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HomeMy WebLinkAboutMINUTES - 02012000 - D2 D.2 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on February 1, 2000, by the following vote: AYES: Supervisors Gioia, Uilkema, DeSaulnier, Canciamilla and Gerber NOES: None ABSENT: None ABSTAIN: None Re: Enrolling Eligible Children into Medi-Cal/Healthy Families for Year 2000 On this date, the Board of Supervisors heard the reports from the Health Services Director and the Employment and Human Services Director for enrolling eligible children in Contra Costa County into the Medi-Cal and Healthy Families Programs in the Year 2000. (seethe attached Exhibits) Following presentation of the reports, the Board discussed the matter. Following the Board's discussion, Supervisor Uilkema moved to accept the reports, and Supervisor Gioia seconded the motion. The Board took the following action: ACCEPTED the Strategic Plans of the Health Services Director and the Employment and Human Services Director for enrolling all eligible children in Contra Costa County into the Medi-Cal and Healthy Families Programs in the Year 2000. I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. Attested:February 1 2400 Phil Batchelor,Clerk of the Board of Supervisors and County Administrator 13 i Dep rk OFFICE OF THE DIRECTOR BOARD OF SUPERVISORS WILLIAM B. WALKER, M. D. JOHN GIOIA, 1ST DISTRICT DIRECTOR Ht HEALTH OFFICER r""�-....,. GAYLE B.UILKEMA,2ND DISTRICT 20Allen StreetCONT � l�` T � �� COSTA � � �� DONNA GERBER,ARD DISTRICT Martinez, California MARK DESAULNIER ATH DISTRICT 94553-3191 SERVICES Y JOSEPH CANCIAMILLA, STH DISTRICT HEALTH Ph (925) 370-5003 V l! COUNTY ADM]NISTRATOR Fax (925) 370-5098 PHIL BATCHELOR DATE: January 26, 2000 TO: Board of Supervisors FROM: William B. Walker,M.D. Health Services Director John Cullen Employment and Human Services Director SUBJECT: MEDI-CAL/HEALTHY FAMILIES ENROLLMENT OUTREACH STRATEGIC PLAN FOR YEAR 2000 In December, Contra Costa Health Services and the Contra Costa Health Access Coalition held a Medi-Cal/Healthy Families Enrollment Summit to develop a strategic plan for enrolling all eligible children. The Summit was a huge success -- 75 people from 40 agencies including county departments, community based organizations,community health clinics,health insurance providers, local legislative/political staff, school districts, and child care agencies. Attached is the result of the Summit including a copy of the strategic plan and the brainstorming sessions which helped to determine the plan. The Contra Costa Health Access Coalition which includes Health Services as well as Employment and Human Services,continues to implement their work begun in December. In addition, both departments are in close contact with interested foundation funders who have identified enrollment as a priority for this year. At the February 1, Board of Supervisor's meeting,we will take an opportunity to bring you up to date with the development of the strategic plan and the changes we anticipate in enrollment, programs, and coverage in the next year. At that time, we can answer any questions you might have. cc .Phil Batchelor County Administrator 'f + Contra Costa Community Substance Abuse Services - Contra Costa Emergency Medical Services + Contra Costa Environmental Health - Contra Costa Health Plan + Contra Costa Hazardous Materials Programs -Contra Costa Mental Health • Contra Costa Public Health + Contra Costa Regional Medical Center + Contra Costa Health Centers MEDI-CAL AND HEALTH' FAMILIES ENROLLMENT/OUTREACH STRATEGIC PLAN MISSION STATEMENT The purpose of this summit is to develop an affordable, realistic strategic plan for enrolling all eligible children and their families in Contra Costa County in the year 2000. ONE YEAR GOALS (Year 2000 *Not in priority order) • Enhance capacities in school districts to adequately reach eligible children through the.Free and Reduced Cost Lunch.Program. • .Develop and deliver a truly trusted message to the immigrant population regarding the public charge • Determine current resources and develop adequate funding sources to do adequate outreach and follow-up in every community • Coordinate geographic assignments through neighborhoods to make sure that all appropriate families are contacted. • Develop and implement an understandable, simplified, coordinated Medi- Cal/Realthy.Families enrollment and outreach system SIX MONTH STRATEGIC OBJECTIVES (December 8, 1999 through June 30, 2000) ONE YEAR GOAL: Enhance capacities in school districts to adequately reach eligible children through the.Free and Reduced Cost Lunch Program. SIX MONTH STRATEGIC OBJECTIVES: 1. By March 15, 2000,the School Committee, in conjunction with School District Superintendents, will develop a template using best practices and request each school district to develop a plan for distributing the request for application through the food service administrator. 