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I_COMedicaidCL_2016A 06/24/2016 08:35:09 AM Committee Summary




Date: 06/24/2016
Time: 08:35 AM to 11:47 AM
Place: HCR 0107
This Meeting was called to order by
Representative Primavera
This Report was prepared by
Anne Wallace
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
Call to Order and Opening Remarks

Overview of Committee Charge and Deadlines

Overview of Client Correspondence and Legal and Policy Considerations

Client Perspectives on Medicaid Letters and Suggestions for Improvements
Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

08:36 AM -- Call to Order and Opening Remarks

Representative Primavera called the meeting to order. An agenda was distributed to the committee members (Attachment A). She explained why she had requested the committee, and indicated that her constituents have received confusing letters regarding Medicaid. She discussed the goals of the committee with the members.

160424 AttachA.pdf160424 AttachA.pdf

08:38 AM -- Overview of Committee Charge and Deadlines

Bill Zepernick, Legislative Council Staff, presented handouts to the committee with information on the committee' s charge (Attachment B). He explained that the committee may meet four times in the interim, and he described the deadlines to the committee to request, draft, and vote on legislation.

160424 AttachB.pdf160424 AttachB.pdf

08:40 AM

Mr. Zepernick responded to a question regarding the date of the Legislative Council meeting.

08:41 AM -- Overview of Client Correspondence and Legal and Policy Considerations

Sue Birch, Executive Director, Department of Health Care Policy and Financing (HCPF), introduced herself and other members of her team. She referenced handouts that had been provided to the committee (Attachment C). She explained that communication between HCPF and clients is very important, especially with the changes that have been implemented as a result of healthcare reform. She described HCPF's person-centered focus, and attempts to simplify the medical system for clients. She described the collaborative effort to address client correspondence across state departments, including the Department of Human Services (DHS) and Connect for Health Colorado. She gave an overview of HCPF's current work on client communication.

160424 AttachC.pdf160424 AttachC.pdf

08:46 AM

Antoinette Taranto, Chief Client Officer, HCPF, gave an overview of her role at HCPF. She explained that HCPF is working on technical changes for communication with clients, and has been receiving direct feedback from clients. She explained how Medicaid clients are covered and get enrolled. She gave an overview of HCPF's points of contact with Medicaid clients, including applying for Medicaid, receiving a disability and level of care decision, and receiving an approval or denial of Medicaid coverage.

08:52 AM

Ms. Taranto replied to a question from the committee regarding communication on eligibility criteria. She continued to explain HCPF's communication with clients after they are approved for Medicaid, including receiving membership cards, enrollment confirmation, and an income letter. In response to a question, she noted that the income letter data is from the previous quarter. She described the renewal letter, termination letter, and open enrollment letters from HCPF to clients. Ms. Taranto responded to a question regarding the contents of the membership handbook, and how the clients access the information. Ms. Taranto responded to a question regarding the HCPF customer service phone line, and HCPF Medicaid agents.

09:01 AM

Chris Underwood, Director of the Health Information Office, HCPF, explained the joint system that HCPF uses to communicate with clients about eligibility for public programs. He explained the challenges that clients have with the eligibility communication, including receiving multiple notices or unclear notices.

09:04 AM

Marivel Klueckman, Eligibility Division Director, HCPF, described the joint eligibility system for public programs to the committee. She explained that changes to correspondence must be made across all programs and departments. She discussed the federal requirements for eligibility that prevent the correspondence from merging completely for the programs, including different deadlines, appeals, and eligibility for each program. Ms. Klueckman responded to a question regarding legislation to align the Colorado Benefits Management System with federal requirements.

09:09 AM

Ms. Klueckman described the four main types of eligibility correspondence with clients, including the notice of action, income eligibility and verification letter, renewal letter, and verification checklist. She responded to a questions regarding the deadlines included in the verification checklist, and the timing of Colorado Department of Labor data. Ms. Klueckman responded to a question regarding language and font in denial letters.

