Improving the Appropriate Collection of Revenue at a Local Health Department: The Medicaid Title XIX Match QI Project

The project team defined the existing Medicaid Random Moment in Time Surveys (RMTS) administrative match process using process maps and workflow analysis and used root-cause analysis to define the problem and identify two root causes—lack of perceived value among Department participants and lack of ownership/leadership of this activity. Team members identified several measures to monitor and collected data to better understand the problem. Measures included (1) response rate for RMTS, (2) number/percentage of RMTS that were incorrectly completed as “non-matchable,” (3) percentage of eligible staff conducting Medicaid administrative match activities who participate in RMTS, and (4) Medicaid-Eligible Recipients (MER) rate. The team reviewed other local health departments’ RMTS processes and identified needed improvements within our processes. Based on all of this work, the team determined that the major improvement initiative would include education and training of participating staff. There were three intervention phases, two of which were conducted by the project team, and one of which was conducted after the team disbanded and the project coordinator began. The first intervention phase consisted of general awareness-building among staff participating in the Medicaid administrative match activities. Project team members discussed with program staff involved in the project the importance of accurately responding to the RMT surveys and accurately describing their work at the moment in time listed in the survey. The discussions were fairly brief, cursory, and informal and occurred as part of an overall description of the project itself. That first intervention phase resulted in a slight increase in matchable moments and Title XIX administrative match revenue. The second intervention phase included formal training and the development/use of training tools to help staff more easily respond accurately and timely to RMTS. The team developed tools to facilitate improvements and understanding of the RMTS process and purpose. The training also educated staff about the importance of collecting and reporting demographics of clients. By doing this, staff provide a more accurate description of the population that they are serving; this is important because the MER rate goes up when the Department more accurately reports the percentage of Medicaid-eligible population. The Department is making continuous improvements in this process. The Department hired a project coordinator as “owner” of the process to continue the improvements when the QI project team finished. For example, the project coordinator implemented the third intervention phase. This phase involved a series of one-on-one and group conversations with staff in the Family Support Partnership program, which conducted the most Title XIX administrative match work. These intensive conversations again focused on training and education around the importance of the RMTS activities, how to complete an RMTS, and how to describe accurately what activity the staff person was doing during a designated moment in time. This changed participants’ attitude, showed them how this program benefitted them, and helped them see the benefit of adding more detail and taking time to accurately describe what they were doing during the moment in time. A key message was, “you are doing the work anyway; now you just need to document what you are doing.” The Department now has agency-wide involvement in training, education, monitoring and reporting, performance measurement, and quality control. We have defined measurements in place that can be evaluated.

The two main performance measures used to evaluate the impact of the QI project are (1) percent of all RMTS moments that are matched, and (2) revenue generated from Medicaid (Title XIX) administrative match activities. The project coordinator hired to sustain the improvements made by the project team sends quarterly dashboards to all supervisors/managers whose programs participate in Medicaid (Title XIX) administrative match activities. The dashboards include the two performance measures by Department, program, and individual staff.