Transcript Presentation Title

North Carolina
Department of
Health & Human
Services
North Carolina Association of
County Commissioners
NC FAST Update
June 9, 2015
Draft
1
County Workload Impacts
Potential FNS Workload Growth:
An influx of applications began being received from Intuit (Turbo Tax) on January 9 th and continued through April 15th,
2015. These must be processed in the same manner as other FNS applications. These applications are received via
ePASS.
NC FAST received 22% more FNS applications via ePASS for the period of January – April 2015 compared to the same
period in 2014. *Data as of April 30th
Jan Total
Feb Total
Mar Total
Apr Total
Jan-Apr Total
ePASS
6,583
4,053
4,680
5,542
20,858
2014
Non-ePASS
49,184
45,854
42,573
44,438
182,049
Jan Total
Feb Total
Mar Total
Apr Total
Jan-Apr Total
ePASS
15%
57%
31%
-3%
22%
Total
55,767
49,907
47,253
49,980
202,907
ePASS
7,581
6,377
6,126
5,383
25,467
Overall
Non-ePASS
4%
-20%
9%
-6%
-3%
2015
Non-ePASS
50,970
36,809
46,523
41,793
176,095
Total
58,551
43,186
52,649
47,176
201,562
Total
5%
-13%
11%
-6%
-1%
Medicaid Workload Impact:
NC FAST received notification from CMS on May 21, 2015 that a additional Federal Facilitated Marketplace (FFM)
applications will be sent to states due to a FFM Healthcare.gov system issues. These system issues have prevented
the account transfer of approximately 9,100 accounts where a full state determination for Medicaid eligibility when
applying via the FFM was requested. Subsequently, North Carolina began receiving these account transfers on May
27th and the corresponding applications are now being sent to the applicable county work queues. If received, these
applications should be processed per normal procedures. Draft
2
General NC FAST Update
•
As of May 29th, In an effort to assist counties with performance monitoring of NC FAST, the BSM
performance monitoring tool has been installed and reporting in the following locations. NC FAST
is continuing to reach out to all counties. The goal is to have all 100 counties utilizing the BSM tool
by July 2015.
Alamance County
Cumberland County
Jones County
Avery County
Dare county
Lincoln County
Stanly County DSS Albemarle
NC
Stokes County
Bertie County
Dare County
Macon County
Surry County
Brunswick County
Davidson
Martin County
Union County
BSM03-Robeson
Davie County
Mitchell County
Vance
Camden County
Duplin County
Moore County
Wake County
Carteret County
Edgecombe County
Nash County
Wake County_ATC
Caswell
Franklin
Pamlico County
Wake County_CW
Cherokee County
Gaston County
Pasquotank county
Wake County_Millbrook
Chowan County
Graham County
Perquimans County
Wake County_SRC
Clay County
Greene County
Person County
Yadkin County
Cleveland County
Hertford county
Polk County
Craven County
Hoke County
Rockingham County
Cumberland
Jackson County
Rutherford County
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3
FNS Issuances Over Time
1 Nov
2
2013 ARRA funding was removed by policy.
Oct 2014 Benefits increased based on Federal COLA adjustments.
Previous Months
Jun
Jul
Aug
Sep
Oct
Nov
# of
Payments
Issued
812,840
823,224
838,938
822,209
836,768
818,561
Amount of
Payments
Issued ($M)
$197.5
$198.9
$201.4
$198.1
$207.3
$204.4
Dec
Current Month
Jan
Feb
Mar
Apr
May
820,150 816,383 808,908 819,079 808,933 806,485
$204.1
Draft
$200.4
$199.1
$200.1
$198.0
$198.5
June 2015
(as of 6/3)
111,300
$30.0
4
FNS Applications Processing Status
 Counties successfully met Feb. 10, 2014 and March 31, 2014 USDA FNS processing deadlines.
*There will always be some applications that remain pending with good cause. As of May 31 st, 727 untimely
pending applications remained.
Note- An influx of applications began being received from Intuit (Turbo Tax) on January 9th and continued through April 15 th,. These
must be processed in the same manner as other FNS applications and may cause an increase in untimely pending FNS applications
beginning in February. This increase in pending FNS applications may in turn cause an increase in pending FNS recertifications.
Several days of winter weather impacted county office operations in Feb. 2015.
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5
FNS Recertifications Workload Snapshot
 Counties successfully met Feb. 10, 2014 and March 31, 2014 USDA FNS processing deadlines.
*There will always be some recertifications that remain pending with good cause. As of May 31st, 1,529 untimely
pending recertifications remained.
