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HomeMy WebLinkAboutMINUTES - 09232003 - C.89 FHS #50 TO: BOARD OF SUPERVISORS Contra FROM: FAMILY AND HUMAN SERVICES Costa COMMITTEE DATE: September 23, 2003 s p a; County SUBJECT: Healthy Families and Medi-Cal Outreach Report SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION(S): ACCEPT the attached report on the status of the Healthy Families Program and Medi-Cal outreach as recommended by the Family and Human Services Committee. FISCAL IMPACT: None CHILDREN'S IMPACT STATEMENT: The Healthy Families and Medi-Cal Programs support the community outcome: Children and Youth Healthy and Preparing for Productive Adulthood. BACKGROUND/REASON(S) FOR RECOMMENDATION(S): On September 23, 2003, the Family and Human Services Committee received an annual status report on the CCFutures project. Dr. William Walker provided an introduction to the report and a brief overview. Cheri Pies updated the Committee on the progress made enrolling children into the Healthy Families and Medi-Cal without impacting health care access. CONTINUED ON ATTACHMENT: X YES STATURE: s � ---- - - --------------------- ------------------- ------------------------ -- - -- --'- '- -r6 - ----- - - RECOMMENDATION OF COUNTY ADMINISTRATOR CbMMENDATION OF BOARD- RE OMMITTEE APPROVE OTHER SIGNATURE(S): FE RAL GLOVER,CHAIR J N GIO€A,MEMBER ACTION OF BOARD ON aEEMM 23, 2003 PPROVE AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN X UNANIMOUS(ABSENT N= AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN. ABSENT: ABSTAIN: ATTESTED SEPTDM 23, 2003 CONTACT: Dorothy Sansoe JOHN SWEETEN,CLERK OF THE 335-1009 BOARD OF SUPERVISORS AND CC: Sara Hoffman COUNTY ADMINISTRATOR CAO xr ,: By DEPUTY WILLIAM B.WALKER,M.D. CONTF A COSTA HEALTH SERVICES DIRECTOR WENDEL BRUNNER,M.D. PUBLIC HEALTH PUBLIC HEALTH DIRECTOR ��r, �n 597 Center Avenue,Suite 20 � Martinez,California CONTRA O S T1 1 t h C t/1..J S "r A 94553-4675 Fx3 -671HEALTH SERVICES As25 1s2 wbrunner@hsd.co.contra-costa-ca.us To: Family and Human Service Committee Date: September 10, 2003 Federal Clever, Supervisor, District 5 John Gioia, Supervisor, District 1 From: Wendel Brunner, MD Re: Healthy Families and Director of Public Health Medi-Cal Outreach Ensuring that all children in Contra Costa County who are eligible receive medical coverage, and enrolling there in a medical and dental home where they receive regular primary care and dental services, is a priority for Contra Costa Health Services. With the institution of Basic Health Care in Contra Costa in 2002, essentially all children in the county should be eligible for some form of health coverage. It is also important to enroll as many children as possible into Medi-Cal or Healthy Families to provide a revenue source for CCHS to provide children's health care. The task of outreach and enrollment into Healthy Families, and connecting children with a medical home, has been assigned to the Public Health Division. Enrollment in Medi-Cal is a collaborative effort with CCHS and EHSD. The attached report describes the enrollment and outreach activities over the last year, including some of the numbers and data available to describe those efforts. Most of these activities have been funded through a combination of limited county general fund and special grants, most recently including $80,000 from the federal Community Access Project (CAP) grant in Public Health. Beginning this fiscal year two changes have occurred which allow the Public Health division to restructure and streamline these activities, and take advantage of a new funding source. The first is institution of the Gateway Program by the State Health Department, which allows many children to receive presumptive thirty-day eligibility for Medi-Cal directly at the health provider's office. The State Gateway Program is implemented through the State Child Health and Disability Prevention (CHDP) program, which expands the scope of activities that State CHDP will allow our local CHDP programs to perform. The second factor is the change in the CCHS appointment system initiated July 1, 2003, which directs all persons seeking appointments who are not already in the CCHS system, to a financial counselor, who will determine eligibility for Medi-Cal and Healthy Families, or BHC. The State changes in the CHDP system allow us to relocate all of our efforts to bring children into health coverage and a medical home into the CHDP Program, where we can take advantage of state and federal funding available through Financial Federal Participation (FFP). As part of anticipated budget cuts, we have transferred a county-funded professional staff person from the Community Wellness and Prevention Program to CHDP to help organize these outreach efforts. This professional's salary will now be almost completely covered by state and federal funding. In addition, we are reassigning existing staff within CHDP to new outreach, enrollment, and medical home efforts. Most of these activities are now covered by state and federal funding. u Contra Costa Community Substance Abuse Services❑Contra Costa Emergency Medical Services a Contra Costa Environmentat Health Cl Contra Costa Health Pian ❑Contra Costa Hazardous Materials Programs n Contra Costa Mental Health 0 Contra Costa Public Health u Contra Caste Regional Medical Canter[l Contra Costa Health Cents The restructuring of the CCHS appointment system allows us to consolidate various CCHS contact points into one toll-free access number. The