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Process Mapping: A Brief Introduction

This module of the Self-Assessment Toolkit offers the following resources and information that will help states map their Medicaid and CHIP enrollment and retention processes from beginning to end:

  • This process mapping guide developed by the National Academy for State Health Policy details steps for states to map their processes
  • Visio is a software available for purchase from Microsoft that states may find helpful to electronically depict their final flow charts or maps 

Why Process Mapping? 

Maximizing Enrollment has worked with grantee states to complete a diagnostic assessment of their Medicaid and CHIP systems, policies, and procedures, and an important part of this assessment included the development of process maps—flowcharts illustrating all of the steps and elements involved in their enrollment and renewal systems.  This instructional guide seeks to help other states develop these process maps.  With these process maps, states can identify the strengths and weaknesses of their enrollment and renewal systems; potential barriers to enrollment and renewal; and places where they can make simplifications and other improvements in the future.

What are the Benefits of Process Mapping?

Process mapping allows organizations—state agencies, non-profit groups, or private companies—to identify effective and ineffective parts of their systems and determine where they can make improvements.  As a state Medicaid or CHIP agency leader, creating process maps for your enrollment and renewal activities will help you discover inherent strengths and weaknesses in your systems, reveal gaps, and expose any unnecessary steps.  In addition, as more states complete these process maps, states increasingly will have the ability to compare and contrast their activities and better identify where they can make adjustments.  Sharing the results of process mapping will allow you to see how your peers accomplish similar tasks and uncover promising practices that you could replicate in your state, with the ultimate goal of maximizing enrollment and renewal of eligible children.

With these objectives in mind, this guide provides technical assistance to help you create process maps for your Medicaid and CHIP enrollment and retention systems.  States with more fully integrated Medicaid and CHIP programs should complete process maps for their enrollment and renewal systems (at least two maps), and those with separately operating CHIP programs should create enrollment and renewal system maps for both programs (at least four maps), making certain to capture the transitions between the two programs.  Although you should make sure to depict your enrollment and renewal systems in separate process maps, you otherwise may use as many maps as necessary to understand the activities involved in your state.  We anticipate that the process of process mapping will allow you to identify opportunities and help advance your important daily work of reaching, enrolling, and retaining eligible children.

What Questions Can Process Mapping Help Answer

  • Is each part of your Medicaid and CHIP enrollment and renewal processes necessary?  
  • Are these processes run effectively?
  • Do staff members follow these processes as mapped?
  • What tasks in these processes are duplicative, and what additional steps could streamline them? 
  • At what points in these processes are the largest percentages of children losing coverage?
  • What steps in these processes are leading to disenrollment of or failure to capture eligible children?
  • What potential improvements would make these processes more efficient and maximize enrollment and renewal?
  • Which potential improvements would necessitate policy change, and which ones are possible without policy change

Process Mapping Considerations

  • Process mapping requires assembling a team of state representatives, ranging from high-level decision makers to front line eligibility workers, each of whom will provide input critical to creating maps of your Medicaid and CHIP enrollment and renewal systems.
  • Process mapping involves examining “how it gets done” not “how it should get done,” and you should indicate this goal upfront—possibly as part of a “mission statement”—to set the correct expectations when assembling team members.
  • Your team should closely examine and map the processes of enrolling and renewing children who qualify for Medicaid and CHIP based on income eligibility alone (e.g. not SSI or foster children) and capture the starting and ending points of the myriad of steps involved in these processes.
  • You should make sure to assign team members specific responsibilities required to complete these process maps.
  • You should expect to set aside several half-days over the next few weeks with your team because process mapping takes time and brain power and office resources.
  • In states without centralized enrollment and renewal systems, your team should consider selecting a large eligibility office to complete these process maps, having several sites create them, or choosing a representative region to develop them.

 Click here to begin process mapping!