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