new outreach brochure in English and Spanish includes the 1-877-503-9350 number to call to access health coverage and services through CCHS. This number and brochure is being made available to community-based organizations and partnerships throughout the county who have contact with the population who need medical coverage and medical services through CCHS. cc William Walker, MD, Director, Contra Costa Health Services Page 2 HEALTH COVERAGE IN CONTRA COSTA COUNTY SEPTEMBER 2003 OAL To increase the number of families in Contra Costa who have health coverage and a medical and dental home. OUTREACH Integrating outreach into Public Health programs has been an ongoing activity for the past year. Community outreach occurs through health fairs,presentations,and information sharing at meetings. A brochure was developed that describes in brief the various health coverage programs available to children and youth in Contra Costa. This brochure has been distributed to Public Health programs so that they may provide basic information along with their program-specific information. Provider outreach has been a priority of the CHDP Program as it prepared medical and dental providers as well as school and community providers for the start-up of the CHDP Gateway to Health Coverage and the new appointment system. Since October 2002, the CHDP Gateway has been in development by various State committees and began in July 2003. During July 2003,484 children received services through the CHDP Gateway. Of the 484 children,74 did not request Healthy Families or Medi-Cal applications. Current Status: The CHDP Program is taking the lead in providing health coverage outreach for Contra Costa Health Services. The CHDP Program will.provide Public Health staff with updates on the changes in Medi-Cal and Healthy Families. They will also inform and link children and families with health coverage by focusing their outreach on day care centers,immunization clinics, WIC, family resource centers, and community events. HEALTH ACCESS DINE(HAI)_(Ir,-877-503-935Q) The Health Access Line is a toll-free line that continues to offer health insurance information to residents in English and Spanish and provides health coverage options including: Healthy Families, Medi-Cal, Basic Health Care, Kaiser Cares for Kids, and AIM. During fiscal year 02-03, the line received between 100-125 calls per month. Some of the calls were handled over the phone,while others resulted in referrals to a Certified Application Assistant (CAA) for application assistance. Although most of the referrals are to CAAs within CCH , the referral list includes CAAs from Community Services, Contra Costa Health Plan,La Clinica,Brookside Health Center, and West Contra Costa Unified School District. Current Status, The line is located at the Concord Public Health Clonic on Stanwell.Circle and since the new CCHS appointment system has gone into effect,the number of calls to the line has increased to 247 calls. Many of the callers had questions about Basic Health Care and Medi-Cal applications. In October 2003, the HAL will be transferred to CCHS' Financial Counseling Unit. This move will place the line and the callers in close proximity of the Financial Counselors whom refer clients to the HAL for assistance. The intent is to improve the assistance provided to callers and minimize the transfer of calls from the Financial Counselors to HAL and vice-versa. Contra Costa Hcalth Services—FMCH Programs I September 10,2003 NtQLLMENT/APPLICATION ASSISTANCE As an Enrollment Entity (EE), Contra Costa Health Services has 23 Certified Application Assistants (CAAs) registered with the State. Centra Costa residents obtain assistance in completing a Medi-Cal or Healthy Families application from a network of CAA's. Several sites have computers available and assist clients with the online application, Health-e-App. In Match 2003, due to budget cuts,the State Healthy Families Program eliminated training for individuals interested in being certified and eliminated technical support and assistance over the phone to CAA's. In Contra Costa,new staff will be trained on completing applications but will not receive a CAA number. This will limit our use of the online Health-e-App. During fiscal year 02-03, county departments and programs completed a total of 2,721 health insurance applications: Contra Costa Health Services (2,469), Community Services Department(91) and Contra Costa Health Plan (161). CCHS APPLICATION FY 2000—2001 FY 2001-A 2002* FY 2002- 2003 ASSISTANCE Healthy Families Unknown 1,731 942 Add a Child to Healthy Families Program Unknown 27 31 ?Medi-Cal Unknown 906 967 Kaiser Cates for Kids ' Unknown 22 23 Medi-Cal Applications for 136 180 197 Pregnant Women Medi-Cal A lications £or Adults Unknown Unknown 305 AIM 4 4 TOTAL APPLICATIONS 1,912 2,866 2,469 COMPLETED BY CCHS * Program funding was cut on June 30,2002,which included personnel that assisted with applications. F- -- —_..,.�. Application Assistance by Region FY 02-13 — I � West County 24% Central County 32% ®Central County . 