The rollout of ONE -- the new statewide health insurance computer system -- and attempts to improve the Ride to Care program dominated Health Share’s Community Advisory Council last week.
“I’ve got great news,” said Jon McDaid, regional outreach coordinator for Oregon Health Authority Health Systems. “We have what we call The Kentucky System implemented and we’re calling it the ONE System.”
Kentucky’s computer system, Kynekt, “was touted as the one that worked under the Affordable Care Act,” he said.
“The system interfaces with all different kinds of portals including the Oregon Employment Department and the federal Healthcare.gov site.”
The Oregon Health Authority is working to adopt the the Kentucky eligibility and enrollment system (kynect) for future enrollment in the Oregon Health Plan. The system will allow individuals and families to apply and enroll in OHP, as well as manage their information online.
ONE will not replace HealthCare.gov for Oregonians. HealthCare.gov is still the place to go to apply and enroll in private health insurance plans through the federal exchange and to find out if people qualify for tax credits and other financial help for private insurance plans.
The kynect system was chosen because of similarity in Kentucky’s and Oregon’s state Medicaid rules, policies and system interfaces. OHA has been working hand-in-hand with Deloitte Consulting to begin the design and development work needed to adapt the technology for use in Oregon.
As for a timeline, there are two components. The system will begin becoming available to OHA eligibility workers and other staff by the end of 2015.
For the public, the timeline is a bit different. The system is expected to become available to Oregonians who are applying for OHP for the first time in early 2016. However, for Oregonians who are current OHP members, they will be asked to renew their coverage using our current renewal process (which is a manual process through an online PDF or paper application). Once they renew in 2016, they will get more information about setting up an online account in the new system.
McDaid added that “MAGI Medicaid” is a new term the council should become familiar with. “MAGI stands for Modified Adjusted Gross Income.”
“Think of MAGI as the new population covered under Obamacare,” said Health Share CEO Janet Meyer. “This is part of the expansion.”
Mixed-eligibility households, in which some members may be eligible for Oregon Health Plan or Healthy Kids, will be referred to the right place.
“What makes me feel good,” said McDaid, “ we’re doing this and in user testing, things are going well.”
Ride2Care helps drivers submit timely bills, appeals
At the October meeting, councilors expressed deep concerns about the bumpy transition of non-emergency medical transportation service to Access2Care, known as RideToCare.
Clients were unhappy with the service and drivers were frustrated with late payments.
Crystal Rouse of Access2Care/RideToCare said 70 providers attended a meeting to discuss the issue.
“We went over their concerns with sample groups and that was absolutely amazing,” she said.
“We had a manual form, but there were language issues and system issues, and we sat down with them and got great feedback.”
Any payment denial from the third quarter was opened to appeal for seven days. Additional training was provided on how to appeal.
Of more than 2,000 denied trip payments, there were more than 1,600 appeals and a payout of more than $45,000.
“We want to make it clear, it’s not in our best interest to deny payments,” said Rouse, who estimated that 3 to 5 percent of rides are audited. When payments for legitimate services are denied, “We all lose.”
Kendra Hogue can be reached at [email protected].