**The April increase is primarily attributable to a large spike in one county. The county has developed a Plan of Action and is
working with State leadership to remediate the issue within the next 30 days.
Note- An influx of applications began being received from Intuit (Turbo Tax) on January 9th and continued through April 15 th,. These must be processed
in the same manner as other FNS applications and may cause an increase in untimely pending FNS applications beginning in February. This increase in
pending FNS applications may in turn cause an increase in pending FNS recertifications.
Several days of winter weather impacted county office operations in Feb. 2015.
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6
Overall Medicaid Applications Processed
• Overall Medicaid Apps includes Adult Medicaid (includes SDX), Traditional Family and Children’s Medicaid, and MAGI
Family and Children’s Medicaid (including those from HealthCare.gov).
*Data as of June 3rd
**Several days of winter weather impacted county office operations in Feb. 2015.
***The quarterly SDX catch-up was processed at the beginning of April.
Note- An influx of FNS applications began being received from Intuit (Turbo Tax) on January 9 th and continued through April 15th,., 2015. These
must be processed in the same manner as other FNS applications This increase in pending FNS applications may in turn affect Medicaid
application processing due to increased workload, most likely in counties where workers work both FNS and Medicaid applications.
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HealthCare.gov Open Enrollment Comparison
ACA Year 2 Open Enrollment
ACA Year 1 Open Enrollment
*Data as of June 4th

During Year 1 Open Enrollment (2013-2014), NC did not
begin receiving applications from HealthCare.gov until
January. This caused applications from Oct.-Dec. 2014 to
accumulate, creating a burden for our counties.

For Year 2 Open Enrollment (2014-2015), NC will receive
applications from HealthCare.gov as they are submitted,
which will help create a more steady workload of
HealthCare.gov applications. Year 2 included a Special
Enrollment Period (SEP) from March 15 to April 30.
Note: CMS notified States on May 22, 2015 that there was an
issue on the Federal side regarding the Account Transfer
functionality. CMS will be sending a total of 9,168 account
transfers to NC over the next few weeks. NC FAST notified the
counties last week.
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HealthCare.gov Applications by Status
•
•
•
70,635 applications from 2014-2015 Open Enrollment submitted at healthcare.gov (FFM) have been transferred to
NC FAST.
87% of those applications have been fully processed by the state.
12% of the fully processed applications were approved for Medicaid; the remainder were denied or withdrawn.
Note: CMS notified States on May 22, 2015 that there was an issue on the Federal side regarding the Account Transfer functionality.
CMS will be sending a total of 9,168 account transfers to NC over the next few weeks. NC FAST notified the counties last week.
2013-2014 Open Enrollment
Status of Healthcare.gov/FFM Applications
FFM applications received by NC FAST
Total FFM applications being processed
Total FFM applications fully processed
Applications approved for Medicaid
("woodwork effect")
Applications denied for Medicaid
Application Count
86,932
2014-2015 Open Enrollment
Application % Application Count Application %
100%
70,635
0
0%
8,999
13%
86,932
100%
61,636
87%
9,004
10%
7,287
12%
77,928
90%
54,349
88%
Duplicate Application
7,063
9%
10,649
20%
Already on Medicaid
12,441
16%
11,944
22%
Withdrawn/ Found Ineligible
58,424
75%
31,756
58%
Data as of June 4th
•
•
•
•
•
The 2013-2014 counts were adjusted to report “Already on Medicaid” as its own category, rather than a subset, to provide a better comparison between
2013-2014 Open Enrollment and 2014-2015 Open Enrollment.
2014-2015 Open Enrollment Dates: November 15th - February 15th; Special Enrollment Period for Tax Season: March 15th – April 30th
Approved: Applications approved for MAGI-based programs from the FFM
Denied: Applications denied for MAGI-based programs from the FFM (this includes duplicate applications, applicants already receiving Medicaid, applicants found
ineligible, and out of state applications.)
Withdrawn: Applicant requested to withdraw the application
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Pending Medicaid Applications
•
There are currently 9,062 pending Medicaid applications that are beyond standard processing time
(Compared to 2014 peak of 104,070):
•
•
•
HealthCare.Gov Applications: 1,224 (Compared to 2014 peak of 45,058)
NC-Based MAGI Applications: 1,524 (Compared to 2014 peak of 31,890)
Traditional Applications: 6,314 (Compared to 2014 peak of 20,938)
*Data as of June 3rd
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Total Untimely Pending Medicaid Applications
 We continue to monitor statewide and individual county progress in working through untimely
pending Medicaid applications.
