namd_enrollment_presentation_november_8x - State Refor ...

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29 Νοε 2013 (πριν από 3 χρόνια και 10 μήνες)

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1

Toby Douglas

November 8, 2011

National Association of Medicaid Directors

California’s Enrollment Future:

Reflections on Federal Guidance and
Work on the Ground


California’s Response to
the Medicaid Eligibility
NPRM

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Coordinating California’s
Responses



Met regularly with Health Benefit Exchange, CHIP
program & HHS Agency



Convened meeting with stakeholders (e.g. consumer
advocates, providers) to provide high
-
level review of the
proposed regulations and hear reactions and concerns.



Submitted comments jointly & transmittal letter directs
questions to specific lead program


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Overview of Response to
Medicaid Eligibility NPRM


Eligibility Simplification



Electronic Verification/Program Integrity



Inter
-
Program Coordination



Information Gaps and Ambiguities

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Simplification and Streamlining

of Eligibility


Substantial progress made with the Medicaid eligibility
NPRM, especially considering the breadth of Medicaid
changes within ACA



Supportive of simplifying and streamlining eligibility
criteria, categories and processes



Landmark opportunity for states to reduce complexities
and burdens which have hampered Medicaid programs
for some time







NPRM exhibits some tension between simplification
theme and the competing aim to maintain pre
-
ACA
coverage continuity in Medicaid



Clarification needed around state
-
selected min/max
MAGI thresholds & ability to align coverage among the
post
-
2014 vertical scheme of subsidy programs



Requesting the ability to further simplify/streamline
programs on an individual state basis, in furtherance of
the themes and intent of the ACA


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Simplification and Streamlining

of Eligibility

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Shift to Predominantly
Electronic Verification


Cautious optimism for reliance on electronic data sources,
ex parte
reviews and self
-
attestation (in lieu of documentation, limited
redeterminations, no status reporting, etc.)



High expectations for the effectiveness of the federal hub and
supplementary state data sources that are not yet concrete



Contingencies
-

where electronic systems falls short, States require
the ability to apply proven program integrity methods



Other issues of note: no signature requirement; furnishing of
benefits “promptly and without delay”; “reasonably compatible”
standard




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Coordination with

Exchange & CHIP


With expanded subsidized coverage and MAGI, the
NPRM appropriately places significant emphasis on
coordination among post
-
2014 insurance affordability
programs



Must maintain a stable, accurate and cost
-
effective
alignment of coverage programs, while minimizing
churning


One major area of uncertainty = scenarios posing the
potential for concurrent eligibility under multiple
programs (e.g. Medically Needy)



Other identified issues of note: addressing coverage
gaps; mixed households; individuals declining subsidy
determinations



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Coordination with

Exchange & CHIP

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Topics Currently Posing
Informational Gaps

Related topics not yet addressed



Single state application and
criteria for supplemental forms



Benefit implications (benchmark
and essential health benefits)



Presumptive eligibility and
transitional medical assistance



Post
-
2014 program integrity tools
available to States



Post
-
2014 performance standards



Topics requiring more detail



MAGI conversion specifics



Non
-
MAGI Medicaid and inter
-
program coordination



Ability for states to optimally align
coverage among post
-
2014 public
programs



Extent and character of information
via federal hub, and expectations for
accompanying state data sources



Finalized menu of FMAP
methodologies and specific
techniques to be employed


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Recommendations for
Next Steps

States need final
regulations & guidance soon in
order to
inform
planning
, procurement and
implementation.
Specifically:



Prioritize maximum state flexibility & administrative ease



Promote state
-
specific solutions and innovation



Timely receipt of interrelated guidance and needed clarifications



Close coordination and collaboration with states in finalizing policy
directives and options



Realistic expectations for implementation efforts and milestones


California’s Planning for the
Enrollment System of the
Future

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California’s Goals for the
Enrollment System


Creating
statewide

enrollment system for all coverage
programs



California Affordable Coverage Enrollment System

(CACES
)



Consumer
-
friendly, seamless, state
-
of
-
the
-
art



Leverage and/or modernize state & county legacy
systems

Planning & Stakeholder
Engagement


Stakeholder workgroups with consumers and small
businesses



Participating in UX2014 project with IDEO



Vendor interviews



Learning from
Innovator States

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On
-
Going Coordination for
Enrollment System


Joint DHCS, Exchange, MRMIB project team for shared
enrollment system development



RFO for system currently in development



Short timeline for RFO release, review and contracting



Create governance structure across Exchange, DHCS,
MRMIB and counties