Case Study | Medicaid Eligibility Screener
In Partnership with Covering Wisconsin
In partnership with Covering Wisconsin, a federally certified, state-licensed navigator agency, CCL built an insurance eligibility chatbot that connects individuals to Medicaid application support, live chat help, and resources for frequently requested services.
2
Languages
(English, Spanish + refers to Hmong speakers)
500+
Hours staff time saved*
*estimate (see below for details)
The Problem
- Referrals are not being tracked
- Navigators spend 5-20 minutes per call on general questions and 30 – 90m on phone and in-person appointments
- Significant number of phone inquiries about Medicare (not in Covering Wisconsin’s service scope)
- Only available channel besides in-person appointments is phone appointments
- Limited Spanish speaking capacity
- No Hmong speaking staff (third most commonly spoken language in Wisconsin)
Solution Features
- Chat, SMS messaging, IVR
- Interactive Surveys
- Interactive, Simple Eligibility Screener
- Referrals to resources
- Live chat
- Call and appointment scheduling
- Multilingual interface
- Fully managed support and content strategy
- Continuous program impact monitoring
- Phone number list cleaning
- HIPAA compliant
Continuous program monitoring
CCL and program staff identified an unmet need during the initial project phase. Many Medicaid recipients in Wisconsin only have landline phone numbers, and physical mailers are difficult to track. We suggested implementing outbound IVR calls to members with a landline in addition to the planned SMS outreach about redetermination.
Solution
CCL worked with Covering Wisconsin to create a chatbot that would include information about Medicaid, an eligibility pre-screener to easily enter # of people in household and income and find out what insurance options they may be eligible for, and the ability for users to select how they’d like to be receive help — fill out an application themselves online; make an appointment with a Navigator that speaks their language; receive a text or call back; or speak with a live agent over chat or SMS during business hours. The chatbot was translated into Spanish and included information about where to access Medicare information to help users avoid occupying phone lines only to result in a referral to somewhere else or limited help in their language.
Results
- Over 4,000 people assisted to date.
- 500+ staff hours saved calculating difference between chat time interaction vs. call wait and duration. Usage peaks during open enrollment, freeing up even more staff time during busy season.
- 83% satisfaction rate: People received what they needed and were happy with the chat experience.
- Key insights data to inform program improvements:
- Services requested
- Most common inquiries
- Languages accessed
- Chat users by county
Mid project improvements (2023)
- CCL provided an interactive voice response (IVR) system that helped direct users to the correct resources via phone call.
- 6,000+ landline users assisted.
- 30,000+ outbound calls made re: Medicaid.redetermination and renewal for the Public Health Emergency unwinding.