OHA MAGI Medicaid System Transfer Project Oregon Eligibility (ONE) Overview Fall 2015

Transcription

1 OHA MAGI Medicaid System Transfer Project Oregon Eligibility (ONE) Overview Fall 2015

2 Table of Contents Project Overview 3 Eligibility and Enrollment 4 Project Mission and Key Benefits 5 Median Household Income Benefits 6 System Functionality 7 Project Approach 8 Project Milestones and Status 9 ONE System Go-Live Dates 10 What to Expect: Worker and Applicant Processes Team Contact Information 14 Appendix 15 2

3 Project Overview Kentucky s Affordable Care Act-compliant system (called kynect), was transferred and configured to meet Oregon s MAGI Medicaid/CHIP eligibility determination needs. Oregon s system is called Oregon Eligibility (ONE) or just ONE. Kentucky system exists in production and works correctly Minimum necessary system customizations were planned and made Policy and business processes will change wherever feasible 3

4 Oregon s Medicaid Eligibility & Enrollment Medicaid eligibility will be completed in the ONE System. The Medicaid enrollment system of record is Oregon s MMIS. Oregon MMIS Oregon CCOs Applicants apply for Oregon Health Plan (OHP) coverage via ONE (Medicaid Eligibility Determination) Applicants eligibility information is passed from ONE to MMIS to enroll in OHP and get a coverage card (Medicaid Enrollment) MMIS sends CCO enrollment files to enroll OHP members in particular CCOs 4

5 Project Mission and Key Benefits The Mission Improve Oregonians access to health care by providing a simplified process for eligibility determination and enrollment in Oregon Health Plan (OHP) Key Benefits Better coordination of care for mixed household families because applicants complete a single application through the HealthCare.gov website or within the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP or private health insurance Oregonians can set-up an account, report changes and receive real-time eligibility determinations via the user-friendly Applicant Portal Simplified OHA eligibility workload via automated process that generates tasks for case management Centralized and verified enrollment data available for Coordinated Care Organizations Consistent quality data source for reporting CMS-mandated operational statistics 5

6 Median Household Income Key Benefit Applicants complete a single application through the HealthCare.gov website or within the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP QHP QHP QHP 400% APTC APTC APTC % of FPL 300% 200% 100% 305% Child OHP Median Household Income in Oregon = Between % FPL 190% OHP Pregnant Woman 138% OHP Adult The Median Household Income in Oregon often results in mixed eligibility households. A key benefit of the ONE system will be the ability to track these households and service each member of the family. 6

7 ONE System Functionality Benefit Programs MAGI Emergency Medicaid Former Foster Care Children Advanced Premium Tax Credit (APTC) Qualified Health Plan/ Employee Sponsored Insurance (Disabled) (Disabled) Capabilities Channels Applicant Portal & Community Partners Worker Portal (Mail / Fax / Phone) Screening Application Document Management Account Registration Check Benefits Case Maintenance Eligibility Override Non-MAGI Referral Inquiry Renewals Hospitalized Inmate Continuous Eligibility Real Time Eligibility Manage Tasks Reasonable Compatibility CAWEM / CAWEM Plus (Emergency Medicaid) Correspondence & Reports Bi-directional Account Transfer MEC Check for Adult Interfaces Federal Healthcare.gov Federal Data Services Hub Public Assistance Reporting Information System Medicaid Management Information System Oregon Employment Dept. New Existing 7

8 ProjectApproach Status Phase What We re Doing Design Finalize requirements Define future-state business processes supporting new capabilities Capture all changes occurring as a result of the new technology and processes Planning to move data from existing systems into the new tool, known as the cutover strategy Communicating with staff and stakeholders about the project Build Build technology, integrating and talking to current systems not being replaced Write scenarios that simulate how the system is used Develop detailed training courses Communicate specifics about changes and benefits that ONE will bring We are here Test Extensively test the system toconfirmit is running correctly and works with other systems OHA currently uses Make final adjustments to technology and processes as necessary, based on the results of tests Implement Conduct training to help staff and others learn new technology and processes Turn on the system to perform business processes Conduct additional training as needed Support Continuous support with help of Local Experts, or staff highly trained on the system Encourage continued momentum among staff to use the system, ask questions, and raise concerns 8

9 Project Status Summary On Track for On-time Go-Live, Tight Schedule Creates Risk Phase Aug Sep Oct Nov Dec Jan Feb Mar Test User Acceptance Testing Begins Implementation Planning Training Applicant Portal Go-Live Go-Live Support Worker Portal Go-Live Milestone Date Milestone (cont.) Date User Acceptance Testing (UAT) Begins 9/15/15 Worker Portal Training Materials Complete 9/30/15 Submit Authority to Connect Packet to CMS 10/15/15 Worker Portal End User Training begins 10/19/15 Applicant Portal End User Training begins 11/30/15 CMS Operational Review 11/4/15-11/5/15 Worker Portal Go-Live 12/15/15 Applicant Portal Go-Live 2/6/16 9

10 ONE System Go-Live Dates December S M T W T F S Worker Portal Go-Live December 15, 2015 Used for eligibility determinations Read only access for DHS staff as needed to review status of client applications February S M T W T F S Applicant Portal Go-Live February 6, 2016 Community Partners/Assisters and public use for self-servicing new eligibility determinations and enrollments Current Medicaid enrollees will need to have an eligibility determination completed in ONE by a worker before they can use the Applicant Portal 10

