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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 – In-reach 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
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
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
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
0 - 499 500 - 999 1,500 – 1,999 2,000+
Central Ohio FQHC Collaborative: 2014 Medicaid Expansion Planning estimated adult Medicaid eligibles up to 138% FPL with no regular source of health care
= FQHC health center = New FQHC 2014 1,000 – 1,499 =Hospital/ED = Sliding Fee Primary Care Site
Affordable Care Act (ACA) Scenarios
6%
38%
7%
49%
Example Current FQHC
Commercial
Medicaid*
Medicare*
Uninsured
* “wrap around” payment for FQHCs
13%
38%
7%
42%
With Exchange?
13%
54% 7%
26%
With Exchange & Expanded Medicaid?
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?
Reluctant but
Reachable: Young,
Diverse Families
Connected, Low
Income Women: The
Medicaid/CHIP/SNAP
connection
Desperate & Believing:
Sick, Poor, Least
Educated
Welcome Mat only Partial or Full Expansion
.
What do We Know about These
Segments?
From Udem & Perry
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
Helping People Move to Where They
Want to Be
Use these four most important facts in an awareness
campaign
1. 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
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:
Learning about financial help
Sample Medicaid incomes with “free or low cost plan”
What services are covered may help move this audience.
Top Motivators
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
Expansion defined as >139% FPL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
FrequentInternet User
Facebook User Smart PhoneUser
Made websitepurchase in last
30 days
Uses text
Total Uninsured Expansion
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-practices-
institute/webinar-archives/enroll-americas-
research-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