May 6, 2013
CWDA Webinar
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 Our
Vision
 Our
Role
 Implementation
 Regional
Support
Seminars
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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.
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Enrollment in All Available Coverage
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No Wrong Door
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First Class Customer Service
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Coordinated Service
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Skepticism about county ability to
meet these goals
Competing desire to split off health
care from other services
Desire to centralize
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 Failure
is not an option
 Perception
and actual
performance are equally
important
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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
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“Warm handoffs” from Covered CA call center
All non-MAGI Medi-Cal eligibility
Case management for all Medi-Cal programs
Horizontal Integration (CalWORKs, CalFresh)
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Counties will receive applications directly
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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
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Process applications from all pathways
◦ Take applications through to completion
◦ Includes eligibility for Exchange-based coverage
◦ Help customers select managed care plans
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Conduct ongoing case management
◦ Process reported changes for all Medi-Cal
◦ Send changes to Exchange for their enrollees
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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
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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
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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
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From statewide Covered CA 1-800 line
◦ State staff will first figure out what they need
◦ If eligibility determination, do Quick Sort
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Likely Medi-Cal eligible cases sent to county
◦ First will look to county of residence
◦ Backup: Another county in that consortia
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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
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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
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During first open enrollment, Exchange call
center staff will process mixed cases first
◦ Including initial Medi-Cal eligibility
◦ Counties will finalize Medi-Cal, send NOA
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After first open enrollment, counties will be
sent mixed cases to process
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Consortia Based Network
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
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
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Multiple planning groups
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Meg Sheldon lead for CWDA
Consortia Leadership Group
Consortia based planning groups
CWDA HCR implementation group
Periodic check ins
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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
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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
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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
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Who in counties must answer phone?
 Counties need to assign eligibility workers to answer
these calls.
 No two-tiered handoff of calls from clerical
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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
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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
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Covered CA will directly operated few paths
◦ CalHEERS online portal
◦ 1-800 number
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CalHEERS online can be real-time
◦ If everything checks out against data hub
◦ If no unanswered/unverified information
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Phone is next logical area to focus
◦ Has been a heavily negotiated process
◦ Lots of technology, staffing, readiness
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“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
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 Where
& When
 Agenda
& What to Expect
 Participant
Preparation
 Questions?
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