Role

Staff Service Designer

SKILLS & SERVICES

• Rigorous end-to-end (policy, communications, data, operations, technical) systems analysis

• Qualitative and quantitative research probes

• Co-design

• Change management

• Wireframing

CODE FOR AMERICA Team

Revolving Code for America team, including:

• Dustin Palmer, Program Director

• Jacob Miller, Solutions Engineer

• Gabby Pietro, Qualitative Researcher

• Nalleli Martinez, Program Manager

• Nat Olin and Allie Morgan, Data Scientist

COUNTY PARTNERS

• Hennepin County Human Services

• Olmsted County Human Services

• Wadena County Human Services

• Beltrami County Health and Human Services

StakeholderS

• Minnesota Department of Human Services (DHS)

• MN DHS Health Care Eligibility and Access

• MN DHS Operations Analyst Team (OAT)

• MN MAXIS Eligibility Systems Team

IMPACT

This project ensured continuous health care coverage of vulnerable groups during the public health emergency unwinding and implemented simple processing measures for caseworkers that resulted in:

• 64% increase in non-MAGI automatic renewal rates

• 120,000 non-MAGI clients seamlessly maintaining coverage per year

• ~122,000 caseworker processing hours saved

• Distribution of $2 billion dollars in benefits

Personal Wins

• Collaborative developing an end-to-end, front-to-back new backend service collaboratively with caseworkers and state policy, operational, and technical staff that erased administrative burden for aged, blind, and disabled health care clients.

• Developing multi-purpose quantitative research surveys and data analytics that allowed us to understand both the time burden of each step of the process while also tracking program eligibility types to case outcomes for continued policy development.

• Improved communications and understanding between county staff and MN DHS leadership through pilot coworking and design sessions that lead to better policy, training, and operational guidance during statewide implementation

• Wrote a blog and spoke at Code for America Summit about the importance of building human-centered processes and solutions.

BACKGROUND

Ex parte renewals are a process by which government renews benefits using data that’s already available. Federal regulations require state agencies to attempt ex parte renewals for Medicaid coverage and check existing data sources before requiring clients to submit any paperwork. But ex parte renewals are underutilized, and there’s no time this process has been more necessary.

Most people have been kept on Medicaid since 2020 through continuous enrollment provisions that were included in federal legislation early in the pandemic, which was intended to ensure people kept benefits without hassle during the pandemic. But with the Public Health Emergency (PHE) unwinding, hundreds of thousands of people have lost Medicaid coverage and states across the country are facing a massive number of expected renewals; it’s a huge challenge for caseworkers—many of whom were hired during the pandemic and have never had to process Medicaid renewals—and clients alike.

In Minnesota, there was not an ex parte process for non-MAGI (aged, blind, and disabled) clients. Streamlining renewals for people who are aged, blind, and/or disabled is a huge opportunity to increase equity for a population where people have ongoing medical needs and whose Medicaid eligibility status is unlikely to change.

PILOT hypotheses SCOPING and PLANNING

COLLABORATIVELY IDENTIFYING PILOT GOALS AND HYPOTHESES

Following a scrappy test run with Olmsted County, the team prepared for a thorough pilot with 4 counties. I led the team in understanding the full end-to-end process, highlighting known constraints, open questions, opportunities, and pain points that would inform and improve the next pilot.

Gaining alignment on policy that informs eligibility determination

With a refocus on individuals with a Supplemental Security Income (SSI) health care eligibility determination category, I worked to visualize the system process and eligibility determination decision flow with Minnesota policy and program leadership. Questions that came up were able to be answered or researched on the spot. This decision and system flow then went directly into information training materials and operational guidance.

IDEATE ON COUNTY TOUCHPOINTS

I worked with program staff to ideate on the county touchpoints required throughout the pilot. We then identified for each touchpoint the: objective, presentation deck or materials needed, the dates, expected duration, additional support materials, and any associated tasks. During each phase of work we also identified timely moments for coworking sessions, qualitative research, and retrospectives.

COunty Selection

Minnesota is a county-based health care administration. This means that each county is tasked with administering health care to their residents. Counties therefore have generated many different processes to support their health care programs.