0 East County ®West County East County 44% Enrollment assistance is offered by all CCHS program staff who are providing information and referrals about how to obtain health coverage to clients in the clinics, in the community and in the Contra Costa Health Services–FMCH Programs 2 September 10,2003 home. Much of this activity is not captured by current tracking methods. There are three sources that are tracked and are listed in the table below. lv"NROLLMENT ASSISTANCE F 2000—2001 FY 2001—2402 FY 2002-2003 404 Assisted Request for Information {RFIj Unknown (763 followed-up by Unknown School Lunch Process tele hone 541 138 Assisted State Referrals (RHA) (Followed up by (661 followed-up by 123 Assisted hone) telephone 511 Assisted Phone Calls to Contra Costa Unknown (975 calls were 731 Calls Received Health.Access Toll Free Line received between Jan-- i June 2002 TOTAL ENROLLMENT AssISTANcE PROVIDED 549 1,061 854 Cwmnt Status: Application and enrollment assistance will continue to be provided by the various community partners. Tracking the number of individuals CCHS assisted in completing applications will continue,and will be the responsibility of the CHDP Program. JJTILIZATION Our work has been focused on assisting families to enroll in a health insurance program,but we recognize that this is just one of the first steps to improving health outcomes. The CHDP Program provides follow up to ensure children are receiving the medical and dental services they need, and to ensure that families are utilizing their health coverage appropriately. C"umnt Status. The CHIP Program ensures that clients with a high-risk medical condition seek and obtain medical and dental care and learn to use their health insurance correctly. RETENTION The majority of the clients enrolled in Healthy Families and Medi-Cal are members of the Contra Costa Health Plan. According to the MRM- IB report of July 5,2003, there are 7,870 Contra Costa children enrolled in Healthy Families Program. Of these, x 2,876 (36.5°/x) are Contra Costa Health Plan (CCH) members. ■ 1,694 (21.5°1x) are raiser members. ■ 1,441 (18.3°/x) are Blue Cross members. ■ 1,250 (15.9%) are Health Net members. ■ 609 (7.79/6) are Blue Shield members Collaborative efforts to help families with children retain their medical and dental coverage included: a. CCHS staff assisted 92 individuals reapply for their annual re-certification of Healthy Families Program b. The Health Access Line assisted 131 individuals resolve problems related to :Healthy Families or Medi-Cal c. Financial Counseling and Public Health Nurses completed 2,690 Newborn Referral Forms and sent to EHSD for Continuous Medi-Cal Contra Costa Tlealth Services--FMCII Programs 3 September 10,2003 d. The Health Access Line telephoned 389 postpartum mothers to remind themm to follow up with EHSD to maintain.Medi-Cal coverage for their newborns. A checklist and an infant t- shirt were also mailed to each mother. Current Status. Can a monthly basis, the Contra Costa Health Plan sends a welcome packet to each new Medi-Cal and Healthy Families member. The packet includes a handbook on how to use the health plan,a provider directory and information on evidence of coverage. Postpartum women on Medi-Cal are seat a letter congratulating them on their birth and encouraging them to obtain health coverage: for their newborn. The Financial Counseling Unit and Public Health Nurses visiting newborns will continue to complete the Newborn Referral Form to facilitate continuous Medi-Cal for the infant. The CHDP Gateway will capture infants that were eligible for Medi-Cal but a Newborn Referral Norm was not completed. HEALTH AccESS 0ALTT1QN The purpose of the Health Access Coalition is to provide a venue for community-based organizations, school district representatives,community safety net providers,and health department programs to discuss access to care issues from a client and systems perspective. The meetings also include updates on the State's health coverage programs (Healthy Families Program, Medi-Cal,AIM, and CHDP) as well as CCHS'Basic Health Care Program. Luring this fiscal year, the Coalition spearheaded the outreach for "Cover the Uninsured Week," began to discuss a health care and transportation platform,and received updates on the impact of the State budget from Dr. Walker and Consumers Union. In addition, Coalition meetings offer agencies a place to network and identify new ways to collaborate on activities, events, or outreach. Current Status. A survey was conducted in July 2003 to obtain feedback from the Health Access Coalition members. Respondents suggested that community members could rotate facilitation of the meetings. Also, funding has been secured from Kaiser Permanente to host an Access to Care Community Summit in November 2003. The last summit was held in January 2001 when many of the changes in Medi-Cal and Healthy Families programs had not gone into effect. It is hoped that the summit will provide the Health Access Coalition with a new road map for their work in the next year and facilitate the changes in staffing and leadership that are being suggested by Coalition members. HEALTH QVERA+GE WORK R U TEERING +C)itilmrrrEE This group is comprised of representatives from Community Services Head Start, Contra Costa Health Plan,Public Health Clinics,CHDP, Financial Counseling, and FMCH. As recommended by Pacific Health Consulting Group a year ago, the group meets monthly to discuss ways to improve our county systems such as Continuous Eligibility (CE) Medi-Cal for newborns, the CHDP Gateway,the CCHS appointment system,and increase application assistance to the Spanish- speaking residents in West Contra Costa. Current Status. This group will continue to meet on a monthly basis to problem solve on issues related to access to care. A goal for this year is to increase the participation of EHSD in the work group. Contra Costa Health Services—FMCH Programs 4 September 10,2003