09:19 AM

Ms. Klueckman continued to describe the contents of the four types of eligibility notices to clients. She gave an overview of the federal and state requirements for information that must be included in the notices. She discussed previous efforts to improve eligibility communication. She noted that the Affordable Care Act implementation made it difficult to gather client feedback, as HCPF was working on enrolling and educating new members. She explained that HCPF is currently prioritizing member testing, in addition to utilizing plain language experts, and evidence-based approaches. Ms. Klueckman responded to a question regarding plain language legislation for private insurance.

09:28 AM

Rachel Reiter, External Relations Division Director, HCPF, explained how the different channels that HCPF receives client feedback. She described a new member feedback channel, the Person- and Family- Centeredness Advisory Council, to the committee. She responded to questions regarding the federal form for proof of insurance coverage, and the membership and frequency of meetings of the Council.

09:34 AM

Ms. Reiter gave an overview of the goals of the plain language program at HCPF. She noted that HCPF seeks to reduce confusion and improve information accessibility, efficiency, and effectiveness. Ms. Reiter responded to a question regarding updating counties on the plain language training. Ms. Klueckman added that the counties are trained for policy changes ahead of time, and refresher trainings for county workers are being considered. Ms. Klueckman responded to a question regarding on-line training and webinars for staff.

09:39 AM

Ms. Reiter gave an overview of the four phases of HCPF's research to improve client communication, including stakeholder feedback, making revisions, testing by diverse members, and policy and legal feedback. She explained that HCPF partners with other agencies on this project. HCPF focused on four letters that were most problematic to clients, and plans to apply what they learn to the additional HCPF letters. Ms. Reiter responded to a question about why the four letters were chosen. Ms. Klueckman added the that the chosen letters impact client's benefits and included a call to action.

09:44 AM

Ms. Reiter explained the stakeholder feedback phase of the research, including key interviews, meetings, and a survey. She summarized the stakeholder comments received. She explained how the letters were revised using the stakeholder feedback, and how HCPF tested the revised letters with members in different locations. Ms. Reiter responded to a question regarding the number of members and location that tested the revised letters. She explained that health literacy was still a challenge for the members that tested the revised letters. Ms. Reiter explained that the last phase of the project, a legal review of the revised letters, is forthcoming. She explained next steps for the project, including sharing the research, developing tools, and creating a final report on the research project.

09:52 AM

In response to a question, Ms. Reiter confirmed that the purpose of the research is to apply the feedback from the four sample letters to the rest of the Medicaid letters. regarding the four letters and the intent to use recommendations to simplify all HCPF letters.

09:55 AM

Joan Winchester, Director, Center for Health Literacy (CHL), described the work and mission of the CHL. She described the work being done in Colorado to analyze and revise client notices, and explained the challenges when clients do not understand notices. She explained the benefits of the joint system notice system in Colorado, but noted that the system may provide too much information to clients.

10:01 AM

Ms. Winchester explained what CHL has learned about developing notices and conducting field work in other states. She provided information on literacy rates around the country, and responded to a question regarding comprehension levels. She explained that CHL conducts testing to obtain information on reading comprehension. She discussed barriers to the comprehension, and responded to a question regarding client intimidation and comprehension. Ms. Writer explained that tone is very important in notices to mitigate fear of the contents. She explained some of the techniques used to overcome comprehension barriers.

10:08 AM

Ms. Winchester explained how CHL developed sample notices, tested the revised notices, updated notices with expert recommendations, and identified best practices for developing future client notices. She detailed how the initial notice revisions were made. She explained how the CHL conducted one-on-one interviews for usability with Medicaid clients at eight locations across the state. She noted that some newly enrolled members were interviewed. She explained the characteristics of the 62 participants in the interviews, and the information that CHL wished to gathered from the interviews. Ms. Winchester explained that the participants thought the revised notices looked easy to read and could understand the purpose of the notice, but she noted the participants' difficulty with the concepts and terms, and the length of the notice. She responded to a question regarding separating out the legal information from the main notice. She explained the specific concerns and opinions of the participants.