2. By June 30, 2000,the School Committee have an action plan from each of the 18 school districts to attach Health Families/Medi-Cal request for applications and information to free/reduced lunch packets in Fall 2000. t' Medi-Cal/Healthy Families Strategic Plan-Page 2 ONE YEAR GOAL: Develop and deliver a truly trusted message to the immigrant population regarding the public charge SIX MONTH STRATEGIC OBJECTIVES: 1. By March 15, 2000,the Contra Costa Health Access Coalition(Tracye Bishop CISCO)to lead)will enlist the support of faith organizations and other community-based organizations to review and revise, as needed,the public charge message. 2. By June 30, 2000,the Health Access Coalition(Francisco Dorado Health Access Coalition Staff to lead)will develop and distribute the amended INS public charge message to trusted community organizations(e.g.,the faith community). OBJECTIVE FOR FUTURE CONSIDERATION: By December, 2000, The Health Access Coalition will develop an evaluation process(e.g., focus group discussion)to determine the effectiveness the amended public charge messages. ONE YEAR GOAL: Determine current resources and develop adequate funding sources to do adequate outreach and follow-up in every community SIX MONTH STRATEGIC OBJECTIVES: 1. By January 15, 2000, Contra Costa Health Services(Julie Kelley), and West Contra Costa Unified School District(Robert Ayasse)will develop and implement a staffing plan to complete the enrollment assistance to the 2000 potential applicants in the West Contra Costa Unified School District. 2. By February 1, 2000, Contra Costa Health Services(Julie Kelley) and Employment and Human Services(Bob Hofmann)will identify existing public funding sources and the application processes. 3. By February 1, 2000,the Contra Costa Funder's Group will identify current and potential private funding sources and the application processes. 4. By February 15, 2000,the Health Access Coalition(Julie Kelley to lead)will establish a governing structure to developing a coordinated funding process and to serve as fiscal agent. 5. By February 15, 2000, Stephan Betz(CAD's Office)and Cheri Pies(Family Medi-Cal/Healthy Families Strategic Plan-Page 3 Maternal and Child Health)will present an executive summary to the Prop 10 Commission supporting allocation of Prop 10 dollars to Healthy Families/MediCal enrollment. 6. Beginning March 1, 2000,the Contra Costa Funder's Group will have developed guidelines for funding proposals submitted through the Health Access Coalition. ONE YEAR GOAL: Coordinate geographic assignments through neighborhoods to make sure that all appropriate families are contacted SIX MONTH STRATEGIC OBJECTIVES: 1. By February 1, 2000 and ongoing thereafter,Health Access Coalition(Francisco Dorado)will develop, update and maintain a Directory of all certified assistor individuals and organizations on the FMCH web site. 2. By March 31, 2000, FMCH Epidemiologist(Chuck McKetney)will utilize available data to identify the neighborhoods where a concentration of the population needing health insurance live. 3. By June 30, 2000,Employment and Human Services and Health Services (Bob Hofmann and Julie Kelley)will coordinate the establishment of five specific help- station/enrollment sites in non-traditional locations (e.g., Target, churches, provider sites, schools, etc.)on a permanent and/or regularly scheduled basis for enrollment and outreach purposes. ONE YEAR GOAL: Develop and implement an understandable, simplified, coordinated MediCallHealthy Families enrollment and outreach system SIX MONTH STRATEGIC OBJECTIVES: 1. By January 15, 2000,the Health Access Coalition(Francisco Dorado)will identify all outreach and enrollment efforts that exist currently in Contra Costa County to enroll families into available health care plans and programs. 2. By June 30, 2000,the Health Access Coalition(Yael Bloom)will assess the knowledge (e.g., eligibility,programs,who to contact,how to enroll)and training needs of 50% of the public and private agencies currently providing outreach and enrollment efforts in Contra Costa County. 