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FQHC Collaborative of Central Ohio 2013-14 Ohio Medicaid Enrollment Project 

Project Purpose: 

Inreach/Outreach: Increase the number of FQHC patients with Medicaid coverage by designing and executing an outreach and enrollment best practices Outreach: Increase the number of individuals with a regular source of primary health care (a medical home)

June 19, 2013 Work Session Objectives   

Shared learning on best practices for Medicaid enrollment – Inreach and Outreach Defining what collaboration means for this project Agreement on shared measures What assistance is most needed from Access HealthColumbus?


Medicaid Expansion Scenarios and Implications to business, government, health care, and the social sectors of Franklin County ACA/Full Expansion • Welcome mat= ~28,000 + New eligible = ~41,000 in Franklin County • Strong revenue and economic benefit for Ohio and counties • Budget scenario = by midnight 6/30/13, full 3 years 100% federal funding • Post budget scenario = potential for partial loss of 100% federal funding • Ballot scenario = target of Fall 2014, partial loss of 100% federal funding Partial Expansion after Jan 2014 • Insured: welcome mat + some new eligibles • Ohio House and Senate sub-committees looking at “reform” versus “expansion” • Potential HHS waiver similar to Arkansas No Expansion • Welcome mat = ~28,000 in Franklin County currently eligible • Loss of $13 billion in additional federal dollars to the state over six years • $59 to $88 million yearly penalties statewide for employers with low-income workers • Loss of significant DSH/HCAP funding for hospitals that serve low-income people • Loss of $1.8-1.9 billion in new net savings and revenue for state budget • Loss of economic impact between $8.6-19.8 billion • Loss of sales tax revenues for counties ~$375 million


Central Ohio FQHC Collaborative: 2014 Medicaid Expansion Planning estimated adult Medicaid eligibles up to 138% FPL with no regular source of health care

0 - 499

500 - 999

1,000 – 1,499

1,500 – 1,999

2,000+

= FQHC health center =Hospital/ED

= New FQHC 2014

= Sliding Fee Primary Care Site


Affordable Care Act (ACA) Scenarios

Example Current FQHC 6%

Commercial Medicaid*

With Exchange With Exchange? & Expanded Medicaid? 13%

49%

38%

42% 38%

Medicare* Uninsured

26%

13%

7% 54%

7%

7%

* “wrap around” payment for FQHCs


Shared learning on best practices for Medicaid enrollment Inreach and Outreach


Medicaid Enrollment: Getting Started This Time Tomorrow  

Craft Message In-Reach 1. Search medical records.  2. Get message out through text, doctors. Do not let them leave the health center without talking to enrollment worker. 

Outreach 1. Connect with people who do not already have a regular source of health care.  2. Partner with ER, signs at Dollar Store, meet them through Google, create a Facebook page. 


Who Will You Enroll? Welcome Mat only 

.

Reluctant but Reachable: Young, Diverse Families Connected, Low Income Women: The Medicaid/CHIP/SNAP connection

Partial or Full Expansion 

Desperate & Believing: Sick, Poor, Least Educated


What do We Know about These Segments?   

Demographic profile Current mindset towards enrollment Core communications findings (Top facts they need to hear, top motivators to enroll, best messengers) Typical Behaviors  e.g.

Smart phone, text, Facebook, shopping at dollar store in past month

From Udem & Perry


Helping People Move to Where They Want to Be 

Use these four most important facts in an awareness campaign There will be new, affordable insurance options. 2. It will cover doctor’s visits, hospitalizations, maternity, ER care, and prescriptions. 3. Free or low cost (for Welcome Mat and Medicaid Expansion) 4. The plan will be explained to show coverage, costs (if any) in simple language and no fine print. Appeal to core motivations Address skepticism 1.

 


Connected, Low-Income Women (9%) 

39% are uninsured - with nearly a third (30%) in the expansion population. Sixty-percent of this cluster is connected to Medicaid - 30% receive it themselves, and another 30% say someone in their home is enrolled in Medicaid or CHIP. A majority of this cluster is women (75%). This is the lowest-income cluster - 77% are under 139% FPL. Slightly more than half (55%) has a child under age 18. This cluster has a fairly representative mix of race, ethnicity, and age.

This is among the sickest clusters 44% have a chronic condition and 40% rate their health as fair or poor.

Top Facts:   

Top Motivators   

Learning about financial help Sample Medicaid incomes with “free or low cost plan” What services are covered may help move this audience.

