Expanding Health Care Coverage

Grantee Name

PMB Healthcare Consulting

Funding Area

Expanding Health Care Coverage

Publication Date

April 2011

Grant Amount

$50,710

Grant Date:

March 2009 – June 2009

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In 2008, the New York State Legislature authorized a statewide enrollment center for public health insurance programs to supplement the existing enrollment infrastructure and provide beneficiaries with a centralized, statewide system for processing their Medicaid, Child Health Plus, and Family Health Plus renewals.

The enrollment center included an integrated call center for these three major health insurance programs, a telephone renewal system, Web-based renewal capabilities, and a centralized enrollment entity for processing applications for unique Medicaid programs with low volume in any one local district. Under this grant, PMB Healthcare Consulting (PMB) conducted technical work to inform the development and implementation of the new telephone renewal system. PMB outlined the scope of work for the development of the Healthcare Enrollment and Renewal Tool (HEART)—software intended to link the enrollment center to State eligibility systems, including the necessary features and functionality of the new system from a policy perspective.

This project was part of a larger NYSHealth authorization that funded a series of quick-strike analyses to help the New York State Department of Health’s Office (NYSDOH’s) of Health Insurance Programs find ways to streamline and expand its public health insurance programs.

Read an NYSHealth special report that contains a summary of findings from this authorization.

Outcomes and Lessons Learned

  • Created a scope of work for the development of HEART, and articulated the necessary features and functionality of the new system from a policy perspective.
  • Developed a detailed “intelligent question set” as the basis for programming HEART, which (a) guided the enrollment center staff through the telephone renewal interview with beneficiaries; and (b) connected to State eligibility and enrollment systems.
  • Created a system of triggers and prompts for programming in HEART to ensure renewal encounter integrity.
  • Supported development of logic statements related to various eligibility scenarios for programming HEART to provide the enrollment center staff with prompts and feedback regarding specific client action(s) required to complete the renewal process and back-end system logic necessary to determine continued eligibility.
  • Participated in weekly meetings with the OHIP staff that facilitated the design and implementation of the enrollment center and the HEART software.
  • Participated in biweekly meetings devoted to addressing pertinent policy and procedural questions related to the enrollment center implementation.