3. By June 30, 2000,the Health Access Coalition(Bob Hofmann and Julie Kelley- leads)will begin to train public and private outreach workers to be knowledgeable about eligibility,programs,who to contact and how to enroll. Medi-Cal/Realthy Families Strategic Plan-Page 4 BRAINSTORM #1 WHAT'S GOING WELL WITH GETTING ELIGIBLE CHILDREN AND FA1VMIES ENROLLED IN MEDI-CAL AND HEALTHY FAAHLIES? • Certified Assistors component of the program • Healthy Start application available everywhere • One-on-one outreach by outreach workers • Access to the Healthcare Coalition • Working with the faith community getting word out from the pulpit • Increased communication among agencies • Increase in staff who make Medi-Cal determination • Changes in State budget which allow increases in family income • Funding allocations from the state to hire more outreach workers • Multiple efforts and consistency over time • We send out reminder postcards to come back and not give up • One-day enrollment fairs • Non-traditional sites with applications and process available, e.g. Rescue Mission, churches • Certified assistors at the Public Health clinics • More user-friendly Social Services Dept. working much faster • Social Service Departments located in neighborhoods • Qualified, experienced Medical working staff • Parents who call in for subsidized childcare are asking if they need the program • Toll-free telephone line • Health Access Coalition has helped by identifying funding and personnel • Healthy Neighborhoods tie-in • Additional linkages for those who are applying for Healthy Families • Reduction requirements to determine Medical eligibility by the State legislature • Having INS make clear the public charge • Efficient appeals process(has reduced fighting) • We're working on centralizing Healthy Families to one worker • Having the Cal Works workers out at the colleges where the students are • Building up faith and trust, especially with the Hispanic population • Using the Assistant Project Coordinator for Contra Costa County(Francisco) • Contra Costa Health Plan(CCHP)went from 100 members to over 500 • Increasing community awareness and outreach • West Contra Costa Unified School District(WCCUSD)sent out a request for application for free lunches over 2000 responded • revised application • Going to communities to get parents and families more involved,word of mouth • Allowing parents to use the mail-in process d Medi-Cal/Healthy Families Strategic Plan-Page 5 • Having our local politicians involved • Serving as an advocate to ensure the applicant is followed up on • TV commercials • Social Services and the Healthy Families are finally starting to work together and it's making a big difference • Reviewing emergency cards at selected elementary schools to see which ones don't show any health care provider • Outreach workers in East County going to clinics • Have an experienced, qualified Medi-Cal analyst(Sandy Baldwin) • Collaboration with CCHP in outreach efforts • Bilingual staff helps build trust • Working with Julie Kelley in the Antioch Medi-Cal office with Aid Code 38 cases to do outreach • Attending hundreds of health fairs • Not being dependent on the State for training of assistors • We are providing services to human beings and not taking their dignity away • Outreach that has been done through the jamborees and fairs • Shift in perspective from screening people out to wanting to provide services for which people are eligible Medi-Cal/Healthy Families Strategic Plan-Page 6 BRAINSTORM #2 WHAT'S NOT GOING AS WELL AS YOU WOULD LIKE WITH GETTING ELIGIBLE CHILDREN AND FAMILIES ENROLLED? • Not having providers involved in the application process • 800 number is often busy-- sometimes a 30 minute wait • Gathering documents takes several interviews • Not enough community outreach on the issue of public charge • Inadequate information regarding denial • Different information it's not always the same • 'urn over of Medi-Cal staff • Some families turned off by first Healthy Families application and never reapplied lack of funding for follow-up • Still have to document information to qualify for Healthy Families • No trained Eligibility Specialist at each site • Concern with confidentiality and release of information • Lack of cultural sensitivity • Medical coverage can't be separated by MediCal • People don't understand why they can't pay a premium to have Healthy Families or Medi-Cal • Families would rather have Healthy Families than Medi-Cal. • Lack of continuous advertising for the program • Problem with program review getting information back from families • Complexity of MediCal rules compared to the streamlined application for Healthy Families • Bundling Healthy Families and MediCal together was a mistake • Inadequate staff time for planning and execution • Undocumented children with medical needs have no medical coverage • People think Healthy Families and Medi-Cal are the same program • Clarification of public charge issue carne too late • Literacy level of application • Distrust of INS and concern about what will affect citizenship status • Lack of outreach in"wealthier"areas • No choice between Medi-Cal and Healthy Families • Reimbursement process for the collaborating agencies is problematic • People would rather not have insurance if they have to go to a"Social Services office" • Fearoflpreconceived notion of applicants fear of being