Plan will be there for you. Financial security Free or low cost

Top Messengers     

Someone like me who tried it Someone from the Medicaid office Someone from a state health agency Doctor Family member (spouse, mom, sister)


Reluctant but Reachable (10%) 

They are the one of the youngest clusters (40% are ages 18 to 29) and earn among the lowest incomes - 50% are under 139% FPL. They are among the least educated (62% have a high school degree or less). A majority (55%) are parents of children under 18, and 36% say someone in their household is enrolled in Medicaid or CHIP

Top Facts:  What is covered 

Financial help

No denial for pre-existing conditions

Top Motivators:  Plan will be there for you1. 

Financial security

Free or low cost

Top Messengers:  Doctor 

Someone like me who has tried it

Someone from state health agency

Family member (Spouse, then mom)

Someone from Medicaid office


Desperate & Believing: Sick, Poor, Least Educated (8%) 

They are the most Latino cluster (53%) and the least white (14%), with 23% African Americans. They are split on gender and include a mix of age - with most under 50. They are low income (52% are under 139% FPL) and are the least educated. They are also the sickest cluster - 43% say they are in fair or poor health. They are the second most likely group to be connected to Medicaid or CHIP (52% say someone in their house is enrolled). Attitudinally, this group is the most reachable - about 80% to 100% are extremely interested in new options, They do not need convincing, they just need education - they are the least aware of new options (12%). 66% have shopped at the dollar store in the last month.

Top Facts:  What is covered  Can’t be denied for pre-existing conditions;  Simple language, no fine print Top Motivators:  Financial security  Find a plan that is free or low cost;  Mandate Top Messengers:  Someone from Medicaid office  Someone from federal or state health agency  Doctor  Family member  Some like me who tried it


Most Are Connected Online 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Frequent Facebook User Smart Phone Made website Internet User User purchase in last 30 days Total

Uninsured

Expansion

Expansion defined as >139% FPL

Uses text


Make Technology Work for You 

Map Your Progress  Use

free or low-cost online mapping tools at HealthLandscape.org to develop a community-wide sense of where work is being done, where progress is being made, and where there are gaps that need to be addressed.  For example, you can map concentrations of uninsured people by primary language spoken and % FPL. In addition, you could map concentrations of children enrolled in Medicaid, whose parents may be eligible for coverage in 2014.


Make Your Data Work for You 



Use current internal data systems to help identify uninsured patients and offer them assistance to apply. For example, Health Centers already collect information about existing coverage when screening patients for Medicaid, CHIP and other programs. Make this data work for you. For instance, patients who are on sliding scale may now be eligible for a Medicaid.


Hold on to What You’ve Got 

Add a tickler to each patient’s record reminding patients to renew their benefits. Automatically send patients a postcard that includes consumer assistance contact info, and/or partner with companies that send out mass text messages. Place “apply and renew” messages in public waiting spaces. Call patients and remind them to renew, offering application assistance.


Develop a Outreach Program Plan 

End goal: No uninsured patient that is seen by a health center leaves without learning about new coverage options and the enrollment assistance that is also available. Build relationships with organizations that provide referrals of uninsured people to outreach staff. 

An Outreach Program Plan outlines goals, objectives, activities, responsible parties, timelines, expected outcome and data collection methods. Find an example: www.enrollamerica.org/healthcenters/Health_Centers_Important_ Role_in_Outreach_and_Enrollment.pdf


Open Enrollment begins October 1, 2013. Recognizing Everyone’s Role: For example Provide basic education to front desk and/or receptionist staff about coverage options so that when clients call with questions, staff have the tools to answer question consistently and refer people to the appropriate staff quickly.  Train patient accounts staff to refer patients who are in difficult financial situations to enrollment assistance services at the health center.


Stay On Top of the News    

www.enrollamerica.org www.healthlandscape.org www.udsmapper.org www.enrollamerica.org/best-practicesinstitute/webinar-archives/enroll-americasresearch-and-message-findings Others?


Questions and Reflections


Medicaid Project Collaborative 

What is the purpose of the project collaborative? 

Shared learning on design and implementation of best practices?

Shared measures of progress?

Shared communications on collective impact with public-private partners?

Shared Measures 

What will define success?  

Number of additional individuals with Medicaid coverage (inreach & outreach) Number of additional individuals with a regular source of health care (outreach)


What assistance is most needed from Access HealthColumbus?

• Please complete checklist in the next two weeks about what assistance from Access HealthColumbus is needed most • Based on your response, Access HealthColumbus will design and coordinate the next work session


June 2013 FQHC Medicaid Project Work Session Presentation Slides