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Health Care Reform

Health Care Reform. May 6, 2013 CWDA Webinar. Today’s Agenda. Our Vision Our Role Implementation Support Regional Seminars. Our Vision.

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Health Care Reform

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  1. Health Care Reform May 6, 2013 CWDA Webinar

  2. Today’s Agenda • Our Vision • Our Role • Implementation Support • Regional Seminars

  3. Our Vision California county human services agencies will provide first class customer service to individuals seeking help under the ACA, and will enhance local agency culture to effectively promote health care coverage and access to vital human services for all who are eligible.

  4. Our Goals • Enrollment in All Available Coverage • No Wrong Door • First Class Customer Service • Coordinated Service

  5. The Context • Skepticism about county ability to meet these goals • Competing desire to split off health care from other services • Desire to centralize

  6. The Bottom Line • Failure is not an option • Perception and actual performance are equally important

  7. Our Role • Comprehensive coverage though all pathways • In-person, online, by phone, by mail • County can sign person up for any program • Including Medi-Cal and Exchange-based coverage • Can help select plan if person wants help • “Warm handoffs” from Covered CA call center • All non-MAGI Medi-Cal eligibility • Case management for all Medi-Cal programs • Horizontal Integration (CalWORKs, CalFresh)

  8. County Application Pathways • Counties will receive applications directly • In person at county offices • Via phone to county call centers • Via mail at county offices • Via SAWS online portals, which will continue to run • Counties will receive applications indirectly • From Covered CA for likely Medi-Cal eligible apps: • Warm handoff phone requests from service center • Online or mailed in that need follow up/verification* • Assister-submitted online or mail that need follow up *Exact business flow still being negotiated

  9. Expectations of Counties • Process applications from all pathways • Take applications through to completion • Includes eligibility for Exchange-based coverage • Help customers select managed care plans • Conduct ongoing case management • Process reported changes for all Medi-Cal • Send changes to Exchange for their enrollees • Convert existing Medi-Cal cases to MAGI • Likely requires supplemental information at renewal • January – March 2014 “grandfather” period • New renewal process starts in April 2014

  10. Questions re Expectations • What will be the performance measures? • County performance measures are statutory. • Until new performance measures are negotiated, current statutory measures continue to apply: • Processing time frames for applications • Processing time frames for annual renewals • MEDS Alert processing • Will counties have to report in 2013? • 25 largest counties would be reporting for October • This will be discussed with the Administration • Stay tuned for more information

  11. Warm Handoff • From statewide Covered CA 1-800 line • State staff will first figure out what they need • If eligibility determination, do Quick Sort • Likely Medi-Cal eligible cases sent to county • First will look to county of residence • Backup: Another county in that consortia • Covered CA keeps likely Exchange eligible cases • CWDA helping negotiate MOUs • Between consortia, Covered CA, DHCS • Contains service level requirements, corrective action, statement regarding funding via budget • Service level examples: 80 percent of calls to be answered in 30 seconds or less; no busy signals* *Exact service levels still being negotiated

  12. Warm Handoff – Mixed Cases • Mixed cases will be different during first open enrollment period than ongoing • Mixed case = seems likely to have people eligible for both Medi-Cal and Exchange • During first open enrollment, Exchange call center staff will process mixed cases first • Including initial Medi-Cal eligibility • Counties will finalizeMedi-Cal, send NOA • After first open enrollment, counties will be sent mixed cases to process

  13. Consortia Based Network

  14. County/Consortia Process • Planning for this started in 2012 • Had put forth idea of counties connecting together to serve as statewide call center • That idea was dropped in favor of warm handoff approach for MC cases • Multiple planning groups • Meg Sheldon lead for CWDA • Consortia Leadership Group • Consortia based planning groups • CWDA HCR implementation group • Periodic check ins

  15. Questions about Handoff • How will counties staff our centers? • CWDA has developed staffing estimate based on call volumes and projected service levels. • Expect to see funds for this in the May Revise • Why give these calls precedent? • Because the counties are the ones who by law do Medi-Cal, callers identified as Medi-Cal need to come to us. • In order for this approach to work, we need to ensure the calls are answered quickly • Not expecting counties to handle this new volume with their existing staff

  16. Questions about Handoff • Doing Medi-Cal real time on phone? • Rules for the new MAGI-based coverage will be simpler. No asset test is the biggest change. • Rules still being developed between state and Legislature on how much verification must be collected on other items. • Some people may not be able to be verified in real time and follow up work will be needed • Who in counties must answer phone? • Counties need to assign eligibility workers to answer these calls. • No two-tiered handoff of calls from clerical

  17. Questions about Handoff • How does “one and done” concept work? • Take application as far through the process as possible on the first call • Working out business flows for follow up if verification or other information needed • Working out business flows and processes related to counties taking calls for one another • What about horizontal integration? • Likely to depend on call volume • Possible approach: • If not that busy, ok to take them through CalFresh* • If high call volume, defer CalFresh until later call* *Exact business flows still being negotiated

  18. Phone: Why so much focus? • Covered CA will directly operated few paths • CalHEERS online portal • 1-800 number • CalHEERS online can be real-time • If everything checks out against data hub • If no unanswered/unverified information • Phone is next logical area to focus • Has been a heavily negotiated process • Lots of technology, staffing, readiness

  19. Implementation Support • “Are You Ready” Guide • A Framework For Advancing A Culture of Customer Service In Health And Human Services • Funding for Customer Service Center Network technology • Funding request for implementation support & ongoing work • Training development/coordination project

  20. Regional Seminars • Where & When • Agenda & What to Expect • Participant Preparation • Questions?

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