 Since the peak of untimely pending applications at the beginning of June 2014, counties
have been successful in lowering the overall backlog by 91% which includes a reduction of
approximately 95,000 untimely pending applications.
 30% of the untimely pending
Medicaid applications are directly
related to Affordable Care Act
changes.
*There will always be some applications that remain pending with
good cause.
Draft
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Untimely Pending Medicaid Apps- Most Impacted Counties
by Total Untimely
County
Wake
Mecklenburg
Forsyth
Randolph
Gaston
Davidson
Onslow
Durham
Rockingham
Guilford
Rowan
Iredell
Harnett
Pitt
Burke
Hoke
Buncombe
Halifax
Union
Columbus
TOTAL
Change
from Last
Week
129
64
2
9
25
-1
-8
22
-1
-1
9
4
11
-11
12
2
-4
-8
-9
24
270
Total Untimely
Total Untimely
Untimely
Pending Applications Pending Applications HealthCare.gov Apps
(as of 5/27)
(as of 6/3)
(as of 6/3)
1,834
1,212
619
462
348
283
195
217
168
159
155
147
151
124
145
134
123
119
118
143
6,856
1,705
1,148
617
453
323
284
203
195
169
160
146
143
140
135
133
132
127
127
127
119
6,586
157
153
75
66
61
47
44
4
90
1
48
10
5
17
3
27
3
4
38
16
869
Historical Avg. # of
Medicaid Apps
Processed (in EIS)
Total Apps Processed
in Current Month
(as of 6/3)
4,987
6,704
2,976
1,088
2,141
1,345
1,177
2,145
599
3,486
1,472
1,157
858
1,160
819
380
2,195
593
1,262
599
37,142
939
1,222
434
168
254
212
177
239
85
390
172
119
131
151
109
61
361
60
145
99
5,528
• Of all Medicaid applications beyond the standard processing time, 73% are from 20 counties.
• 13% of the pending untimely applications are from HealthCare.gov
• The following county is no longer considered a Most Impacted by Total Untimely county: Cumberland
• The following county has been added to the Most Impacted by Total Untimely list this week: Union
*There will always be some applications that remain pending with good cause.
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Untimely Pending Medicaid Apps- Most Impacted Counties
by Volume
County
Pamlico
Hyde
Washington
Graham
Randolph
Hoke
Wake
Yancey
Davie
Rockingham
Jones
Avery
Halifax
Davidson
Forsyth
Columbus
Onslow
Mecklenburg
Mitchell
Moore
TOTAL
Current Untimely Medicaid
Applications as a % of Typical
Monthly Application Volume
Total Untimely Pending
Applications (as of 6/3)
Historical Avg. # of Medicaid
Apps Processed (in EIS)
Total Apps Processed in
Current Month
(as of 6/3)
89%
67%
66%
58%
42%
35%
34%
33%
30%
28%
24%
24%
21%
21%
21%
20%
17%
17%
17%
16%
25%
82
25
82
48
453
132
1,705
40
73
169
20
28
127
284
617
119
203
1,148
17
99
5,471
93
38
125
82
1,088
380
4,987
123
240
599
83
118
593
1,345
2,976
599
1,177
6,704
103
602
22,054
18
7
15
9
168
61
939
23
20
85
10
18
60
212
434
99
177
1,222
25
100
3,702
*There will always be some applications that remain pending with good cause.
• The following counties are no longer considered Most Impacted by Volume counties: Burke, Harnett
• The following counties have been added to the Most Impacted by Volume list this week: Moore, Onslow
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Medicaid Recertifications Processed
 Historically, the average number of recertifications processed each month in EIS is 82,191. The average
overdue recertifications per month is 7,166, and the average extended per month is 6,578.
 December 2014 through April 2014 totals are increased due to the Medicaid Waiver extensions.
*Data as of June 3rd
**Family and Children’s Medicaid recertifications were auto-extended for 41 counties on the evening of May 20th
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Pending Medicaid Recertifications
 A total of 170,213 Medicaid recertifications are pending through the end of June 2015.
