Medicaid Advisory Committee December 9 th , 2015 Oregon State - PowerPoint PPT Presentation

Medicaid Advisory Committee December 9 th , 2015 Oregon State Library Salem, Oregon

Time Item Presenter 9:30 Opening Remarks Co-Chairs OHA OmbudsAdvisory Council  9:35 Recently activities and informational sessions Ellen Pinney, OHA  Client-based initiatives Oregon Health Plan (OHP) and Coordinated Care Organizations – OHA update 9:55 Rhonda Busek, OHA  OHP determination and enrollment 2015  CCO integration OHA Legislative Update 10:15 Brian Nieubuurt, OHA  2015 implementation update, next steps OregonONEligibility 10:25 Sarah Miller, OHA  Informational update 10:50 Break Basic Health Program (BHP): HB 2934 11:00 Staff, OHA  Review BHP Stakeholder Group recommendations Public Health Modernization 11:15 Cara Biddlecom, OHA  Informational session Committee Planning for 2016  Review committee’s work in 2015 11:50 Co-Chairs; staff  Identify priority policy areas for 2016  Committee calendar 12:20 Closing comments Co-Chairs

OHA OmbudsAdvisory Council Ellen Pinney, OHA Ombudsperson

OHA Update: Oregon Health Plan (OHP) and CCOs Rhonda Busek Health Systems Division, OHA

OHA Legislative Update 2015 Brian Nieubuurt, OHA

OregonONEligibility MAGI Medicaid System Transfer Project Sarah Miller, Project Director, OHA

OHA MAGI Medicaid System Transfer Project Oregon Eligibility (ONE) Overview December 2015

Project Overview Kentucky’s Affordable Care Act -compliant system (called kynect), was transferred and configured to meet Oregon’s MAGI Medicaid/CHIP eligibility determination needs. Oregon’s system is called Oregon Eligibility (ONE) or just ONE. • Kentucky system exists in production and works correctly • Minimum necessary system customizations were planned and made • Policy and business processes will change wherever feasible 8

Oregon’s Medicaid Eligibility & Enrollment Medicaid eligibility will be completed in the ONE System. The Medicaid enrollment system of record is Oregon’s MMIS. Oregon MMIS Oregon CCOs • Applicants apply for Oregon Health Plan (OHP) coverage via ONE (Medicaid Eligibility Determination) • Applicants eligibility information is passed from ONE to MMIS to enroll in OHP and get a coverage card (Medicaid Enrollment) • MMIS sends CCO enrollment files to enroll OHP members in particular CCOs 9

Project Mission and Key Benefits The Mission Improve Oregonians’ access to health care by providing a simplified process for eligibility determination and enrollment in Oregon Health Plan (OHP) Key Benefits • Better coordination of care for mixed household families because applicants complete a single application through the HealthCare.gov website or within the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP or private health insurance • Oregonians can set-up an account, report changes and receive real-time eligibility determinations via the user-friendly Applicant Portal • Simplified OHA eligibility workload via automated process that generates tasks for case management • Centralized and verified enrollment data available for Coordinated Care Organizations • Consistent quality data source for reporting CMS-mandated operational statistics 10

Median Household Income Key Benefit Applicants complete a single application through the HealthCare.gov website or within the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP QHP QHP QHP APTC 400% APTC APTC The Median 305% Household Income in OHP 300% Oregon often results Median Household Income in Oregon = % of FPL in mixed eligibility Between 200-300% FPL households. A key 200% benefit of the ONE 190% OHP system will be the 138% OHP ability to track these 100% households and service each member of the family. Child Pregnant Adult Woman 11

ONE System Functionality Benefit Programs Advanced Premium Qualified Health Plan/ Emergency Former Foster Tax Credit (APTC) Employee Sponsored Insurance MAGI Medicaid Care Children (Disabled) (Disabled) Capabilities Community Partners Applicant Portal & Federal Check Real Time Healthcare.gov Screening Inquiry Verification Benefits Eligibility Federal Data Services Hub Correspondence Case Application Renewals Manage Tasks & Reports Maintenance Interfaces Public Assistance Reporting (Mail / Fax / Phone) Information System Reasonable Worker Portal Eligibility Document Bi-directional Hospitalized Medicaid Compatibility Override Management Account Transfer Inmate Management Information Channels System CAWEM / Oregon Continuous Account Non-MAGI CAWEM Plus MEC Check Employment Eligibility Registration Referral ( Emergency for Adult Dept. Medicaid ) New Existing 12

