How to Enroll 1,700 People an Hour

By Jennifer Sullivan

California will have to enroll 1,700 people in coverage every hour between October 1, 2013 and January 1, 2014 in order to enroll all of the estimated 4 million Californians who will be newly eligible for coverage starting on that day. The Children’s Partnership came up with this clever way of looking at the challenge in a recent memo, and although no state actually expects to enroll every person who is eligible (not even Medicare can claim that achievement), this certainly puts things into perspective.

How can California expect to put a dent in that 4 million number during the first open enrollment period, so that as many people as possible can start 2014 off with health coverage? The memo lays out some detailed steps the state can take to reach out to the uninsured in households that are already receiving benefits through other programs, like the Supplemental Nutrition Assistance Program (SNAP), the Women, Infants, and Children program (WIC), and children’s coverage through Medicaid and CHIP. For these households, the state already has the key pieces of information it needs to determine eligibility for Medicaid and exchange coverage, like name, address, income, social security number, and, in many cases, even citizenship status.

In order to use this information to get people enrolled, The Children’s Partnership urges California to make it one step easier by using “Express Lane Eligibility” (ELE)—fast-tracking health coverage eligibility determinations based on information and findings a state already has from other programs. To do so, the state first needs to get permission from the Centers for Medicare and Medicaid Services to use ELE for adults, which is only allowed without a waiver for children. However, last December, Massachusetts became the first state to receive a waiver to use this option for adults. If California got a similar waiver, it could reach out to households enrolled in other programs, get their consent to use the information and findings the state has about them to make an eligibility determination for health coverage, and then set up the IT systems to make this happen (with a generous 90 percent federal match for Medicaid-related spending). And applications for other programs could be updated so that new applicants can choose to receive an eligibility determination for health coverage, too.

This is all much easier said than done, but it is also much easier done than requiring each of those 4 million uninsured Californians to complete a full application. The Children’s Partnership estimates that California could reach hundreds of thousands of its uninsured through SNAP, WIC, and children already participating in health coverage programs (whose parents might be uninsured). The state will also be transitioning those in its current Low-Income Health Program (LIHP) and the Pre-Existing Condition Insurance Plan (PCIP) directly into coverage, rather than requiring them to complete new applications for 2014. These simplifications will make it easier for even more Californians to get enrolled and start coverage January 1, 2014.

These strategies are not unique to California. All states can build bridges to make enrollment faster and easier for those already receiving other kinds of benefits. This will reduce the burden for consumers as well as the state. As we’ve blogged about before, simplifying enrollment can create millions of dollars in administrative savings.

Enrolling 1,700 people per hour may be a stretch, but enrolling millions by January 1, 2014 doesn’t have to be.

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