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Automated-Health Systems
The Enlightened Choice
in Health Service Management
Enrollment Brokering

Family

To control Medicaid budgets but also increase low-income families' access to quality primary health care, sufficient momentum has gathered in many states over the last several decades

…to move the focus of medical care from the emergency rooms and clinics of neighborhood hospitals to alternative delivery sites, specifically to conveniently located community clinics (linked to backup hospitals) and expanded health maintenance organizations... 1

As a result, and as the rationale behind states' commitment to Medicaid managed care, many states

...have bolstered their efforts to successfully and effectively enroll a substantial proportion of the Medicaid-eligible population in HMOs as a means of controlling the steeply rising expenditures and improving the equality of care they receive. 2

To facilitate the change to this model of managed care, many states have launched enrollment brokering initiatives to ensure the success of the transition away from fee-for-service Medicaid or the PCCM approach. Serving as the link between the managed care delivery system and Medicaid consumers, the enrollment broker (normally chosen as the result of a competitive bid process) provides outreach, enrollment and education services from a single, unbiased source to Medicaid consumers about the available participating Medicaid HMOs in their area.


AHS' Enrollment Broker Contracts
Time Period Location Contracting Agency Program
2016 - Present Nebraska Nebraska Department of Health and Human Services Nebraska Heritage Health
2015 - Present Alabama Alabama Medicaid Agency Alabama Regional Care Organization (RCO) Initiative
2010 - Present Florida Agency for Health Care Administration Medicaid Reform Enrollment Broker Program
2006 - 2013 Illinois Department of Healthcare and Family Services Illinois Client Enrollment Broker program development and administration
1998 - Present Ohio Department of Job and Family Services Managed Care Plan Enrollment Services program administration
1996 - Present Wisconsin Department of Health and Family Services Managed Care Outreach, Enrollment and Education Specialist program administration
1996 - 2016 West Virginia Department of Health and Human Resources Health Benefit Manager program administration

These HMOs (through their associated primary care providers) function as the "gatekeepers" for Medicaid consumers-assisting, guiding and overseeing the utilization of health services. As many states prudently have recognized, however, an HMO's gatekeeping function is undermined if the consumer is not well-educated about managed care, the role of HMOs and PCPs, and helped to wisely choose the "best fit" HMO/PCP. Enrollment brokers educate the potential and current managed care enrollees with respect to these issues. Only if the Project staff delivers an accurate, understandable and culturally sensitive presentation can the benefits of managed care be realized. Fortuitously, this is what happens when Automated Health Systems, Inc. (AHS) is the enrollment broker, as we are in Florida, Illinois, Ohio, West Virginia, and Wisconsin. Additional information about these contracts is provided below.


1 Eli Ginzberg, Improving Health Care for the Poor: Lessons for the 1980's, JAMA, February 9, 1994, pp. 466.
2 Ibid., p. 467.

Nebraska Enrollment Broker Project

In 2016, AHS was awarded an Enrollment Broker contract with the Nebraska Department of Health and Human Services. Our approach to supporting the State in their implementation of Heritage Health, an integrated Medicaid managed care delivery system, is built on our proven approach to assisting members with making a best-fit MCO selection. Our approach:

  • Leverages our Choice Tools to maximize informed decision making
  • Streamlines assistance through tools that use plain language
  • Accommodates the diverse population and landscapes across Nebraska
  • Implements processes that minimize any time in FFS
Alabama Enrollment Broker Project

In 2015, AHS was awarded a contract to provide Enrollment Broker services for the State’s implementation of their Regional Care Organization (RCO) Initiative. Our proven support with helping members transition among various delivery systems provides us with the systems tools, educational message and outreach strategies, and member-engagement protocols will maximize informed decision making among members as they select a RCO and equip members to successfully navigate the new health care delivery system.

Florida Medicaid Reform Choice Counseling and Medicaid Options Project

In 2011, the Florida Legislature directed the Florida Agency for Health Care Administration (AHCA) to create the Statewide Medicaid Managed Care (SMMC) program. The SMMC program has two key components:

  1. The Long-term Care program
  2. And the Managed Medical Assistance program
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Illinois Client Enrollment Broker Project

AHS provided comprehensive, unbiased phone- and field-based outreach, education, and enrollment services to enrollees residing in counties where risk-based managed care and PCCM were jointly offered. We also provided comprehensive mailings, including initial New Enrollment Welcome packets, enrollment reminder letters, and auto-assignment confirmation letters. Our sophisticated website included not only links to all of our educational materials and a calendar with links to our outreach events, but also included a robust, secure online enrollment module.
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Ohio Enrollment Broker Services

In May of 1998, AHS was awarded a contract with the Ohio Department of Human Services (now the Department of Job and Family Services) to administer an Enrollment Services Project for the State’s Medicaid managed care expansion. Although the implementation time frames were tight, AHS met the deadlines and began providing services on July 1, 1998.
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Wisconsin Enrollment Broker Services

In 1996, the Wisconsin Department of Health and Family Services (DHFS, now the Department of Health Services) contracted with AHS to become the Enrollment Broker Contractor and assist the state with Medicaid managed care expansion. At that time, enrollment into Medicaid and BadgerCare HMOs (Health Maintenance Organizations) became mandatory for consumers in zip code areas where there were two or more HMOs available from which to choose. Additionally, we began to provide outreach, education and enrollment for the SSI Managed Care Program in 2005.
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West Virginia Health Benefits Manager and Enrollment Services Project

AHS has been the Health Benefits Manager and Enrollment Services contractor for the State of West Virginia since 1996. Prior to 1996, West Virginia Medicaid consumers all participated in Fee-for-Service. AHS actively helped design and implement the combination of a risk-based Health Plan component (Mountain HealthTrust, MHT) and a PCCM effort (Physician Assured Access System, PAAS). AHS worked extensively to network with community and provider groups and promote a successful managed care experience for West Virginia’s Medicaid enrollees.
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