*Data as of June 3rd
**Family and Children’s Medicaid recertifications were auto-extended for 41 counties on the evening of May 20th
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Medicaid Recertification Workload
*Data as of June 3rd
**Chart illustrates number of recerts due through the end of June.
***Family and Children’s Medicaid recertifications were auto-extended for 41 counties on the evening of May 20th
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Pending Medicaid Recerts- Most Impacted Counties
County
Recerts Due through June (as of
June Recerts Due as of 6/3
Total Recerts Due Past Due Recerts as
"Typical" Monthly Average
6/3) as Percentage of "Typical"
(Originally Due and Extended
through June
of 6/3
of Recerts Due
Monthly Average
Due)
Harnett
Pamlico
Rowan
Pitt
Union
Rockingham
Watauga
Randolph
Granville
Martin
Surry
New Hanover
Guilford
Durham
Polk
Jones
Davie
Hoke
Wayne
Washington
Total
610%
378%
328%
327%
327%
321%
316%
306%
286%
269%
255%
239%
231%
216%
206%
201%
200%
180%
178%
176%
284%
9,672
632
7,113
5,098
4,656
3,441
1,096
5,941
2,052
795
2,946
5,106
9,957
6,678
389
288
827
798
2,435
311
70,231
217
27
454
715
312
306
77
278
292
18
142
75
909
485
7
15
140
31
274
65
4,839
9,455
605
6,659
4,383
4,344
3,135
1,019
5,663
1,760
777
2,804
5,031
9,048
6,193
382
273
687
767
2,161
246
65,392
1,585
167
2,170
1,557
1,423
1,072
347
1,944
717
296
1,156
2,136
4,314
3,089
189
143
414
443
1,371
177
24,710
Statewide
144%
170,213
10,777
159,436
117,998
• The following counties are no longer considered Most Impacted Medicaid Recertification counties: Johnston, Wake
• The following counties have been added to the Most Impacted Medicaid Recertification list this week: Hoke, Washington
Draft
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Pending Medicaid Recerts- Counties Caught Up by Month



Total of 50 counties are current on Medicaid recertification processing through the end of May.
Total of 57 counties are projected to be current on Medicaid recertification processing by the end of June.
Total of 59 counties have been removed from the end of month automated recertification extension process for F&C Medicaid.
End of
December
Caswell*
Cherokee*
Lee*
Lincoln*
McDowell*
Moore*
Current.- 6
Counties
Total Current- 6
Counties
End of
January
End of February
End of March
End of April
Anson*
Brunswick*
Franklin* Alexander*
Greene*
Alleghany*
Haywood*
Macon* (14%) Buncombe* Lenoir* (14%) Ashe*
Hertford*
Beaufort*
Jackson*
Camden* Perquimans*
Bertie*
Nash*
Cabarrus* Northampton*
Carteret*
Person*
Bladen* Richmond* (14%) Columbus*
Robeson*
Catawba* Rutherford* Chowan*
Stokes*
Edgecombe*
Wilkes*
Cleveland* Vance (26%)
Clay*
Transylvania*
Current- 2
Currituck*
Wilson*
Craven*
Tyrrell*
Counties
Dare*
Duplin*
Warren*
Remaining
Current- 1
County
Total Current7 Counties
Current- 15 Counties
Remaining Current- 13 Counties
Total Current- 20 Counties
Current- 16 Counties
Remaining Current- 15 Counties
Total Current- 35 Counties
Current- 10 Counties
Total Current- 45 Counties
End of May
End of June
(Projection)
Caldwell*
Forsyth*
Henderson*
Hoke*
Mecklenburg*
Avery
Gates
Halifax
Johnston
Orange
Sampson
Scotland
Current- 5
Counties
Total Current- 50
Counties
Current- 7
Counties
Projected Total
Current- 57
Counties
Note- Counties are considered “current” when they are within 10% of the typical monthly average for Medicaid recerts and remain
current on all other application and recertification workloads.
Counties in red were considered caught up in the month listed but had more than 10% of the typical monthly average remaining at the
end of May.
* Denotes counties where Family and Children’s Medicaid recertifications are no longer being auto-extended. Burke, Chatham, Davie,
Iredell, Swain, and Washington are also no longer being auto-extended.
*Data as of June 3rd
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Child Welfare Assessment Activities
The Child Welfare Committee is in the process of gathering information for the Business Plan.
Currently, members of the group are engaged in Business System Function (BSF) reviews,
conversations with other states to discuss lessons learned and visits to counties to document
business processes. These activities will help inform the overall business model and
implementation approach. The committee is also reviewing workload data gathered by DSS.
Basis of
Estimate
Update
BSF Review
Needs
Review
Industry
Surveys
and
Lessons
Learned
Business
Process
Review
Business Model
Implementation
Options
Business
Plan
Implementation
Dependencies
= Activities In Progress
= Activities Completed
Draft
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