Eligibility Determination a Large Focus at California Exchange’s 3rd Board Meeting
On May 24, Getinsured was in Sacramento, CA to participate in the California Health Benefit Exchange’s third board of directors meeting. The meeting covered various topics, but most of the discussion was about integrating the state’s eligibility determination processes for its public assistance programs. While far from perfect, the current infrastructure appears to provide a good web and data-sharing framework for California’s Exchange to build on in implementing ACA requirements.
At the meeting, the County Welfare Directors Association (CWDA) and the Managed Risk Medical Insurance Board (MRMIB) presented the two main eligibility and enrollment systems for California’s public health programs. The CWDA provided information about the state’s county-based eligibility determination process, whereas the MRMIB provided information about California’s statewide eligibility determination process. While there is some overlap between the two processes, there also appear to be substantial gaps.
The county-based eligibility method assists Californians in determining their eligibility and enrolling in Medi-Cal (the state’s Medicaid Program), County Medical Services Programs, and other non-healthcare based programs. To enroll, individuals apply according to their county of residence. There are 58 county social service departments in California that are supported by 3 different automated eligibility systems, but all applicants can start the process from a single web portal (www.benefitscal.org). Alternatively, MRMIB discussed a statewide eligibility and enrollment process called the Health E-App (www.healtheapp.net), which has a “Single Point of Entry” process for Medi-Cal, Healthy Families (California’s CHIP initiative) and other public health programs not currently available in the county-based model.
Both eligibility determination processes cannot co-exist under the ACA because they screen for different public programs from different portals. A logical next step is to seamlessly integrate the county-based portal and the Health E-App portal. The ACA requires a one-stop shop for health insurance and individuals should not have to enter their eligibility information twice. Over the next 6 months, such critical decisions are ahead for the California Health Benefit Exchange Board, which also released the following eligibility and enrollment timeline for implementation.
Terri Shaw, project director for Enrollment UX 2014, also briefed the board about their national initiative to help states implement optimal user experience on their Exchanges. She discussed the potential need for Exchanges to accommodate the growing number of tablet users, which are estimated to almost triple in number by 2014 to 71 million users.
The board is still awaiting its 5th member, who will be appointed by the California senate, but their next meeting is scheduled for June 15, 2011. CMS Director Cindy Mann and HHS Director Joel Ario are scheduled to attend, which will provide a unique federal perspective to the Exchange implementation discussions of the state.
Posted on Tuesday, June 7th, 2011 at 1:02 pm. You can subscribe via RSS 2.0 feed to this post's comments. You can comment below. Your comments will appear immediately, but the author reserves the right to delete innapropriate comments.