In the first effort of its kind, an estimated 75% of California's 2 million uninsured children could sign up for health coverage through a Web-based registration process, the project's partners say.
The electronic enrollment initiative was designed to streamline the application process for the state's Medicaid program, Medi-Cal, and its Children's Health Insurance Program (CHIP), Healthy Families. In about 20 or 30 minutes, low-income families with children and expectant mothers who are eligible but not yet enrolled can apply for both programs and learn, in real time, where they likely are to be enrolled.
The program's goal is to speed the sign-up of new enrollees and improve the quality of demographic information.
A pilot test of the Internet application, called Health-e-App, was launched in January at multiple sites in San Diego County.
"Already in this community the news is spreading by word of mouth about this easier and faster way to enroll," says Sam Karp, spokesperson for the California HealthCare Foundation. "More people are coming in. Others are coming back faster with all of the proper information. People used to wait for answers in the mail, but the convenience of this new way is already demonstrating real value."
The California HealthCare Foundation invested $1 million in software development, testing and a forthcoming business analysis of the program's effectiveness. Other partners in the effort include the California Health and Human Services Agency, the Managed Risk Medical Insurance Board, which is a government advisory board, and San Diego County.
While the foundation will license the application to the state for no cost, a formal report on the pilot data is needed before a statewide rollout can be planned or included in a future budget proposal, says Bertha Gorman, a spokesperson for CHHSA. But Gorman agrees that Health-e-App's efficiency is promising.
"There is real excitement about the possibilities of increasing the enrollment of kids, and for other applications as well," Gorman says, noting that Gov. Gray Davis has requested a federal waiver to allow the state to expand enrollment by including certain parents in public insurance.
Between 1998 and 2000, California spent only $259 million of its $885 million federal CHIP allotment. Simplifying enrollment and eliminating the mailing of paper forms would remove one of the major barriers to access, Karp says.
Fully automated, Health-e-App was modeled after Turbo Tax, an interactive program that walks the user through an interview based on their circumstances. The significance of the Health-e-App service is the immediate interface with the state's eligibility system, Karp says, as well as with a database of health plans and providers.
Enrollees can choose their own physician if the doctor is in a participating plan, or they can find a new doctor based on specialty, language spoken, proximity to the applicant's home or other criteria. Dental and vision plans can be selected in the same manner.
Built-in error checks help speed up the eligibility determination. For example, a pregnant woman's due date can't be more than nine months away, Social Security numbers must have the right number of digits and a ZIP code needs to match the applicant's county.
While a survey from the Medi-Cal Policy Institute, a part of the foundation, reports that only about 26% of Medi-Cal enrollees have access to the Internet, Karp notes that 90% of the applicants currently go to community-based organizations where state-trained helpers can take them through the online process.
Approximately half of the applications in the San Diego pilot have been completed using wireless modems, Karp says.