Statewide Health Insurance Enrollment Center Will Streamline Enrollment, Reduce Local Burden

Will Assist New Yorkers Enrolling in Medicaid, Family Health Plus, Child Health Plus

ALBANY, N.Y. (Oct. 16, 2008) – State Health Commissioner Richard F. Daines, M.D., announced today that New York State has taken the next step toward the development of a statewide centralized Enrollment Center that will simplify re-enrollment for Medicaid, Family Health Plus, and Child Health Plus and reduce the economic burden on counties.

Plans for the Statewide Enrollment Center, included in this year's enacted Executive Budget, were outlined in a Request for Proposal (RFP) issued today by the State Health Department. The RFP can be viewed on the Health Department's website at www.health.ny.gov/funding/rfp/0808040239/

"As the pressure on the state budget increases, we must continue to look for ways to streamline and make government programs more efficient," said Commissioner Daines. "Economic conditions are likely to make more New Yorkers eligible for public health insurance programs. A centralized enrollment center will make it easier to obtain information and renew coverage, while reducing the local administrative burden for Medicaid and Family Health Plus."

The Statewide Enrollment Center will include a single statewide telephone and mail-in renewal system and toll-free call center for New Yorkers seeking information and assistance enrolling in Medicaid, Family Health Plus, and Child Health Plus. Currently, separate hotline numbers exist for each of these programs, and telephone re-enrollment assistance is not available.

In the first year of the Enrollment Center, telephone and mail-in renewal options will be developed for Medicaid, Family Health Plus, and Child Health Plus. Additionally, a single toll-free line will be launched for New York's Medicaid, Family Health Plus, and Child Health Plus programs for information and renewals. These new features will allow local departments of social services, which currently process all new and renewal applications for Medicaid and Family Health Plus, to focus on new applicants and eliminate administrative time and paperwork involved in re-enrollments.

"The Enrollment Center will consolidate several fragmented health insurance enrollment services and reach out to current enrollees so they can more easily renew in the appropriate health care plan and not lose coverage, even though they are still eligible," Dr. Daines said.

In general, about 30,000 people a month lose their Medicaid coverage because they are unaware of or missed some step in the renewal process. This "churning" of re-enrollments results in eligible beneficiaries losing coverage and creates paperwork burdens on local social services departments, which administer the enrollment system on the state's behalf.

"With less time spent re-enrolling people, we can reach out to more uninsured people to determine whether they qualify for public health insurance," Commissioner Daines said.

As outlined in the Request for Proposal, the Health Department will invest up to $34 million in the Statewide Enrollment Center, with the following features developed first:

  • A new statewide telephone and mail-in renewal system for Medicaid, Child Health Plus and Family Health Plus. About 1.5 million households enrolled in public health insurance programs can now renew by self-attesting to their income and residency, which can then be verified through electronic data sources. The addition of a telephone renewal option will maximize the number of enrollees who successfully renew. Medicaid and Family Health Plus renewals are now processed by mail at county social services departments, including the New York City Human Resources Administration. Child Health Plus renewals are processed by an enrollee's managed care plan. Telephonic renewals would lessen the processing burdens on local governments and simplify the annual renewal process for enrollees.
  • A single statewide toll-free call center for Medicaid, Child Health Plus and Family Health Plus, with assistance in English, Spanish, Russian, Arabic, Haitian Creole, Cantonese and Mandarin. The call center will operate from 8 a.m. to 8 p.m. weekdays and Saturdays from noon to 5 p.m. The measure will consolidate separate hotlines for Medicaid, Child Health Plus and Family Health Plus, which currently have a monthly call volume of about 67,500, with up to 525 calls an hour during peak times.

In subsequent years, the Statewide Enrollment Center will also provide:

  • Administration of the Premium Assistance Program and the Family Health Plus Employer Buy-in Program.
  • Management of Internet-based renewals, processing new applications and other renewals.

Together, Medicaid, Family Health Plus and Child Health Plus cover approximately 4.5 million New Yorkers. However, nearly half of New York's uninsured population – 1.2 million people – is eligible for coverage in one of these programs but remain uninsured. Evidence demonstrates that health insurance coverage for low-income workers helps prevent absenteeism at work or school and increases job retention.

Simplifying the health insurance enrollment process and reducing the paperwork burden for re-enrollment is part of Governor David A. Paterson's overall health reform strategy to increase access to health coverage and care and to raise the quality of care provided. Other initiatives include:

  • Expanding Income Eligibility for Child Health Plus. Because many parents work for small businesses that do not offer health insurance coverage, or cover only the employee and not their children, effective September 1, income eligibility for Child Health Plus was expanded from 250% to 400% of the Federal Poverty Level, up to about $70,000 for a family of three. Child Health Plus is free only for those with the lowest incomes. Others pay a monthly premium ranging from $9 to $40. With this expansion, affordable health insurance is available to all uninsured children in the state.
  • Doctors Across New York. To provide incentives for primary care and specialty physicians to practice in shortage areas, Doctors Across New York will provide up to $150,000 in educational loan repayment for a five-year service obligation in an underserved area and up to $100,000 in practice support funding over two years for providing medical services in an underserved area. The first awards will be made in 2009.
  • Medicaid Reimbursement Reform. To encourage greater access to primary and preventive care, as part of a multi-year plan to reform the health care system this year New York will reduce inpatient hospital rates by over $170 million and increase outpatient rates for hospitals, community clinics, and primary doctors by $300 million. At the same time, New York is phasing in a new outpatient reimbursement methodology that is more sensitive to the intensity of patient visits.
  • No payment for preventable errors. The Health Department is implementing a new policy denying Medicaid reimbursement for 14 "never events" – avoidable hospital complications and medical errors that are identifiable, preventable, and serious in their consequences to patients. Such events include surgical procedures performed on the wrong body part or the wrong patient, complications such as leaving a foreign object in a patient, and administering incompatible blood. The federal Medicare program is implementing a similar program.
  • Better primary care. To improve the quality of primary care, the Health Department is currently circulating for public comment draft primary care standards that will apply to physicians and clinics serving Medicaid patients.
  • Patient safety protections. Governor Paterson signed legislation this year to improve patient safety, enhance the State's authority in medical investigations, and help to prevent future infection control violations. The law strengthens the physician disciplinary system and increases the Health Department's authority in disease control investigations while also providing more public information about physicians, particularly those charged with misconduct.