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Technology and the Vision for Paperless, Technology and the Vision for Paperless, Simplified Eligibility and Enrollment under Simplified Eligibility and Enrollment under
the Affordable Care Actthe Affordable Care Act
Tricia Brooks
National Covering Kids and Families Webinar
December 15, 2011
Countdown to 2014Countdown to 2014
The Vision of the ACAThe Vision of the ACA
o Robust website
o Electronic application with electronic signature
o Verification through electronic data sources
o Real or near-real time eligibility decision
Woe is the State’s Eligibility SystemWoe is the State’s Eligibility System
o Sick of hearing what the state can’t do because of its aging systems?
o State budgets got you feeling under the weather – no money to upgrade systems
Help Has ArrivedHelp Has Arrived
o Unprecedented federal funding opportunity
o 90% system development
o 75% system operating costs
o Expires at end of 2015
Expedited IT Funding ApprovalExpedited IT Funding Approval
o Waiver of certain cost-allocation rules in integrated systems (e.g. SNAP)• Don’t have to allocate costs for
functions/process needed for Medicaid (even if other programs benefit)
• Only the incremental cost of integrating other programs are charged to them
o Expedited process for funding approvalo Sharing system resources across states
Strings AttachedStrings Attached
o Customers should experience a high level of service, support and ease of use
o Flexible, modular systems to promote ease of maintenance, sharing and reuse
o Support accurate, timely eligibility and effective communications
o Produce performance datao Ensure seamless coordination
with the Exchange
Georgetown Health Policy InstituteGeorgetown Health Policy InstituteCenter for Children and FamiliesCenter for Children and Families
o Tricia Brooks, Assistant Research Professor, Health Policy InstituteSenior Fellow, Center for Children and Families• [email protected]• 202-365-9148
o Our Website: http://ccf.georgetown.edu/
o Say Ahhh! Our child health policy blog:http://www.theccfblog.org/
Developing a First-Class User Experience for Affordable Care Act Enrollment
Jim Jones, Senior ConsultantSellers DorseyEnroll UX 2014 Project Team
NCKF WebinarDecember 15, 2011
Project Objectives
1. Develop first-class user experience (UX) design for health insurance exchanges operated by state and federal governments under the Affordable Care Act.
2. Design the UX based on an understanding of consumer needs and refined through user testing.
11 Participating States
AL, AR, CA, CO, IL, MA, MN, MO, NY, OR, TN
UX 2014 Design Partner
World-class design and innovation firm
Market leader in simplifying design of complex systems; understanding and then translating needs and desires of end users
Project Scope
Individual market (possibly SHOP)
End-to-end eligibility, enrollment, plan selection, premium payment and retention experience
All insurance affordability programs (Medicaid, CHIP, tax credits, cost sharing reductions, Basic Health Program)
Multiple pathways
Design for diversity and ADA compliance
Vendor / system neutral, technology agnostic, customizable
OVERVIEW
Support for Assisters
Based on assister role generally, including navigators, brokers, eligibility workers and community-based organizations
Proxy access for family members, caregivers, providers, etc., with read and/or read-write options
Support for initial application, enrollment and change in circumstances
Tools to support caseload management
13
Assister Scope – High Priority
Assisters having their own separate accounts with certification date/ID number, etc.
Organization has an account with all of its individual assisters affiliated with that organization.
Caseload management tools, sort of cases (by status, name, etc.), including information regarding the disposition of their cases (for credit and case management).
Ability for an assister to help someone with paper documents The ability of the assister to transfer a case and to manage
cases within an organization, including the ability to make and attach notes/comments to the case.
Assister Search functionality
Assister Scope – Medium Priority
Different versions of Exchange web pages (skip questions/shorter questions/low-speed and high volume versions)
Presumptive Eligibility: An abbreviated data collection web page that includes approximately six data fields
Type of Assister: If broker/agent is the assister, relationship of assister to insurance carriers
Assister Scope – Lower Priority
Audit trail for assister activities over time. Specialized help function (FAQs, help line, on-line
manuals/handbooks, etc.), but not the content. APIs – clearly should be offered to
brokers/agents/navigators
Overview
Draft Content The following slides represent draft wireframes for
the individual user experience under the Enroll UX 2014 project.
• These drafts are a work in progress and should not be considered final design products.
• Wireframes represent page layouts; no visual design is reflected. The actual “look and feel” of the user experience will be very different than portrayed here.
• Wireframes for the UX for assisters and the SHOP Exchange are not included.
Placeholder language is used throughout.
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Overview
Scenario
Family of 3, all citizens, 308% FPLApplication filer, not applying for coverage
• Penelope Hermannson-Smith− DOB: 06/18/1971
Applying for coverage• Gustav Hermannson
− DOB: 10/02/1973
• Beatrice Hermannson− DOB: 03/21/2001
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