Applying for Medi-Cal On-Line

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					California Statewide Automated
Welfare Systems (SAWS)
Consortia Modernization and
 ISM 2011

 Michael J. Sylvester II
 Assistant Director
 Bureau of Contract and Technical Services
 County of Los Angeles
 Department of Public Social Services

Overview of Presentation
 Background
 SAWS Consortia Modernization Initiatives
     On-Line Application Customer Portals
     Interactive Voice Response (IVR)
     Outbound Dialing
     Contact/Call Centers
     Document Imaging/Electronic Case Records
     Kiosks
     Lessons learned
     Future Enhancements

 Questions

County Social Services
 58 county social service departments

 Serving clients
      In over 1,000 offices
      In conjunction with community organizations
      Over the phone
      Online
      Through the mail

 In multiple languages
 Using automated systems
      LEADER/GEARS/GROW – Los Angeles County
      CalWIN – 18 counties
      C-IV – 39 counties
      Interacting with state & federal systems for information   4
Assistance Programs Supported
 Medicaid – Medical coverage (Medi-Cal)
 SNAP – Food Assistance Program (CalFresh)
 TANF – Cash & Employment Services (CalWORKs)
 Refugee Cash Assistance
 Cash Assistance Program for Immigrants (CAPI)
 General Assistance/General Relief (GR/GA)
 Foster Care, KinGAP & Adoption Assistance

Clients Assisted
    400,000 Applications Monthly
        (8 Million Recipients)

     1.5 million CalWORKs recipients
     4.7 million Medi-Cal recipients
     3.9 million CalFresh recipients

   Application Process
 Seek services
 Complete application
 Communicate with Eligibility Worker as needed
 Submit any needed documentation
 Receive notice of eligibility decision
 Receive ID card, EBT card, benefits

 Annual eligibility renewal
      Requirement in federal law
      Clients receive packets in advance
      Provide information to eligibility worker
      Eligibility recalculated

 Periodic reporting requirements
      Quarterly for CalWORKs & Food Stamps
      Semi-Annual for most Medi-Cal parents

 Changes most often reported
      Employment
      Income
      Address
      New family member

 Reported changes often affect eligibility
   If moved to a new county
   If gained/lost job or gone from full to part time
   If family member moved into/out of household

 Eligibility worker processes these changes
    Gathers any necessary verifications
    Enters changes into automation system
    System recalculates eligibility for all programs
    Notifies clients if eligibility or benefits change
Automated Verification &
Information Exchange
       Statewide client index
       Benefit Identification Card Issuance
       Support Child Support collection & accounting

 Electronic Benefits Transfer
       EBT card issuance
       Cash & CalFresh benefit allotment

 Child Support
       Provide client information and referral

 Social Security (via MEDS)
       Citizenship verification

 Other State & Federal Systems
    Income & employment verification




 Modernization Initiatives

 On-Line Applications / Customer Portals

On-Line Applications/Customer
Portals – What are they in CA?
 California Customers can submit an application for
  multiple programs (i.e. Medi-Cal, CalFresh, CalWORKs, and
  County Medical Services Program (CMSP))

 CA Statewide Benefits Portal –
 This portal connects three On-line SAWS websites
  for application processing for all 58 CA Counties
      YourBenefitsNow!   
      BenefitsCalWIN     
      C4Yourself®        

