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Assessment and synthesis of selected Medicaid eligibility, enrollment, and renewal processes and systems in six states
Assessment and synthesis of selected Medicaid eligibility, enrollment, and renewal processes and systems in six states
- Collection:
- Health Policy and Services Research
- Author(s):
- Zylla, Emily, author
Ouyang, Chaoluan, author
Lukanen, Elizabeth, author
Worrall, Christina, author - Contributor(s):
- State Health Access Data Assistance Center, University of Minnesota, issuing body.
University of Minnesota. School of Public Health. Division of Health Policy and Management, issuing body. - Publication:
- [Minneapolis, Minnesota] : State Health Access Data Assistance Center, October 19, 2018
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Eligibility Determination -- organization & administration
Medicaid -- statistics & numerical data
United States
United States. Department of Health and Human Services
United States.
State Children's Health Insurance Program (U.S.) - Genre(s):
- Technical Report
- Abstract:
- This report was produced by the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota under contract to the Medicaid and CHIP Payment and Access Commission (MACPAC). The project sought to assess current processes and systems for Medicaid eligibility, enrollment, and renewal in six diverse states: Arizona, Colorado, Florida, Idaho, New York, and North Carolina. SHADAC used a multi-case study methodology and key informant interviews with state and local agency staff and advocacy organizations to collect data on enrollment processes and systems for individuals whose income eligibility is based on Modified Adjusted Gross Income (MAGI). MACPAC was specifically interested in auto-enrollment and auto-renewal practices, the use of electronic data sources for verification, and the degree of integration with non-MAGI Medicaid populations and other public benefit programs. Our data collection strategy also assessed the extent to which states are achieving desired goals such as program efficiency and a simplified beneficiary experience. This report summarizes how MAGI Medicaid populations apply to and are determined eligible for the Medicaid program, and describes state approaches to streamlining enrollment and renewal for these populations in light of statutory and regulatory requirements. Additionally, the full report discusses common themes (as identified by key informants across study states) related to the Medicaid program and beneficiary experiences, as well as future plans to further simplify and streamline practices. The content of this report is drawn from individual state summary reports that more thoroughly describe the MAGI Medicaid application, eligibility determination, and renewal processes (available separately). The six study states varied widely in their Medicaid policy, program priorities, and the ages and capabilities of their eligibility systems; therefore, they took different approaches to streamlining their Medicaid enrollment and renewal processes. Some states prioritized real-time, no-touch enrollment and renewal for MAGI Medicaid populations, meaning same-day eligibility determinations or redeterminations with no worker involvement. Other states prioritized the involvement of eligibility workers in the process. All states focused on the transition to MAGI-based eligibility determinations and use of electronic data sources for verification of beneficiary information called for under the Patient Protection and Affordable Care Act (ACA). Highlights from the various state approaches include: (1) Arizona facilitates access to multiple health and human services programs, including MAGI Medicaid, State Children's Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF). The state has a combined online application; however, Arizona's shared eligibility system is used only across health programs. (2) Colorado emphasizes easy access to a variety of health and human services programs, including usability of its combined online application and ongoing improvements to its legacy shared eligibility system. Colorado's Medicaid agency accepts self-attested information as it relates to application requirements and conducts income verifications post-eligibility to facilitate high rates of MAGI Medicaid determinations in real time. (3) Florida has a history of using shared eligibility processes and systems for health and non-health programs. For example, its combined online application pre-dates the ACA and supports applications for Medicaid, CHIP, SNAP, and TANF. In response to the ACA, Florida built new infrastructure alongside its legacy system to allow for processing of real-time determinations where possible. (4) Idaho prioritizes a high-touch, either in-person or phone-based, approach to enrolling individuals in Medicaid and other health and non-health programs. The state achieves high rates of auto-renewal of MAGI Medicaid populations and supports a shared eligibility system across health and non-health programs. (5) New York's decision-making is built on integrating health programs, including exchange plans, supported by automation. To that end, New York's Department of Health created one application and eligibility system for all MAGI-eligible populations. (6) North Carolina has emphasized benefit integration across health and human service programs, and this state values its tradition of county caseworker interaction. MAGI Medicaid and other programs are supported by North Carolina's shared eligibility system, although on separate information technology platforms.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (1v. (various pagings))
- NLM Unique ID:
- 101745975 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101745975