Healthcare Access, Eligibility & Enrollment Unit (HAEEU)

What We Do

The Health Access Eligibility and Enrollment Unit (HAEEU) consists of five teams that each fulfill a specific function in helping Vermonters down the path from learning about health programs to applying, enrolling, and understanding their rights and responsibilities.

Eligibility & Enrollment Team works directly with members and is responsible for managing documents sent in by applicants, determining eligibility, assisting in enrollment, providing customer support through the call center, and resolving escalated cases.

Maintenance & Operations Team ensures that the Unit’s systems are well maintained and tested. They monitor the integrity, accuracy, and timeliness of transactions and are accountable for the overall success and delivery of Open Enrollment. They document policies and procedures, streamline business processes, and provide member facing staff with the training and knowledge needed to be operationally ready. During Open Enrollment they manage outreach and education efforts, helping Vermonters understand health insurance terms, compare options, and get the most out of their health coverage by communicating with community partners, including hospitals, clinics, agricultural organizations, libraries, pharmacies, and other stakeholders.

Data Team reconciles file transactions between Vermont Health Connect’s case management system, billing system, health insurance issuers, and the State’s legacy ACCESS system. They maintain the Unit’s data and provide operational reports and dashboards.

Assistant Operations Team serves as the policy liaison for HAEEU. They provide guidance, direction, and interpretation of state health care eligibility and enrollment rules. They also direct the technical and operational implementation of those rules. Additionally, this team manages member notices, and application and form development.

Assister Team supports and manages the In Person Assister program which works to ensure that Vermonters have in person (or remote) assistance available to them to understand their benefits and responsibilities and help potential applicants understand health care programs and the application process. The program includes Assisters from 43 organizations throughout Vermont offering coverage of all 14 Vermont counties. Vermont In Person Assisters support thousands of households annually and each Assister organization has between 1 and 17 Assisters on staff. The Assister team also supports customers questions and concerns via the customer service email inbox and social media.

Who We Serve

HAEEU serves the more than 200,000 Vermonters who receive health benefits through Medicaid programs and/or the State's health insurance marketplace. Medicaid program members include those Vermonters who receive health coverage through Medicaid for Children and Adults (MCA), Dr. Dynasaur, Medicaid for the Aged, Blind and Disabled, VPharm, and the Medicare Savings Programs. The health insurance marketplace enrolls members in qualified health plans (QHP) and administers federal and state-based financial assistance, while also providing resources to Vermonters who buy unsubsidized health coverage on their own or through a small business.

How We Impact

Quality health coverage is a key ingredient of health and well-being. Vermont has one of the lowest uninsured rates in the nation and its health care system is consistently ranked one of the best, with one of the narrowest gaps in access between rich and poor residents. For many Vermonters, HAEEU is the doorway into this healthcare system.

Action Plan
  • Operational performance improvement as an on-going effort to continually improve processes, products, and the services we provide with DVHA and DCF staff acting as one unit that strives towards operational excellence and sustainability and continues its focus on technical development work with different IT platforms, leveraging different vendors, creation and restructuring positions, and an aggressive approach to minimizing the financial footprint created by contractors and large staffing numbers in the current fiscal year.
  • Advance several Integrated Eligibility and Enrollment products, including an online application, a customer portal that will allow Vermonters to apply online for benefits electronically, and reconfiguring and developing our systems to return premium billing to the carriers.
Measures
Time
Period
Current Actual Value
Current Target Value
Current
Trend
Baseline
% Change
PM
Sep 2020
90%
75%
2
181%
PM
Sep 2020
85%
95%
1
70%
PM
Sep 2020
0
15
7
-100%
PM
Sep 2020
100%
100%
36
0%
PM
Sep 2020
5.0%
5.6%
3
400%
Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy