sonoma county child health care access- health care coverage for every child ages 0-18 years at 300%...
TRANSCRIPT
Sonoma County Child Health Care
Access-Health Care Coverage for Every Child
Ages 0-18 Years at 300% of Poverty and Under
Norma Doyle, BSN, MPADirector of Maternal Child Health
County of Sonoma
Background
• Sonoma County has a population of
500,000 with 112,000 Children ages 0-18 years.
• 8,000 children are estimated to be without health care coverage.
• The majority of these children are below 200% poverty, age 12 and older, Hispanic, living in a single parent family with a woman as head-of-house.
• Lack of health care coverage limits access to health care, impacts the early diagnosis and treatment of health conditions or developmental concerns and appropriate linkage with resources.
Child Health Problem Analysis
Family may have children under different insurance coverage and had difficulty understanding varied retention and utilization policies
Child is able to get free immunizations thus doesn’t need health coverage
School age children appear “healthier or less in need of care: then their young siblings
Child is undocumented
Targeted Indicator: Children under 18 at 300% poverty or less need health care insurance
Consequences: Less preventive care, exacerbation of higher levels of disease and misuse of emergency room
INDIVIDUAL LEVEL/PRIMARY PRECURSORS
Family has difficulty making health insurance payments
Family may be very mobile or homeless and misses mailed notification of need to re-establish insurance eligibility
Child appears well, and not in need of health care
Seasonal work creates changing income and may impact families eligibility for coverage
Complexity to application process and annual redetermination for eligibility makes retention of coverage difficult for familyMedi-Cal seen by family as
government aid rather than insurance
Family leaves USA seasonally and drops insurance
Cultural perception that when health care is needed parent will pay for it or use a public program
Family has working parent(s) but no access to insurance through work
Family may have lack of knowledge about the importance of preventative health care
Medi-Cal seen by family as government aid rather than insurance
Public insurance programs have complex regulations, slow or faulty eligibility determination process
Stigma attached to using Medi-Cal
Societal belief that undocumented families don’t deserve health care
Health system has minimal providers who take children under public insurance
Health systems may have staff who show disdain for families using public insurance
FAMILY/INSTITUTIONAL LEVEL/SECONDARY PRECURSORS
SOCIETAL/POLICY LEVEL/TERTIARY PRECURSORS
Objectives
1. Create a community plan with key participants to provide policy development, fund raising and a detailed work plan for outreach, enrollment and retention of uninsured children in health coverage. (3-6 months)
2. Contract with a plan administrator for a product, which covers children who are uninsurable under public programs. (6-9 months)
3. Enroll children through a single portal, which links health care coverage and education on appropriate uses of health care. (9 months and ongoing)
Anticipated Results
1. Maximize enrollment of children in health insurance plan by three years.
2. Maximize retention within the health plan.
3. Improve use of preventive care and reduced use of emergency room use.
4. Long term funding identified to maintain available health insurance products .
Steps in Creating the Initiative
1. Key leaders met regarding the lack of health care coverage in Sonoma County.
2. They focused their efforts on children.3. Contractor helped obtain funds for
planning and creation of the system.
Key Partners
• Health Services Department• Human Services Department• Redwood Community Health Coalition
(coordinating agency for community clinics)
• Family Action (childhood advocacy group)
Health Services Role
• Convener• Provision of key staff• Administrative support• Processes contracts• Media Releases• Quality assurance• Evaluation
Early Accomplishments
• Business plan with enrollment projections, proposed expenses and revenues
• Outreach and media plan• Funding plan• Incorporation of other “like-
minded” local efforts
Training Plan for Assistors
• 12 hours state sponsored training• Training on new product• 1 week with a mentor on
applications• Monthly meetings with other
assistors• Access to Retention Specialist
Intake Flow Chart1. Outreach/ Inreach and information & referral
2. Program Screening including education & application assistance
5. Post-enrollment education & retention
4. Enrollment or denial follow-up
3. Product enrollment
Inreach
Outreach
Family
Eligibility Worker
CHIRepresentati
ve
CAA
800#
Medical EW
Healthy Family
Cal Kids
Kaiser
New Product
Family
CHI Rep
Resource Education
Utilization Refe
rral
OVERSIGHT ENTITY-Oversight for CAA/CHI Rep - Training-Regular information sharing meetings - Ongoing support-Troubleshooting team
800#
Family AppliesFamily comes into HSD seeking
services. Reception screens to see what they want to apply for:
Onsite CAA assists family with Children’s Health program
application(s), provides benefit information and directs family to mail premium to TPA and provide
verifications to assigned EW.
Application MC or HK is passes on to Mail in EW (MIM) for eligibility determination. EW certifies eligibility for:
Medi-Cal or Healthy Kids
EW sends (faxes?) Healthy Kids certification to TPA or carrier. HK information is entered into database.
Healthy Families referral made if appropriate.
Family is interviewed for all programs by an EW. Family is directed to provide verifications
to assigned EW. Family is directed to pay premiums to TPA.
Intake EW determines eligibility for Food Stamps and MC and HK programs. EW sends
notices to family. EW makes HF referral if appropriate. EW sends certification to HK or
TPA or carrier.
Case is passed to continuing
worker.
Case information is forwarded to CAA or Clerk Typist for
retention activities.
1. Family wants a Children’s Health Program only
2. Family wants a Health Program and Food Stamps
Application is referred to HF,
CK or K
Legend:MC = Medi-Cal K = Healthy KidsCK = CalKIDs K = KaiserHF = Healthy Families TPA = Third Party Administrator
Insurance Retention
1. Address updates with consumer at every contact
2. Consumer friendly and accessible documents
3. Reminder letters, postcard and/or phone calls for annual redeterminations
4. Consistent relationship with assistor
Major Accomplishments
• Funding from endowment for implementation and program coordination
• Formation of a steering committee with high level decision makers for credibility, sustainability and funding
• Formation of an operations Committee for detailed direction to the Coordinator on implementing multiple activities
• Formation of a Single Portal Committee who design the methodology for identifying, enrolling and retaining children on health insurance
Major Accomplishments
(continued)
• Release of a RFP to obtain a product and project administrator for coverage of those children who are ineligible for public programs
• Release of a RFP to obtain a funding consultant and media plan
• Identification of additional funding
Lessons Learned
• Have the right people at the table• Plan for time intensity within first year• Identify crucial information and take
advantage of opportunities rather than delaying actions
• Fix the current system before enhancing it
Barriers
• People who believed this couldn’t be done
• Lack of status as a Managed Care County• Complexity and rigidity of Medi-Cal
eligibility and redetermination system• Decreasing level of available health care
services• Changes occurring in the California Medi-
Cal system• Lack of a product for “uninsurable”
children
Overcoming Barriers
• Involve those who are doubtful• Work with state regarding options of
becoming Managed Care• Involve Human Service staff in
“personalizing eligibility”• Use family planning residents across
local health care clinics• Reframe the issue based on the
audience while maintaining the vision• Use the available products and heighten
enrollment and retention efforts
Evaluation
• Measure all progress by:– Sustainability– Effectiveness– Efficiency– Will our children be better insured
and better able to access health services than before?