Enrollment Modernization
Can Radical Incrementalism Get Us There?
Child Health Policy Research Symposium
March 2, 2009
“Modernization”
Change the culture, organization and
structure of how program eligibility is
determined and how enrollment
activities are carried out…
to make it more efficient, consumerfriendly and comprehensive.
No Wrong Door or Single Stop
approach to enrollment.
CALIFORNIA HEALTHCARE FOUNDATION
Key Barriers to Modernization
 Categorical nature of of programs
 Welfare Reform’s missing “de-link”
 Outdated and disparate systems
 Reliance on manual processes
 County vs. statewide enrollment
CALIFORNIA HEALTHCARE FOUNDATION
County
Clinics
Health
Plans
Medi-Cal,
Healthy
Families &
Healthy Kids
Community Clinics
Medi-Cal, CHDP,
Healthy Families,
Healthy Kids & WIC
Physician
Offices
Breast
Cancer
Referral &
CHDP
Hospitals
Indigent Care
WIC & CHDP
Maze of Local
Health Program
Referrals
Public Health
Indigent Care
WIC & CHDP
ER
Medi-Cal,
Healthy
Families
Breast &
Cervical
Cancer
Treatment
Schools
CHDP &
Medi-Cal
(School
Lunch)
Social Services
Medi-Cal, Food
Stamps & Family
Planning
What most applicants experience…
“Is this by design or what?”
CALIFORNIA HEALTHCARE FOUNDATION
Real World Example
30,000 applications / month at Single Point of Entry for
Healthy Families and Medi-Cal for Children programs

50% submitted on paper by applicants

20% submitted on paper with assistance from
Certified Application Assistors (CAAs)

30% submitted electronically via Health-e-App
with assistance from CAAs
CALIFORNIA HEALTHCARE FOUNDATION
Single Point of Entry Enrollment Process
Station #1
Open
Envelopes
Station #2
Remove Staples,
Paperclips, etc.
Station #3
Feed HighSpeed Scanner
Health-e-App
Station #6
Apply Eligibility
Rules
Station #5
Call Family
For Missing
Information
CALIFORNIA HEALTHCARE FOUNDATION
Station #4
Manually Enter
Application Data
Preliminarily Determined Applications
Healthy
Families
Application
Medi-Cal
Application
Final Eligibility
Determined
Batch Paper
Applications;
Mail to Counties
CALIFORNIA HEALTHCARE FOUNDATION
Enrolled in
Health Care
Coverage
County Worker
Manually Enters
Application Data
Incremental Improvements

SPE, mail-in application and presumptive eligibility

Application simplification efforts

Express Lane Eligibility

CHDP Gateway / improved newborn enrollment

County / health plan call-in / continuation centers

Other policy and administrative changes
Setbacks
DRA requirements
Setbacks
More frequent re-certification
Setbacks
Loss of outreach funds
CALIFORNIA HEALTHCARE FOUNDATION
CALIFORNIA HEALTHCARE FOUNDATION
CALIFORNIA HEALTHCARE FOUNDATION
CALIFORNIA HEALTHCARE FOUNDATION
CALIFORNIA HEALTHCARE FOUNDATION
Key realization along the way…
CALIFORNIA HEALTHCARE FOUNDATION
Future State*: Vision
State-level approach that uses integrated
technology and shares information to
streamline eligibility, enrollment and retention.
Requirements include:
 Strong leadership, sustained sponsorship
 Adequate funding
 All-inclusive governance structure
 Comprehensive IT solution
* Recommendations from Modernizing Enrollment in California’s Health Programs: A
Blueprint for the Future, Eclipse Solutions, November 2007
CALIFORNIA HEALTHCARE FOUNDATION
Future State: Technology
Enterprise approach that uses shared services
and shared information, including:

Common, web-based front-end that is publicly
accessible, allows applicants to be screened for
many programs, from many locations and
transmits completed applications.

Common messaging infrastructure on which to
build secure common back-end services.
CALIFORNIA HEALTHCARE FOUNDATION
Enterprise Enrollment Project (EEP)

Led by Health & Human Services Agency

Established formal governance structure

Developing requirements for a single statewide
enrollment process

Conducting cost–benefit study

Workgroups to standardize data elements and
harmonize and privacy and security policies

Plan to be complete by July 2009
CALIFORNIA HEALTHCARE FOUNDATION
Initial EEP Programs
Available through a Single Application

Medi-Cal

WIC

Healthy Families

TANF

AIM

Food Stamps

CHDP

Family PACT

County Medical Services Program

Breast and Cervical Cancer Treatment Program

Cancer Detection Programs: Every Woman Counts
CALIFORNIA HEALTHCARE FOUNDATION
Programs Not Yet Included
Local Health Programs




County Indigent Care programs
Healthy Kids
CalKIDS
Kaiser Child Health Program
Other Supplemental Programs





Earned Income Tax Credit
Low-Income Energy Assistance Program
Child Care Tax Credit
California Low Cost Automobile Insurance Program
Voter Registration
CALIFORNIA HEALTHCARE FOUNDATION
How will it actually work…
CALIFORNIA HEALTHCARE FOUNDATION
Service Oriented Architecture
Amazon.com Example
Common Shared Services
Search
Ordering & Payment
Consumer
Personalization
Gift-Wrapping &
Fulfillment
Messaging Interface for Data Exchange
Enterprise Service Bus
Messaging Interface for Data Exchange
Web-based
application
Amazon Store
(Purchase)
Rare Book Dealers
(Purchase)
Toy Stores
(Purchase)
Common Business Processes
CALIFORNIA HEALTHCARE FOUNDATION
Health & Beauty
(Purchase)
Service Oriented Architecture
A Prototype to Modernize Public Program Enrollment
Common Shared Services
EDD
(Income Verification)
Consumer
DMV
(ID Verification)
MEDS
(File Clearance)
Vital Statistics
(Birth/Death Records)
Messaging Interface for Data Exchange
Enterprise Service Bus
Messaging Interface for Data Exchange
Web-based
application
CHDP
(Program Enrollment)
Single Point of Entry
(Program Enrollment)
SAWS Systems
(Program Enrollment)
WIC Program
(Program Enrollment)
Common Enrollment Business Processes
Source: Modernizing Enrollment in California’s Health Programs: A Blueprint for the Future, 2007
CALIFORNIA HEALTHCARE FOUNDATION
Questions & Answers
For more information:
Sam Karp
skarp@chcf.org
CALIFORNIA HEALTHCARE FOUNDATION