11 A Day in the Life of an Eligibility Worker Eligibility Worker Log In Dashboard Data Entry Authorize Benefits Yes Single Sign On Pull appropriate task from queue. Manage from your dashboard Complete Applicant Registration and data collection successful? No Authorize the appropriate benefits Request for Information Receive Documents Re-run Authorize Benefits System generates correspondence Applicant provides verification documents Data needed to run verification is received and entered Authorize the appropriate benefits Other OHA / DHS Non-MAGI Referral DHS Report Results 11 Reassign applicant to appropriate queue Applicant is handed off to DHS and processed outside of the ONE system The eligibility results will be reported to the ONE System

12 Application Lifecycle for Applicants and Workers General New Applicant Does not have Medicaid Applicant Applies Data Collection Eligibility Determined CCO Selection Applicant Portal (On-Line) Community Partner Assistance in Applicant Portal Complete Applicant Registration and data collection *Applicant known to Oregon Systems? No successful. Applicant not previously known to the Oregon system has their eligibility determined Applicant or Community Partner selects a preference, MMIS assigns CCO finally Existing Applicant Has Medicaid Yes Worker Log In Worker Dashboard Data Collection Eligibility Determined Single Sign On Pull appropriate task from cue. Manage from your dashboard Complete Applicant Registration and data collection successful Applicant not previously known to the Oregon system has their eligibility determined

13 Application Lifecycle for Applicants and Workers Applicant without Computer or Access to a Community Partner Applicant Applies IRMS Worker Log In Worker Dashboard Completes their application via Paper, Fax, Fillable PDF Scans the application into the Worker Portal Single Sign On Pull appropriate task from cue, Manage from your dashboard Data Collection Eligibility Determined Complete Applicant Registration and data collection successful Applicant not previously known to the Oregon system has their eligibility determined

14 Project Team Contact Information For additional information regarding the OHA MAGI Medicaid System Transfer Project or the ONE System, the project team: 14

15 Appendix

16 10 Things to Know About the ONE Project l. Oregon has elected to transfer and implement the Kentucky eligibility and enrollment system (called KYNECT) meaning we are bringing a system that already works, to Oregon for use by OHA. 2. The project is minimizing changes to the KYNECT system and limiting them to the ones needed for Medicaid policies in Oregon that don t exist in Kentucky (like emergency Medicaid for non-citizens) or are necessary to support a Supported State Based Marketplace (like Account Transfer with the Federal Marketplace (FFM) or Medicaid Coverage Check (MEC)). 3. OHA is using a system integrator on the project Deloitte Consulting who built the original system in Kentucky. 4. The system will be hosted in the Oregon DAS Enterprise Technology Services State Data Center under control of state resources to support it. 5. There are some technical changes that need to be made to the Kentucky system to make it work in Oregon, including integration with an existing Document Management Solution and a new security COTS software product (Kentucky had a custom developed application) for their specific needs. 6. The ONE system will have interfaces with Oregon s MMIS (5 total), with the FFM (10 total) and with a few Oregon specific data sources (like Employment Department). Interface development is on-track based on the project schedule. 7. There is a phased implementation schedule planned for the ONE system: Worker Portal & integration with FFM (i.e. Bi-Directional Account Transfer) December 15, 2015 Applicant Portal for client self-service February 6, 2016 (after open enrollment finishes)

17 10 Things to Know About the ONE Project 8. OHA is convening a group of external advisors including Legislators, Coordinated Care Organization representatives, as well as Community Partner representatives to advise on implementation planning for the ONE system. First meeting will be held in July When the system goes live, each current Medicaid enrollee will need to have an eligibility determination completed in the ONE system by a worker before they can use the Applicant Portal for inquiries or reporting changes in circumstance, via self-service. 10. Nothing about the new ONE system makes the problem of Medicaid clients wanting to choose a CCO based on participating providers better (or worse). The ONE system will provide a webpage with links to CCO provider directories, maintained by CCOs so that Oregonians can search to see if their provider is in a particular organization. The ONE system does provide applicants (accessing the system through the online Applicant Portal) the ability to choose a preferred CCO based on residential zip code should the applicant be found eligible. The ONE system will NOT interface with OHA Office of Health IT (OHIT) Provider Directory at initial implementation. OHIT is currently working on a statewide provider directory project that will leverage data from existing, authoritative, and accurate provider data sources, such as common credentialing. The provider directory is not anticipated to be consumer-facing but instead will be a resource for provider directory systems (potentially including MAGI) to validate their own directories and improve the accuracy of their data they provide. See attached PDF for useful information regarding the MAGI Medicaid System Transfer project. MAGI Project Information

18 Updated ONE System Experience After December 15 th internal OHA Staff will access the Worker Portal to complete all eligibility determinations, each current Medicaid eligible will have to have a redetermination completed through Worker Portal before using Applicant Portal to self-service. Worker Portal 18

19 Updated ONE System Experience After February 6 th new and returning applicants who have had an initial redetermination completed within Worker Portal will initiate their application or renewal by way of the Applicant Portal Applicant Portal 19