Simplified Medicaid Application Process to Enhance Acceptance Rates

There are close to 16 million disabled and elderly beneficiaries of Medicaid in the United States. Each Federal government in the US establishes certain parameters for all states to follow, however, each state administers its Medicaid program differently, resulting in variations in citizen registrations across the country. Its major roadblock is its complex eligibility determination process, causing low enrollment.

Our client, a leading consultant company in the healthcare sector, wanted to build a web application for needy citizens to successfully apply for assisted medical care. The product would help streamline the lengthy and complex process of documentation and verifications to help more and more senior citizens reap the deserved benefits of assisted medical care and close the gap separating aided healthcare funding and the needy.

The complex eligibility determination process caused a slow rate of enrollment. There was tremendous potential for human error in documentation during the data transfer from paper-based forms to online systems, with the whole process being excessively dependent on individual field agents.

• Eligibility requirements and application forms are often lengthy, filled with complex legal terminology, and lack clear explanations leading to errors and incomplete applications.
• The lack of a unified application process across different states creates confusion due to state-specific requirements and variations in forms and documents.
• The application process requires multiple visits or interactions to gather and submit documents which is overwhelming and discouraging for users, particularly those with limited mobility or cognitive difficulties.
• The absence of guidance and support within the application causes abandonment and incomplete applications.

Build an interactive and responsive solution that streamlines the Medicaid application process for needy citizens and individuals with disabilities. This application aims to:

• Reduce complexity by simplifying complicated information and terminology.
• Accommodate variations in state-specific requirements while maintaining a consistent user experience.
• Ensure the application is accessible for users with varying levels of digital literacy and potential disabilities.
• Increase the number of successfully completed applications by reducing friction and confusion.

Our research began with conducting user and stakeholder interviews to discover the top tasks that each identified user type would perform using the application. We uncovered challenges, limitations, instructional gaps, dependencies, and motivations faced by the users through process maps, workflows, and user journeys.

 

 

The stakeholders in the process include:

• The Medicaid Application Agency, responsible for procuring and validating all the documents required to successfully apply for Medicaid.
• Field Agents employed by the Agency that visit applicants assigned to them and build the Medicaid forms. They are responsible for collecting the documents against the claims put forth by the applicant.
• Verifying Officers are responsible for verifying the application and paperwork submitted by the agent on behalf of the applicant and matching it against the state- and federal-mandated eligibility determination criteria.
• Applicant is the individual who is seeking welfare under Medicaid or their representatives (spouses, children, immediate family members, neighbors, caregivers, etc.) can connect with the agent on behalf of the applicant to complete the formalities.

Key Findings

• The average case duration is between 1.5 to 3 months, with new applications coming in weekly.
• The Medicaid application is extensive, completed over several meetings, each lasting 5 to 7 hours.
• A better interaction experience was noted when the field agents filled out the paper-based forms along with the applicant as compared to when the agent used his laptop to fill up the same data. However, filling out the paper forms meant that the agent had to spend additional time entering those details into the system.
• High incidence of verifying officers rejecting applications on grounds of insufficient or incorrect documentation. Review of each document takes up to 2 days.
• Agents find it difficult to manage their queue. They might often forget to track long open applications as they keep moving down in priority as new cases come in.
• Some applicants find the questions on the application to be intimidating owing to the technical jargon. They display discomfort while being probed on private matters in a manner that may appear pushy.

Ideation

A viable direction was to split the system in two – one app for the field agent and another for the applicant.

We brainstormed and picked specific areas for enhancements considering the top challenges and focus areas in mind to develop the proposed features for the Field Agent and Applicant.

From the field agent’s perspective

• Create a checklist so that they are aware of the right documentation which fulfills the eligibility criteria.
• Create a checklist to ensure that the information entered at the basic level is sans errors.

From the applicant’s perspective

• Create forms that are simple to read, understand and fill out.
• Develop a ‘What to expect’ pre-appointment orientation and checklist document.

User Feedback

Key Highlights of Medicaid Applicant Facing App

• Conversational Copy: Warm and personal language was used to create a pleasant interaction experience.
• Distinct Spacing: To assist people with motor skill issues in easy navigation.
• Minimal Features: Guided walkthrough of controls and features for the user to discover, making it less overwhelming for seniors.
• Contrast: Warmer, yellow-based tones with a distinct contrast to make sure the screens are easy on the eyes.

Key Highlights – Agent Facing App

• Kanban vs List View: Lets the users manage their cases with a listing style they prefer
• Data Sync Indicator: To notify the latest data sync, with a feature to do it manually anytime
• Quick Preview of Case Status: Users can view the status of each case with a single glance for better workflow management.
• Access to Documentation: Direct access to attached documents for each case provides a better understanding of the case’s progress.