 All were live by February 2011
 Multiple languages supported

On-line Applications/Customer Portals –
CA Statewide Benefits Portal

YourBenefitsNow   BenefitsCalWin   C4Yourself®
On-Line Applications/Customer Portals –
Benefits and Services Offered
 Anonymous pre-screening
 Apply for benefits in CalWORKS, CalFresh, Medi-Cal, etc.
 Submit periodic reporting requirements through on-line forms
   (i.e. QR-7 Submissions)
 Annual Redeterminations
 Uploading required supporting documentation
 Check case status and benefit amounts (past, current and
 Obtain worker information, office hours and location, GIS
   maps, directions, etc.
 Provide messages: system and worker initiated
 eSignature capabilities & latest security features, i.e.
   „Captcha‟                                                     16
 On-line Applications/Customer Portals –
 Statistics (as of June 2011)
 The number of hits to ‘’ has increased over time
  and is approaching 100,000 hits since going live in February 2011
 The number of applications processed through the On-line SAWS
  websites is approximately 250,000 total thus far (with approx.
  27,000 new on-line apps per month Statewide):
       • YourBenefitsNow (approx. 11,000 since February 2011); currently
         averaging approx. 4000 per month
       • BenefitsCalWIN (approx. 71,000 since November 2010); currently
         averaging approx. 9,000 per month
       • C-4-Yourself (approx. 164,000 since Oct 2007); currently
         averaging approx. 14,000 per month
 On-line applications comprise (%’s change constantly):
       • CalFresh        45-60% (approx.)
       • Med-Cal         25-35% (approx.)
                         10-15% (approx.)
       • CalWORKs
On-line Applications/Customer Portals –
Best Practices & Lessons Learned
 Include the users of the application in the design, development and
    testing up-front and perform usability studies prior to completion of
    design to avoid rework
   Ensure executive level management are engaged in project through out
    the project life-cycle
   Ensure all levels of management are made aware of potential direct
    and indirect business impacts on their operations
   Ensure all appropriate staff receives training prior to implementation of
    the project for processing of the incoming applications
   Develop an on-line survey for users or other mechanisms to see where
    customers are abandoning the application process or having difficulties
   Include a “Report a Problem” link in the application so customers can
    report issues as they experience them
   Survey the public prior to implementation of the project for valuable
   Ensure all appropriate application/server monitoring software is tested
    prior to implementation of the project
   Ensure your product works successfully with all browser types             18
 Modernization Initiatives

 Interactive Voice Response (IVR)

Interactive Voice Response (IVR) –
Benefits (Information over the Phone)
 Used by many CA Counties for incoming self-service
  primarily for the CalWORKs, CalFresh, and Medi-Cal
 Case Specific Information
   • Check address
   • Check grant amount or CalFresh allotment
   • Check Medi-Cal Share of Cost

 General Information
  • Office hours
  • Contact information

Interactive Voice Response (IVR) –
   Reduces lobby traffic by 30% or more
   Linked to real-time data in SAWS systems
   Available on a 24X7X365 basis with a Customer ID and PIN
   Provides Clients the Ability to:
     • Obtain automated case and benefit status information
     • Check benefit amounts
     • Check QR-7 and redetermination packet receipt
     • Request replacement EBT/BIC cards
     • Leave a message for a worker
    •   Check offices hours and verify address
    •   Obtain worker information
    •   Change/reset PIN for log-in (self-help)
 Receiving over 400,000 calls (for self-service alone) per month
    in CA Counties Statewide and climbing
Interactive Voice Response (IVR) –
Best Practices & Lessons Learned
   Real Time Benefit information look-ups can have performance challenges, check
    business requirements to determine if prior day information will work
   Ability to request forms to be sent without staff intervention is very beneficial to
    customer and staff
   Adding IVR phone number to outgoing voicemail messages dramatically increases
   Ensure self-help features are enabled to reset PINs automatically without staff
   Be sure that reporting mechanism captures all calls and selections regardless of
    whether the customer listened to the entire message
   Ensure enough time for JAD Sessions, finalizing the scripts, translations, recordings,
    getting the wave files, scripting, testing and mailing of notices. Any potential slippage
    in these tasks could impact the Project Implementation.
   Look for data anomalies in back-end SAWS systems, as they will present to users
    through this new media, i.e. blank worker names, or numbers
   Ensure test data is consistent with what is expected in production. Using „Dummy
    data‟ leaves you vulnerable to errors
   Initially, the IVR offloads are not that high but ramp up over time. Marketing and
    communication strategies play a very important role in adoption
   Once IVR is implemented, customer involvement and feedback in very important
 Modernization Initiatives

 Outbound Dialing

 Outbound Dialing – Benefits
 (Communication via Phone Messages)
 Implemented for CalWORKs, CalFresh, Medi-Cal, General
   Assistance/Relief and IHSS programs
 Option to Receive Various Information via the Phone,
   including, but not limited to the following:
     Reporting requirements reminders
     Eligibility renewal due date reminders

