The California Health Benefit Exchange: Eligibility and Enrollment Design Options Stakeholder Workgroups Meeting
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1 The California Health Benefit Exchange: Eligibility and Enrollment Design Options Stakeholder Workgroups Meeting In-person/Webinar event Thursday, September 15, 2011
2 Welcome
3 Partners Thanks to our partners: Department of Health Care Services (DHCS) California Health and Human Services Agency (CHHS) Managed Risk Medical Insurance Board (MRMIB) Office of Systems Integration (OSI) 3 3
4 Introductions
5 Summary of Key Stakeholder Input Build confidence and trust through reliable process at launch Consumers control the use of their personal information Consider the perspective of all consumers Enable live contact at all points of enrollment process Provide status updates during eligibility process Apply rules consistently regardless of method of entry 5 Small Business Health Options Program (SHOP) must bring value to the marketplace, employers and brokers
6 How Stakeholder Input is Utilized Inform design options Inform system usability requirements Inform Notice of Proposed Rule Making (NPRM) comments Structure ongoing workgroup meetings 6
7 Objective of Today s Meeting To obtain stakeholder feedback on design options related to eligibility and enrollment processes 7
8 Eligibility and Enrollment Principles No Wrong Door service system Culturally and linguistically appropriate oral and written communications Seamless transition between health programs Reductions in the burden of establishing and maintaining eligibility Security and privacy of consumer information 8
9 Decision Criteria 9 Does the option comply with federal and state requirements? Does the option provide a feasible solution to be operational by 2014? Does the option provide a first class customer service experience? What are the cost considerations, most notably ongoing operational costs? Are current assets being leveraged? Is the option efficient? Are there redundancies? What risks are associated with the option?
10 Consumer View Consumer Consumer Consumer Consumer Web Portal Mailing address Face to Face Service Toll free hotline Mail Processors Counties, Navigators, Brokers Service Representatives Web Portal Web Portal Web Portal IT INFRASTRUCTURE
11 IT Infrastructure Framework Types of consumers: Individuals receiving subsidies Individuals not receiving subsidies Employers/ees (SHOP eligible) MAGI Medi-Cal eligible people Non-MAGI Medi-Cal people Children eligible for Healthy Families Potentially Basic Health Program eligible people (TBD) 11 *MAGI: Modified Adjusted Gross Income
12 IT Infrastructure Framework Key Required IT Functions: Website Eligibility determination for: Exchange subsidies, SHOP, MAGI Medi-Cal, Non-MAGI Medi-Cal, CHIP, Basic Health Plan Shop/compare/plan selection functionality for: Exchange subsidies, SHOP, MAGI Medi-Cal, Non-MAGI Medi-Cal, CHIP, Basic Health Plan Case maintenance Maintain master client index Retrieve information to support service calls Referrals to other human services programs: CalFresh, TANF, etc. 12
13 Federal Long Term Vision Face to Face Service Counties, Navigators, Brokers Central IT Infrastructure (CITI) Service Center Respond to consumer calls Process mail Provide website offering ACA required functions Determine eligibility for all types of coverage Deliver eligibility determination results to applicant Provide online shop/compare/plan selection functionality for all applicable health programs Store all cases centrally for ongoing case maintenance Retrieve information to support service calls
14 Option #1: Distributive Consumer View Service Center Respond to consumer calls Process mail Central IT Infrastructure (CITI) Provide website offering ACA required functions Determine eligibility for Exchange subsidies and employee coverage Obtain eligibility determination for MAGI and non MAGI Medi Cal from appropriate County SAWS system Obtain eligibility determination for CHIP from MRMIB system Deliver eligibility determination results to applicant Provide online shop/compare/plan selection functionality for Exchange enrollees Store new Exchange subsidies and employee coverage cases centrally for ongoing case maintenance Send new MAGI and non MAGI Medi Cal cases to appropriate County SAWS system for ongoing case maintenance Send new CHIP cases to MRMIB for ongoing case maintenance Update master health care coverage client index Retrieve information to support service calls Governance CHHS DHCS CDSS Exchange Board MRMIB DHCS Contractor Provide online shop/compare/ plan selection functionality Counties/SAWS systems Determine eligibility for MAGI Medi Cal and non MAGI Medi Cal & return results to CITI Store new MAGI and non MAGI Medi Cal cases and perform ongoing case maintenance MRMIB/MAXIMUS system Determine eligibility for CHIP & return results to CITI Provide online shop/compare/plan selection functionality Store new CHIP cases and perform ongoing case maintenance
15 Option #2: Partially Integrated Consumer View Service Center Respond to consumer calls Process mail Central IT Infrastructure (CITI) Provide website offering ACA required functions Determine eligibility for Exchange subsidies, employee coverage and MAGI Medi Cal Obtain eligibility determination for non MAGI Medi Cal from appropriate County SAWS system Obtain eligibility determination for CHIP from MRMIB system Deliver eligibility determination results to applicant Provide online shop/compare/plan selection functionality for Exchange and MAGI Medi Cal enrollees Store new Exchange subsidies, employee coverage and MAGI Medi Cal cases centrally for ongoing case maintenance Send new non MAGI Medi Cal cases to appropriate County SAWS system for ongoing case maintenance Send new CHIP cases to MRMIB for ongoing case maintenance Update master health care coverage client index Retrieve information to support service calls Governance CHHS DHCS CDSS Exchange Board MRMIB DHCS Contractor Provide online shop/compare/ plan selection functionality Counties/SAWS systems Determine eligibility for non MAGI Medi Cal & return results to CITI Store new non MAGI Medi Cal cases and perform ongoing case maintenance MRMIB/MAXIMUS system Determine eligibility for CHIP & return results to CITI Provide online shop/compare/plan selection functionality Store new CHIP cases and perform ongoing case maintenance
16 Option #3: Fully Integrated Consumer View Service Center Respond to consumer calls Process mail Central IT Infrastructure (CITI) Provide website offering ACA required functions Determine eligibility for all types of health care coverage Deliver eligibility determination results to applicant Provide online shop/compare/plan selection functionality for all applicable types Store all health care coverage cases centrally for ongoing case maintenance Update master client index for all health and human services programs Retrieve information to support service calls Governance CHHS DHCS CDSS Exchange Board MRMIB DHCS Contractor (System retired) Counties/SAWS systems Determine eligibility and enrollment and on going case maintenance for human services programs: CalFresh, TANF, etc. MRMIB/MAXIMUS system (System retired)
17 Q & A
18 Questions for the Break-out Session 18 Are the decision criteria appropriate for evaluating the options? Why or why not? What would you change? Are the principles adequately reflected in the options? Are the principles appropriate? What would you change? What are the pros and cons of each option? Are there other options that should be considered?
19 Group Summary Feedback
20 Public Q & A
21 Next Steps Board presentation on design options on September 27, 2011 Board decision on overall design vision on October 21, 2011 Solicitation draft target date, November 2011, for public comment Board approves Solicitation on December 20, 2011 Send all stakeholder comments to: by Monday September 19,
22 Thank You
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