Looking ahead, we were would be considered during state implementation. Therefore, the goal became to pilot the process with counties who represented:

• Diverse population sizes (urban, suburban, rural)

• Shared processing structures with neighboring Tribal Nations

• Outsized elderly populations with a high social vulnerability index

We then set up a learning goal for each county which was then reflected on throughout the pilot.

DEFINING PILOT SUCCESS

Once we aligned with hypotheses we wanted to test, understood that the policy team was bought in, ideated on the pilot schedule and touchpoints, and thoughtfully considered county selection, we then defined our success criteria. With this, we began creating materials that would support success.

GENERATING PILOT TRAINING AND RESEARCH MATERIALS

DEVELOPING QUANTITATIVE SURVEYS THAT SUPPORT TRAINING

The companion survey helped us understand 1) how long it took caseworkers to complete this step and 2) what type of changes occurred on the case in between the first phase and the second phase of work. This would help us understand what edge cases we would need to think through during implementation.

We developed video trainings with a county leader to support quick onboarding.

Aligning on language FOR CASE NOTES AND COMMUNICATIONS

Caseworkers annotate actions they take on a case through a case note. Each caseworker has their own method for annotation. While this may work on the individual level, on the system level it becomes difficult to see trends in outcomes through these system notes. For the pilot we would need caseworkers to input the outcomes on their cases consistently.

Additionally, we would need to generate a one-off letter, called a SPEC memo. The SPEC memo would be sent to clients to notify them that they had been approved for their annual renewal automatically. We worked with both caseworkers and clients to align on shared language.

VISUALIZING A SIMPLIFIED PROCESS OVERVIEW

While a full service blueprint was not necessary for training purposes, a simplified process overview would help convey to caseworkers the nuanced timing of their actions.

Creating a shared place FOR UNDERSTANDING

With policy, communications, operations, and training all aligned, I created a simple google doc webpage to share with pilot county caseworkers that would outline everything they needed in one place.

This webpage included:

• The quantitative survey

• Training recordings and training decks

• Any updates and Q+A that were answered in our working sessions

• Case note and SPEC memo templates

• Detailed process steps

• Working session dates

RUnning At the Pilot AND STATE WIDE SCALING AT THE SAME TIME

coworking with counties and state staff

The Code for America team scheduled two working sessions across two weeks with each pilot county. We encouraged caseworkers to bring complex cases to walkthrough with one another. We shared screens and asked questions of each processing moment.

To support these efforts, we asked that Minnesota state staff have one policy and one operational representative in each meeting. This would allow for exploration of edge-case guidance and on-the-spot system issue spotting.

These sessions were a huge success: caseworkers got to speak to state leadership directly about their needs, state staff got to hear about caseworker issues that helped them further refine their guidance, and caseworkers learned from one another.

PREPARING FOR STATEWIDE IMPLEMENTATION

As we began the pilot, Minnesota DHS informed us that they would need to roll out our ex parte process to the state immediately. We were in the unique position to instantly roll over the things we were learning in the pilot into the statewide implementation plan.

During the pilot we saw a need for:

• a case selection list that would make it easier for caseworkers to identify the right cases

• edge case guidance for the trickiest cases

• automation of the most cumbersome part of the process: the SPEC memo

We quickly enmeshed with policy, operations, and tech team to support:

• Requirements development

• Training materials

• Operational guidance

• Communications development

• Policy development

This was completed in a 1 month timeline.

DEVELOPING COmmunications pathways

A rising need was to quickly address duplicated notices that were being sent out to clients with conflicting information.

Because a rushed timeline, there was only one technical indicator (“Y” for yes) that would trigger an ex parte client communication.

Suggesting a “N” (for no) indicator would also allow the system to know when to suppress dual notices and would also support reporting outcomes for understanding who was eligible for ex parte and be able to update the case outcome if new information was found (such as moving, death, a new member on the case, or some other income or status that resulted in differing eligibility outcomes).

The operations and technical teams were able to address this in the moment which lead to a better client experience and reporting measures.

STATEWIDE MONITORING

With the statewide scale happening so quickly, we were concerned the time savings realized in the pilot would not hold during implementation. I worked with a data science colleague to develop a time measurement survey with reported outcomes to better track and flag state implementation.

rising opportunity

Following the successful implementation of the ex parte process in Minnesota, I internally advocated for this type of work to continue. With leadership, and teammates, we developed an ex parte service offering that enabled the cultivation of three additional state partnerships.