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The Next Revolution: The Role of Informatics in Improving Health Care

Health e-app: Electronic Application for Health Families/Medi-Cal for Children and Pregnant Women

Slide Presentation by Sandra Shewry (Text Version)

On July 26, 2001, Sandra Shewry, made a presentation during the Web-assisted teleconference, The Next Revolution: The Role of Informatics in Improving Health Care entitled "Health e-app: Electronic Application for Health Families/Medi-Cal for Children and Pregnant Women."

This is the text version of Ms. Shewry's slide presentation. Select to access the PowerPoint® slides (1.3 MB).

Slide 1

Health e-app: Electronic Application for Health Families/Medi-Cal for Children and Pregnant Women

Agency for Healthcare Research and Quality (AHRQ)
User Liaison Program
July 26, 2001

Sandra Shewry, Executive Director
Managed Risk Medical Insurance Board (MRMIB)

Slide 2

Medicaid and State Children's Health Insurance Program (S-CHIP)

  • Reduce the number of children without health insurance coverage.
  • Medi-Cal (MC) for Children and Healthy Families (HF) programs are jointly marketed.
  • Applicants complete a mail-in application that serves both programs.
  • All applications are sent to the State's Single Point of Entry for income screening.

Slide 3

Application Process

  • Applicants apply on their own or with assistance from Certified Application Assistants (CAAs).
  • CAAs are paid $50 for each application resulting in an enrollment.
  • A PDF (printable) version of the application is available on the MRMIB Web site; it is mailed to the single point of entry (SPE).

Slide 4

Single Point of Entry

  • The SPE utilizes an automated business logic to screen applications for Healthy Families (S-CHIP) and Medi-Cal (Medicaid).
  • Logic screens for family composition and income.
  • Healthy Families applications electronically forwarded to the Healthy Families enrollment contractor.
  • Medi-Cal applications mailed to the appropriate county for processing (58 counties).

Slide 5


  • Health-e-App [HeA] is a Web-based, paperless application process.
  • Application data, supporting documentation and signatures are transmitted to appropriate entities through electronic interfaces or channels.
  • Used by CAAs in clinics, schools, and community-based organizations to help families apply for HF and MC (CAAs use notebook computers w/ wireless Internet connectivity to conduct enrollment in community—even in app's homes).

Slide 6

Data Flow

This slide features a diagram of the data flow in the Health e-app process. Data flows from the CAA/Applicant to the Single Point of Entry, and then to either Healthy Families (S-CHIP) or Medi-Cal (58 counties). Disposition flows from both Healthy Families (S-CHIP) and Medi-Cal (58 counties) into the Single Point of Entry, and finally back to the CAA/Applicant.

Slide 7

"Real Time" Features

  • Preliminary eligibility determination.
  • Instantaneous error checking to improve data quality.
  • Online selection of health plans and provider.
  • Automated computing of income/calculations.
  • Electronic signatures.
  • Generation of an application summary for applicants.
  • Application tracking.

Slide 8

Development & Testing

  • Public/Private Partnership between State and California HealthCare Foundation (CHCF contracted with Deloitte to develop, and worked with MRMIB and the Dept. of Health Services [DHS] to design & test).
  • Development effort took 2 years and cost $1M.
  • Successful Pilot Test completed in February (Partnership with Department of Health & Human Services [HHS] and State agencies; 6 sites in San Diego County.  School, clinic, Women, Infants, and Children [WIC], church.  Pilot sites still using HeA today.).
  • Independent Business Case Analysis conducted by Lewin Group (to measure HeA performance and quantify efficiencies and user impressions).

Slide 9

Business Case Analysis

  • Quality—Application errors were reduced by nearly 40 percent.
  • Speed—The time between application submission and eligibility determination decreased by 21 percent.
  • Satisfaction:
    • Ninety percent of applicants would rather apply online using Health-e-App and 95% of CAAs preferred using Health-e-App.
    • Applicants liked confirmation that their application was received and the immediate "official" decision, even if preliminary.
    • CAAs took to Health-e-App quickly, even those with little or no computer experience.

Slide 10


  • eSignature (concern about fraud).
  • Healthy Families Premium Payment (Premium must be mailed, does not always get sent; manual match up with the electronic data).
  • Matching faxed documentation to electronic submissions (Matching documentation sent after the application has been problematic.  Expensive (!) solution underway.  Would remove barrier if documentation reduced or self-cert permitted).
  • Design—States may need intermediary to help design and implement.

Slide 11

Next Steps

  • Add parents to automated application in conjunction with S-CHIP 1115 Waiver.
  • Automate Healthy Families Premium Payment.
  • Web-based Training for CAAs.
  • Rollout statewide to CAAs.
  • Incrementally bring on the Counties (interfaces will need to be built between SPE and the 58 counties to allow for electronic transmission of data and supporting documentation).

Slide 12

Electronic Signature

This slide displays a page on the Health e-app Web site where applicants sign their digital signature

Slide 13

Faxing Documentation

This slide displays the documentation fax cover sheet on the Health e-app Web site. Applicants can fill in personal information such as name, address, phone number, and a checklist of attached documents

Slide 14


This slide displays the login page on the Health e-app Web site where applicants must enter a username and password to gain access to the site.

Slide 15

Provider Selection

This slide features the Provider Search and Selection page on the Health e-app Web site that allows individuals to search for providers by name, specialty, gender, language, location and proximity.

Slide 16


This slide displays the map/directions feature of the Web site, which can provide door-to-door directions to providers' offices.

Slide 17

Error Checking

This slide illustrates the error checking feature of the Web site, which ensures that entered information is accurate so as to prevent delays and confusion later in the process. On this particular page, an error message appears after an applicant inadvertently entered "today's date" in the "date of birth" field.

Slide 18

Real-Time Determination

This slide illustrates the real-time nature of the Web site. After an applicant completes the online forms, the following message appears before one can proceed and click the "continue" button:

"You have successfully completed the application. To see which programs you and your children may be eligible for, click the button below. This is a preliminary calculation—your application is NOT being submitted at this point."

Slide 19

Real-Time Determination

This slide displays the Web page that lists preliminary eligibility of members for certain programs. On the screen is a table with members' names and the program they may be eligible for, such as Health Families or Medi-Cal.

Slide 20

Printable Application Summary

This slide features the application summary that appears on the computer screen at the end of the Health e-app process. The summary includes the members' names, contact information, and additional applicants (children, for example) if applicable.

Current as of August 2001

Internet Citation:

Shewry, S. Health e-app: Electronic Application for Health Families/Medi-Cal for Children and Pregnant Women. Slide Presentation (Text Version) presented at The Next Revolution: The Role of Informatics in Improving Health Care, Web-Assisted teleconference, July 26, 2001. Agency for Healthcare Research and Quality, Rockville, MD.

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