Since the Affordable Care Act (ACA) was signed into law, 15 million citizens who previously did not have health insurance are now covered--reducing the total number of uninsured adults across the country from 18 to 13.4 percent. The U.S. Department of Health and Human Services reported that enrollment in Healthcare.gov singlehandedly brought in 8 million citizens during the first open enrollment period. One of the largest impacts of the ACA was that many of these people, nearly 6 million of them, were deemed eligible for Medicaid coverage and generated a major surge of new Medicaid applications nationwide. For some state Medicaid Directors, this surge created a sudden backlog of Medicaid applications, one that has left more than 1.7 million waiting for their applications to be processed.
With the second open enrollment quickly approaching, limited state resources, and complexities around eligibility determinations, the challenge of how to solve a complicated problem in a short amount of time is requiring a nearly heroic effort by state Medicaid Directors. There aren't any silver bullets, but there are some ways to manage the impacts.
Prepare Customer Contact Centers to Help
During the first open enrollment, much of the attention was focused on the glitches of Healthcare.gov and the state health insurance exchanges. While some of these issues have been resolved, the results showed that people will pick up the phone or send an email when they have a question or issue, whether or not the technology tools are available. Medicaid Directors saw huge increases in their customer contact center volumes from people who needed assistance with their application or just wanted to check on its status.
The second open enrollment will be heavily focused on bringing in even harder to reach populations, many of whom will be deemed eligible for Medicaid coverage. These consumers may not have had previous health insurance coverage or much experience with the application process, and will in many cases speak a primary language other than English. Coupled with the fact that there will likely be no increase in resources for providing in-person assistance this enrollment period, it is predictable that call volumes may greatly increase in the contact centers.
Medicaid Directors can prepare for the new influx by ensuring that their contact centers are adequately staffed and well-prepared for a wide variety of questions and issues, including new ones that will arise during this open enrollment. By conducting in-depth training of customer service representatives (CSRs) in the contact centers that is both continuous and extends past the first day of open enrollment, Medicaid Directors can help ensure that consumers get their application questions answered and verification issues resolved quickly. One of the new issues that will arise for this open enrollment is from consumers who are re-enrolled into their health plan, but see a change in the price of their premiums and have questions about it. With intensive training, and armed with a strong knowledge of how to resolve a wide variety of issues, the CSRs are more able to help consumers can get their enrollment or re-enrollment completed.
Managing the Backlog
Along with making eligibility determinations for the next open enrollment, Medicaid Directors have a large number of eligibility redeterminations to process from their existing program beneficiaries, further taxing their systems and resources. Many would find this situation daunting and overwhelming, but there are ways for state Medicaid Directors to get a handle on the backlog.
One of the first steps Medicaid Directors can take is to develop escalation units to handle the most complex applications. The staff on these specially-trained teams would have the experience and tools to better manage these more complex applications. This means that more easily evaluated applications are not waiting to be reviewed while these more difficult cases are being processed ahead of them.
Additionally, many states have a decentralized eligibility process that relies on county and district offices to determine program eligibility, leading to varying volumes and processing times. Because resources are scarce and adding new caseworkers is not often an option, Medicaid Directors can look to centralize or use a shared services model to take over the more simple functions for processing applications in the counties or districts that have the largest backlogs. Additionally, a broad review of all processes and systems tools can often help Medicaid Directors identify key process "bottlenecks" that can be streamlined, or at least mitigated, to help improve the number of applications processed.
Time Is of the Essence
The second open enrollment period begins on November 15th and is rapidly approaching. It is compressed into three months, from six months for the previous open enrollment, so Medicaid Directors must take quick action to implement these solutions for handling the existing Medicaid applications and in preparation for new ones. By instituting an intensive focus on training, preparing the contact centers to handle increased call volumes, and finding new ways to streamline the eligibility determination process, Medicaid Directors can better prepare for the influx of Medicaid applications and further progress with their mission of helping vulnerable populations receive health insurance coverage.