Overview of Client Correspondence and Legal and Policy Considerations
COMMUNICATION BETWEEN HCPF AND MEDICAID CLIENTS
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.