     Up coming appointments reminders

     General information
     Emergency messages

  Outbound Dialing – Specifics
 Automatically calls customers about missing documents needed
   for continued eligibility (i.e. missing QR-7/Income reporting…)
 Calls to remind customers of appointments, particularly effective
   for Welfare to Work (WtW) requirements
 Reminder calls to IHSS Providers to turn in time sheets
 Messages sent in multiple languages
 For sensitive messages, add‟nl security invoked by msg type for
   individual ID prior to msg delivery. (ie: consent or requiring PIN or
   personal info {i.e. birth date} entered prior to playing message)
 Detailed reporting statistics captured for call dispositions, (i.e.
   answered , reached V-mail, ring/no answer, busy signal, answered
   hung-up, etc.)
 Capacity: Some systems capable of making up to 40,000
   outgoing calls per day
Outbound Dialing – Best Practices &
Lessons Learned
   Need to consider whether consent is needed and what type of messages to
    send as appropriate
        Example: If customer provides a cell phone number, should he/she have to enter their
         case number and PIN to get the message? If a customer is on a bus, driving a car,
         pushing a stroller, or out job hunting, will they be able to or want to take the time to
         enter the information?
        Example: If the customer provides a home phone and lives with others, then should
         they have to authenticate, provide case number and PIN prior to message being
   Need to consider the timeframes for making call (i.e. too late or too early)
   Automate call disposition status being updated in the backend SAWS system.
    For appointment reminders, allow customers to respond to whether they will
    attend or not, then automatically update the customer appointment in the system
    so workers know immediately
   When reporting, make sure a successful call is not defined by the customer
    listening to the entire message
   Perform full and thorough testing for campaigns to make sure that the messages
    are clear and consistently played on phones, voicemails. Also, keep the
    messages short and precise to be effective and save costs related to telephone
   Ensure business owners are assigned to each campaign to continually evaluate
    their effectiveness                                                           26
 Modernization Initiatives

 Contact/Call Centers

Contact/Call Centers – Benefits (Quick
access to County Eligibility Staff)

 Apply for benefits
 Check on case status
 Report changes
 Get information

 Contact/Call Centers – Example of
 Call Flow
                                                           Route to Agent with
                     IVR                                   Correct Skills (Program
                                                           and Language)
                           Self-Service     Check for
                           (existing)       Agent
                           and Collecting   Availability
Internet                   Information

                                                            VoIP or            Ticketing
                                                            ACD Call           System
        Cell phone                                          System


                                                                   System                           29
Contact/Call Centers – Specifics
 customer information (including exit point in IVR) provided
in „Soft Phone‟ client
 Screen-Pop between Contact Center and SAWS with
case information
 Calls and screens recorded for QA
 Workforce management capabilities provided for staff
loading and planning
 Supervisor management capabilities, (ie. queue
monitoring, call hold times, call wrap-up times, etc.)
 Multiple languages supported
 End-to-End reporting
 Receiving nearly 700,000 calls (for full-service Contact
Center agents) per month in CA Counties Statewide and
climbing                                                   30
Contact/Call Centers– Best Practices
& Lessons Learned
   Include various partners in designing, planning and expanding services such as
    Program, Line Ops, HR, IT and also, Community Agencies and Advocacy
    Groups, PSS Commissions, Employee Unions and Bargaining Groups
   Establish service delivery standards up-front ( i.e. acceptable hold times, call
    back times, call wrap-up times, trouble ticket closure times, etc.) & actively
    MEASURE performance & QC Error Rates
   Do a ‟lot of research‟ and plan your staffing and infrastructure investments on
    solid business measurements (i.e. caseloads, call volumes, tracking ticket data,
    # of available agents, available square footage, geography, budget, etc.)
   Continually research and implement best practices from other successful Public
    & Private contact centers
   Perform full Ergonomic workspace assessment and provide adequate and
    efficient spacing and furniture (provide incentives…)
   Have professional training and certificate programs for Customer Service Agents
    available on an ongoing basis
   Have an independent consultant do a thorough evaluation of the current
    operation and provide recommendations on future expansion at a business,
    technical and operational level
   Adjust business processes to take full advantage of Contact Center services
   Survey Customers to get information and feedback via surveys and interviews
 Modernization Initiatives

