Expanding Health Care Coverage

Project Title

Developing a Telephone Renewal System for New York State Public Health Insurance Programs

Grant Amount


Priority Area

Expanding Health Care Coverage

Date Awarded

August 21, 2008


Hudson Valley



In 2008, the New York State Legislature authorized a statewide enrollment center for public health insurance programs to supplement the existing enrollment infrastructure and provide beneficiaries with a centralized, statewide system for processing their Medicaid, Child Health Plus, and Family Health Plus renewals.

The enrollment center included an integrated call center for these three major health insurance programs, a telephone renewal system, Web-based renewal capabilities, and a centralized enrollment entity for processing applications for unique Medicaid programs with low volume in any one local district. Under this grant, PMB Healthcare Consulting (PMB) conducted technical work to inform the development and implementation of the new telephone renewal system. PMB outlined the scope of work for the development of the Healthcare Enrollment and Renewal Tool (HEART)—software intended to link the enrollment center to State eligibility systems, including the necessary features and functionality of the new system from a policy perspective.

This project was part of a larger NYHealth authorization that funded a series of quick-strike analyses to help the New York State Department of Health’s Office (NYSDOH’s) of Health Insurance Programs find ways to streamline and expand its public health insurance programs.

Read an NYHealth special report that contains a summary of findings from this authorization.

Complex renewal processes are major stumbling blocks to maximizing the health insurance coverage enrollment of all eligible people. In New York State, Medicaid, Child Health Plus and Family Health Plus experience tremendous levels of “enrollee churning;” between one-third and one-half of eligible beneficiaries fail to complete the renewal process and lose coverage only to reenroll months later.

PMB Healthcare Consulting will conduct the technical work necessary to inform and influence the development of a new phone renewal system that has been successful in other states. Until now, beneficiaries in New York State could only re-enroll via mail. For the first time, the State has the authority to offer telephone and Web-based renewals. Specifically, the project will create a renewal module within the State’s Electronic Eligibility Decision Support System (EEDSS) computer software, which contains questions to determine initial eligibility.