Project Approach Status Phase What We’re Doing • Finalize requirements Design Define future-state business processes supporting new capabilities • Capture all changes occurring as a result of the new technology and processes • Planning to move data from existing systems into the new tool, known as the “cutover • strategy” Communicating with staff and stakeholders about the project • Build Build technology, integrating and “ talking to” current systems not being replaced • • Write scenarios that simulate how the system is used • Develop detailed training courses • Communicate specifics about changes and benefits that ONE will bring • Extensively test the system to confirm it is running correctly and works with other systems Test OHA currently uses Make final adjustments to technology and processes as necessary, based on the results of • tests Implement Conduct training to help staff and others learn new technology and processes • We are “Turn on” the system to perform business processes • here Conduct additional training as needed • Support • Continuous support with help of “Local Experts”, or staff highly trained on the system • Encourage continued momentum among staff to use the system, ask questions, and raise concerns 13

ONE System Go-Live Dates December Worker Portal Go-Live S M T W T F S December 15, 2015 1 2 3 4 5 • Used for eligibility determinations 6 7 8 9 10 11 12 • Read only access for DHS staff as needed to review status of client applications 13 14 16 17 18 19 15 20 21 22 23 24 25 26 27 28 29 30 31 February Applicant Portal Go-Live S M T W T F S February 6, 2016 1 2 3 4 5 6 • Community Partners/Assisters and public use for self-servicing new eligibility 7 8 9 10 11 12 13 determinations and enrollments • Current Medicaid enrollees will need to 14 15 16 17 18 19 20 have an eligibility determination completed 21 22 23 24 25 26 27 in ONE by a worker before they can use the Applicant Portal 28 29 14

A Day in the Life of an Eligibility Worker Eligibility Worker Authorize Benefits Log In Dashboard Data Entry Verification Yes Single Sign On Authorize the Complete Applicant Verification Pull appropriate task appropriate benefits Registration and data successful? from queue. Manage collection from your dashboard No Request for Receive Re-run Authorize Benefits Information Verification Verification Documents System Data needed to run Applicant provides verification Authorize the generates verification is received documents appropriate benefits correspondence and entered Other OHA / DHS Non-MAGI DHS Report Results Referral Reassign applicant to Applicant is handed off to DHS The eligibility results will be appropriate queue and processed outside of the reported to the ONE System 15 15 ONE system

Application Lifecycle for Applicants and Workers General New Applicant — Does not have Medicaid Verification Applicant Applies Data Collection Eligibility Determined CCO Selection Applicant Portal Verification Applicant not previously Applicant or Community Complete Applicant Registration (On-Line) successful. known to the Oregon system Partner selects a and data collection has their eligibility preference, MMIS assigns Community Partner Assistance in *Applicant known to Oregon determined CCO finally Applicant Portal Systems? No Yes Existing Applicant — Has Medicaid Worker Log In Worker Dashboard Data Collection Verification Eligibility Determined Applicant not previously Complete Applicant Pull appropriate task Single Sign On Verification known to the Oregon system Registration and data from cue. Manage successful has their eligibility collection from your dashboard determined

Application Lifecycle for Applicants and Workers Applicant without Computer or Access to a Community Partner Applicant Applies IRMS Worker Log In Worker Dashboard Completes their Pull appropriate task Scans the Single Sign On application via Paper, from cue, Manage application into Fax, Fillable PDF from your dashboard the Worker Portal Data Collection Verification Eligibility Determined Applicant not previously Verification Complete Applicant known to the Oregon system successful Registration and data has their eligibility collection determined

Project Team Contact Information For additional information regarding the OHA MAGI Medicaid System Transfer Project or the ONE System, email the project team: OHAOregon.Eligibility@state.or.us 18

BREAK

Basic Health Program (BHP): Oregon Considerations 2013-2015