denied coverage • Long waiting period to determine Medi-Cal eligibility • Except for those county departments directly involved(Health, Social Service, Community Service)there is a lack of enrollment involvement by city and county 4 CIO Medi-Cal/Healthy Families Strategic Pian-Page 7 agencies • Employers are not giving release time to allow eligible families to apply • Lack certified workers in the faith community • Continuing problem of getting information on immigrant status out to people • Targeting adults for Medi-Cal Healthy Families is just children and not adults • Lack of training around advocacy and follow-up • Parents who are not legal residents fear their children's opportunity to become legal not enough staff with ethnic and language backgrounds of potential applicants • Not getting Healthy Families forms out and in problems with the mail • Inadequate transportation to Medi-Cal offices,Health Centers • Not enough staff to follow-up on enrollment(i.e., gathering information) • Lack of a closer relationship with Social Services Department • Sent out outreach information last summer,but have not staff to do follow-up • Need outreach to businesses that employ eligible population • Stigma associated with welfare linked to Healthy Families -�'- Medi-CaUHealthy Families Strategic Plan-Page 8 BRAINSTORM #3 INTERNAL FACTORS/TRENDS THAT WILL/MIGHT HAVE A POSITIVE IMPACT ON ENROLLING ELIGIBLE CHILDREN AND FAMILIES IN THE YEAR 2000? • Election year • In 2000, all Medi-Cal applications will become mail-ins • Universal coverage is back on the political agenda • Report on universal coverage is due in December 2001 • Supervisors voted the tobacco funds to go to the Health Department • Collaboration potential with funders, schools,private sector and public entities * Boost 4 Kids project in Contra Costa • Surgeon General is moving toward eliminating disparities in public health trickle down effect • Internet becoming an advocacy tool • Technology for better communication • Changing state demographics with continuing momentum for change • More faith communities dealing with health issues • President Clinton has put aside$200 million in incentives for counties to enroll Applicants in Medicare • Census year • Proposition 10 allocates tobacco tax for services to children age 0-5 • Trend toward contract workers will cause people to apply for private insurance • Community based organization networking • More cooperation between different agencies than ever before • More useful information and materials available • Many children of immigrants are applying for the program • Increase in program eligibility to 250% of the federal guidelines • Greater information out about the detrimental effects of not having insurance • Health coverage is getting attention at the state and federal levels • Word of mouth from satisfied families • Technology exists to track families and kids Medi-Cal/Healthy Families Strategic Plan-Page 9 BRAINSTORM #4 INTERNAL FACTORS/TRENDS THAT WILL/MIGHT HAVE A NEGATIVE IMPACT ON ENROLLING ELIGIBLE CHILDREN AND FAMILIES IN THE YEAR 2000? • State's failure to publicize Medi-Cal and Healthy Families • Healthcare is not one of the governor's priorities • Fear of welfare reform • Rise Spanish-speaking community not enough resources to meet their needs • Factions who want to limit services to immigrants • Blindness to certain subcultures and their needs (e.g.,people on drugs) • Inability to service transients (e.g., lack of addresses) • No leadership to change coverage to include adults • Census may undercount or not provide the information we need to demonstrate need • Lack of childcare for parents when applying • Problems with the systemic way we deal with things not all parts are user-friendly • Lack of understanding of the Managed Care system • Negative perception of Managed Care • Lack of clarity regarding age of a pregnant mom and service/qualifications • Some children within a family may qualify others may not; results in different providers and programs • Fear of government services • Not enough funding sources to do training in outreach • Language barrier the materials handed out are often in a language or terminology that people don't understand • Rising uninsured rates • Lack transportation to clinics • Unknowns of the election year • People focusing on the one negative they hear about the program rather than all the positives • Within the same family, all may be covered,but some may have a share of costs while others don't--very confusing • No good point of contact when we have a questions about Healthy Families • Rising costs of health care and reimbursements of Healthy Families may not match • Divisive factors where some children in a family are covered because they are documented and those that are undocumented are not covered