10:23 AM

In response to a questions, Ms. Winchster explained a Notice of Action. She explained final steps in the process, including making many revisions and formulating recommendations for future notices. Ms. Reiter went over each CHL recommendations to HCPF with the committee. She described ways to mitigate the length of the notice, including separating out the legal information and defining terms.

10:28 AM

Mr. Underwood gave concluding remarks on HCPF's work on client communication. Ms. Winchester responded to a question regarding including school-aged children in the notice revision process.

10:45 AM -- Client Perspectives on Medicaid Letters and Suggestions for Improvements

Julie Reiskin, Executive Director, Colorado-Cross Disability Coalition, thanked the committee for the brining the issue and distributed a handout to the committee (Attachment D). She noted that readability of notices is only one component of the challenges with Medicaid communication. She explained that clients are having issues receiving notices in a timely manner and receiving open enrollment letters every year. She responded to a question regarding communication with clients with disabilities.

160424 AttachD.pdf160424 AttachD.pdf

10:51 AM

Ms. Reiskin went over the different types of communication with Medicaid clients, including notices, calls, and emails. She suggested that a greater effort should be made to move away from blaming clients in notices. She noted that programs other than traditional Medicaid are problematic because they do not receive much attention. She described the issues with forms of communication other than the notices, including problems contacting HCPF by phone. She summarized other issues with communication, including state and county confusion, missing information, not following up with clients in a timely manner.

11:00 AM

Ms. Reiskin described client issues with written Medicaid notices, including contradictions, incorrect regulations, and unclear information on appeals.

11:03 AM

Elisabeth Arenales, Colorado Center on Law and Policy (CCLP), explained the role of the center and their work with Medicaid clients. She distributed handouts to the committee (Attachment E) and gave an overview of the Colorado Benefits Management System, and the evolution of the system. She noted that there have been multiple efforts to improve client communications, including using stakeholder meetings and focus groups. She summarized problems with communication that have not been addressed, including missing notices, incorrect dates, and conflicting information. She noted that many of these problems are incorrectly blamed on user error. Ms. Arenales continued the discussion by explaining that staff training is not sufficient to address the problems with the system.

160424 AttachE.pdf160424 AttachE.pdf

11:15 AM

Ms. Arenales responded to a question regarding the origin of the communication problems. She noted that the Medicaid communication has improved, but she is unsure whether the issues are a result of poor training or programming issues. Ms. Reiskin provided examples of programming issues, and confusion between the state and county agencies. Ms. Arenales noted that the county involvement in the Medicaid system is challenging, but it would be difficult to combine it with the state.

11:24 AM

Bethany Pray, CCLP, provided an overview on the legal requirements for Medicaid notices and denials. Her presentation was handed out to the committee (Attachment F). She described the due process requirements for notices. She explained that notices must be in plain language, timely, and provide adequate information, including a reason for the action. Ms. Pray explained that the information in the notice may be too vague and general for a client to understand. She explained that clients must follow-up to obtain necessary information from HCPF, and this may lead to loss of benefits.

160424 AttachF.pdf160424 AttachF.pdf

11:32 AM

Ms. Reiskin discussed the concerns that the disability community has with Medicaid correspondence. She explained that the disability community relies heavily on the Medicaid system, and the issues with Medicaid communication may make their lives difficult. She provided examples of specific problems that have occurred as a result of incorrect or confusing Medicaid correspondence.

11:39 AM

Ms. Arenales provided a handout to committee and (Attachment G) and discussed the CCLP's four preliminary recommendations for improvements to Medicaid correspondence with clients. Ms. Arenales responded to a question regarding the type of audits on client notices. She noted examples of best practices in other states. Ms. Reiskin made final comments on the tone of Medicaid notices.

160424 AttachG.pdf160424 AttachG.pdf

11:47 AM

Representative Primavera adjourned the meeting.