Achieving Mile-High Enrollment Simplifications

By Guest Blogger

The vision for a simple, streamlined, real-time enrollment process that was laid out in the August eligibility and enrollment regulations is inspiring, but thinking about how to get from here to there can be overwhelming. Reducing paperwork? Great! Using electronic data to determine eligibility? Even better! But is the world ready for streamlined, paperless enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), and other forms of health coverage? Can states really take on this tall order in the current budget climate?

Well, skeptics take note: A mere mile above sea level, one state is tackling these issues head on. This August, acting on legislation passed in 2008, and with the help of a State Health Access Program grant, Colorado began making it significantly easier for its residents—children and adults alike—to apply for Medicaid and CHIP (CHP+ in Colorado) coverage. The state is allowing people to apply without providing paper documentation of identity, citizenship, or income (although in limited cases, some applicants may still need to provide paper documentation).

It’s easy. People can apply for coverage through the state’s online eligibility system, Colorado PEAK, at a hospital, doctor’s office, or community health center, or through traditional paper or in-person routes. But regardless of the way a person applies, the state can confirm his or her identity, citizenship, and income using information it already has or can obtain from another government agency. That way, people only need to gather and submit paper documentation along with their application when there isn’t a match. As long as the information the state finds in its databases is close enough to the information the person supplies on the application, the state considers this sufficient to establish eligibility.

The state is even looking into making online application determinations in real time. In other words, with only a few mouse clicks, people could find out whether they are eligible as soon as they apply, reducing the turn-around time from weeks to minutes.

And Colorado isn’t stopping there. The state is simplifying the renewal process as well. When it’s time to renew coverage, the state checks its income databases and sends a notice to enrolled individuals that shows the information the state has in its databases. An individual only needs to return the form if the information is incorrect. Otherwise, if the information is correct and the person appears to still be eligible for coverage, he or she can stay enrolled without having to jump through administrative hoops. This will help ensure that once people get enrolled, they stay enrolled. That means fewer barriers for enrollees and reduced administrative costs for the state.

These significant steps in the right direction are exactly the kinds of best practices that will be necessary to achieve optimal enrollment in 2014. We’ll be eager to hear—and share—the lessons that Colorado learns as it implements these streamlined processes.  

Special thanks to Antoinette Taranto, Eligibility Division Director at the Colorado Department of Health Care Policy and Financing, for her assistance with this blog.


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