Not-for-profit company leads push for automation of Medicaid enrollment process

Venture capitalists and Wall Street have invested millions of dollars to capitalize on the health care industry's burgeoning demand for information technology. But in New York State, the push to automate the Medicaid enrollment process is being led not by a behemoth IT corporation, but by a tiny not-for-profit: the Hudson Center for Health Equity & Quality (Hudson Center). And 2012 is shaping up to be its breakout year.

The Hudson Center estimates its automated enrollment technology has streamlined enrollment for nearly one million of the 5.7 million people covered by New York State Medicaid Managed Care, Child Health Plus, and Family Health Plus. Its technology is used by enrollment organizations big and small, from the Westchester County Department of Health to a national commercial health plan. Now that the Affordable Care Act requires states to set up online health insurance exchanges in 2014, the Hudson Center is playing a role in developing one for New York State, and is talking to other states as well.

"The last 12 to 18 months have clearly been a watershed year for the Hudson Center," explains Georganne Chapin, President. "People know who we are, know what we do, and know we have the experience to develop an efficient, user-friendly, end-to-end enrollment solution to meet everyone's needs."

In the last 18 months, the Hudson Center has:

• Licensed its electronic Medicaid application FEEA(TM), or Facilitated Enrollment Electronic Application to a commercial health plan offering public health insurance in 13 New York State counties. FEEA also was licensed to Neighborhood Health Providers, a New York City Medicaid managed care plan serving over 200,000 enrollees.
• New York City Human Resources Administration (HRA) certified the Hudson Center to electronically submit Medicaid renewals to HRA's system. The Hudson Center is the only vendor so certified.
• Developed a "Provider Portal" for a "Go Before You Show" initiative that encourages women to access prenatal care and enroll them in public health insurance.
• Worked with a group of Federally Qualified Community Health Centers to secure a grant from the federal Centers for Medicare and Medicaid Services to build a platform for enrolling uninsured patients and to streamline the re-enrollment process so their insured patients don't lose coverage.
• Continued to license electronic enrollment systems to Health Plus in New York City; Total Care in upstate New York; and the Westchester County Department of Health.

But success hasn't come overnight for the Hudson Center, which was founded eight years ago as the advocacy arm of Hudson Health Plan (Hudson), a community based not-for-profit health care organization. Hudson had developed FEEA for its own use and saw the potential to use the technology to streamline enrollment in public health insurance. So Hudson transferred the FEEA technology to the Hudson Center, which was able to license FEEA to other health plans and facilitated enrollment agencies—known as FEs.

"Our goal was not to 'sell' FEEA just to sell a product. We wanted to make a difference," explains Catherine Clancy, CEO of the Hudson Center. "We developed a way to streamline Medicaid enrollment, and we wanted everyone to use it so that more uninsured people could be covered efficiently, and also keep their coverage."

Revolutionizing the Medicaid Enrollment Process

Before FEEA, all Medicaid applications had to be submitted on paper and needed between 45 to 60 days to process. Often applications were rejected because of calculation errors or because they were illegible. In comparison, FEEA applications typically are turned around in just two weeks. There are no legibility problems, calculations are made automatically, and a built-in knowledge base offers eligibility guidance for FEs completing the forms. Because all supporting documentation is digitally scanned, the FEEA application can be used to expedite the recertification process. Now New York City FEs use FEEA to submit completed applications electronically to the city's Human Resources Administration.

The Hudson Center also saw an opportunity to use FEEA technology to build a Web site that consumers could use to self-apply for public health programs. The organization secured a grant from the New York State Health Foundation to build Enroll NY, a free Web site that lets users start the application online and then connects them to a health plan or FE to complete the process. Enroll NY is linked to 29 FEs and is available statewide.

Regrettably, most Medicaid applications are still paper-based. Only a handful of local governments have upgraded their enrollment processes to accept electronic applications. However, FEEA can be used by FEs to streamline their workflow and increase their efficiency, even if they need to produce paper applications in the end.

On the Horizon: Health Insurance Exchanges

The Affordable Care Act requires that by 2014 all states operate a health insurance exchange where individuals can choose and enroll in a health plan. The Hudson Center has begun to build a tool to use in state exchanges.

An IT gap analysis study prepared by two national organizations, Social Interest Solutions and The Lewin Group, for New York State, recommends drawing on the Hudson Center's expertise to develop key parts of the exchange. The study states that "The lessons learned [by the Hudson Center] from developing and managing Enroll NY and FEEA can provide real and practical insight."

Specifically, the study notes that the Hudson Center's experience with Enroll NY "...could be useful in building the robust consumer front-end for the Exchange." It continues by saying that FEEA "... helps Health Plans and Facilitated Enrollment Entities (FEEs) process applications and support families who are applying. [The Hudson Center's] experience in supporting assistors could be useful in designing features to support the Community Assistors, Navigators and Brokers who will be using the Exchange."

Ms. Chapin says that as long as people are uninsured, the Hudson Center will be challenged to development more enrollment solutions.  "There is no shortage of suitable projects for the Hudson Center to undertake," she explains.