 Document Imaging / Electronic Case

Document Imaging – Benefits
 Applicants only need to provide information once

 Information is made readily available for authorized use in eligibility and
   benefits issuance process
 Information is accessible from various locations (in-person, phone, etc.)
 Reduces substantially the time it takes Intake and eligibility workers to
   locate case records
 Improves efficiency and effectiveness of the clerical support
 Reduces errors and negative hearing outcomes

 Improves communications between County workers and customers
 Improved records retention, integrity and backup capabilities

 Provides the potential for clients to submit documents and forms

             Document Imaging – Example of
             Process (Integrated with SAWS)
Image Scanning                         Image Retrieval
1. A worker opens a                    1. A worker opens a
   case file in the                       case file in the
   SAWS system.                           SAWS system.

2. The worker triggers                 2. The worker
   scanning by clicking                   requests to see
   the Scan button on                     images relevant to
   the page.                              the current SAWS
                                          system page by
3. System scans the                       clicking the Images
   image and                              button on the page.
   automatically pulls
   the metadata for the                3. System requests
   case from SAWS                         appropriate images
   system.                                and displays them
                                          to the worker.
* Note: Barcodes are also directly
     scanned.                                         34

Document Imaging – Best Practices &
Lessons Learned
   Find the „right‟ scanning process for your business environment, distributed or
    centralized scanning
   Build-in Quality control check-points and processes & create a official record of the
    process followed for each document/case ingested (eJounral)
   Regularly monitor workflow queues to index/file documents in a timely and
    consistent manner and develop corresponding performance standards
   Visit other counties to see other solutions before deciding on technology platform
    and corresponding processes/approach
   Training, Training and more Training - very important for adoption of the system
   Forms Ownership - Identify forms and assign owners early in project (Develop an
    Enterprise Forms Taxonomy)
   Develop internal champions/experts and put them „out-front‟ to help their peers
   Make use of Bar coding or special markers to reduce the need for separator sheets
   Trusted System Certification – seek independent review before destroying paper
   Establish an Exec Steering Committee with reps across organization
   Plan for and document case storage and case retention/destruction processes
   Involve HR and Labor Unions
 Modernization Initiatives

 Kiosks

 Kiosks – Benefits
 Placed in Office Lobby and Community Organizations
 Customers use Kiosks to:
      (Re) Apply for assistance
      Provide documents
      Submit updates
      Check Benefits
      Get Information

Kiosks – Best Practices & Lessons
 Connectivity – rural areas have connectivity challenges. Understand
   connectivity options and limitations before you decide on a location
 Hours of operation – businesses with later hours offer opportunity to the
   community to use Kiosks more after hours
 Developing informal agreements with Kiosk hosts on moving Kiosks,
   reporting technical issues and routinely checking to see that Kiosk is
   operating throughout the day (we have had incidents of people
   unplugging Kiosks so they can charge cell phones)
 Decide on access to which websites are needed and have them
   enabled at time of deployment
 Install screen saver with a message to ensure Kiosk appears
 Educate staff on how to support devices in the field
 Consider initially having staff available at the Kiosk to facilitate and
   encourage use
 Measure usage and survey the Kiosk value with customers regularly
 Modernization Initiatives

 Future Enhancements…
 Marketing?

Future Enhancements

 Assistor Role (Community Partner Portals)
 “Click to Chat” Option on websites
 eTelephonic Signature
 eNOAs (Electronic Notices of Action)
 Mobile applications and SAWS Website &
  Statewide Portal support for SmartPhones
 QR (Quick Response) Codes
on correspondence                             40
 Marketing – Important?

 Strong marketing is one of the most
 important things you can do
 Having well defined functionality does
 no good, if customers don’t know about
 it or how to use it!
 Make sure to include marketing costs in
 the budget and plan appropriately



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