resources across states
strings attached
Strings Attached
  • Customers should experience a high level of service, support and ease of use
  • Flexible, modular systems to promote ease of maintenance, sharing and reuse
  • Support accurate, timely eligibility and effective communications
  • Produce performance data
  • Ensure seamless coordination with the Exchange
georgetown health policy institute center for children and families
Georgetown Health Policy InstituteCenter for Children and Families
  • Tricia Brooks,

Assistant Research Professor, Health Policy Institute

Senior Fellow, Center for Children and Families

    • 202-365-9148
    • Our Website:
    • Say Ahhh! Our child health policy blog:
project objectives
Project Objectives
  • Develop first-class user experience (UX) design for health insurance exchanges operated by state and federal governments under the Affordable Care Act.
  • Design the UX based on an understanding of consumer needs and refined through user testing.
11 participating states
11 Participating States


ux 2014 design partner
UX 2014 Design Partner
  • World-class design and innovation firm
  • Market leader in simplifying design of complex systems; understanding and then translating needs and desires of end users
project scope
Project Scope
  • Individual market (possibly SHOP)
  • End-to-end eligibility, enrollment, plan selection, premium payment and retention experience
  • All insurance affordability programs (Medicaid, CHIP, tax credits, cost sharing reductions, Basic Health Program)
  • Multiple pathways
  • Design for diversity and ADA compliance
  • Vendor / system neutral, technology agnostic, customizable
overview support for assisters
OVERVIEW Support for Assisters
  • Based on assister role generally, including navigators, brokers, eligibility workers and community-based organizations
  • Proxy access for family members, caregivers, providers, etc., with read and/or read-write options
  • Support for initial application, enrollment and change in circumstances
  • Tools to support caseload management
assister scope high priority
Assister Scope – High Priority
  • Assisters having their own separate accounts with certification date/ID number, etc.
  • Organization has an account with all of its individual assisters affiliated with that organization.
  • Caseload management tools, sort of cases (by status, name, etc.), including information regarding the disposition of their cases (for credit and case management).
  • Ability for an assister to help someone with paper documents
  • The ability of the assister to transfer a case and to manage cases within an organization, including the ability to make and attach notes/comments to the case.
  • Assister Search functionality
assister scope medium priority
Assister Scope – Medium Priority
  • Different versions of Exchange web pages (skip questions/shorter questions/low-speed and high volume versions)
  • Presumptive Eligibility: An abbreviated data collection web page that includes approximately six data fields
  • Type of Assister: If broker/agent is the assister, relationship of assister to insurance carriers
assister scope lower priority
Assister Scope – Lower Priority
  • Audit trail for assister activities over time.
  • Specialized help function (FAQs, help line, on-line manuals/handbooks, etc.), but not the content.
  • APIs – clearly should be offered to brokers/agents/navigators
questions answers
Questions & Answers

For more information, contact:

overview draft content
OverviewDraft Content
  • The following slides represent draft wireframes for the individual user experience under the Enroll UX 2014 project.
    • These drafts are a work in progress and should not be considered final design products.
    • Wireframes represent page layouts; no visual design is reflected. The actual “look and feel” of the user experience will be very different than portrayed here.
    • Wireframes for the UX for assisters and the SHOP Exchange are not included.
  • Placeholder language is used throughout.
overview scenario

Family of 3, all citizens, 308% FPL

  • Application filer, not applying for coverage
    • Penelope Hermannson-Smith
      • DOB: 06/18/1971
  • Applying for coverage
    • Gustav Hermannson
      • DOB: 10/02/1973
    • Beatrice Hermannson
      • DOB: 03/21/2001