REPORT TO THE FAMILY AND HUMAN SERVICES COMMITTEE ON CHILDREN S HEALTH COVERAGE IN CONTRA COSTA COUNTY SEPTEMBER 2004 RECOMMENDATIONS Maintain and monitor success of outreach and enrollment efforts in schools throughout the county. Identify data sources that provide current information regarding the number of individuals enrolled in the various health coverage programs. Assess the feasibility of creating a database or web-based system to coordinate the enrollment process among county departments to increase enrollment and eliminate duplication. Continue to promote a consistent message that serves to educate community residents about the importance of health coverage now and in the future. Secure funding to print and distribute materials for the It s No Secret media campaign designed to encourage parents to obtain health coverage for their children. Encourage the Board of Supervisors to identify access to care and achieving health coverage for all in Contra Costa County as a special focus for 2005. INTRODUCTION According to the Institute of Medicine, those who have health insurance have better health and receive better, more timely care than those who don't. During the past six years, Contra Costa County has been working to improve access to care by conducting broad-based outreach and education efforts to inform county residents about health insurance options, assisting families in enrolling in health coverage programs, and promoting retention in these health coverage programs through a variety of activities. These efforts are a result of collaboration across and among county departments, community-based agencies, community clinics, schools, and others. This report highlights the collaborative work of these agencies and provides a description of the various systems created by county departments to increase health insurance coverage for our youngest and most vulnerable populations. As part of our efforts to reach our goal to increase the number of families in Contra Costa who have health coverage and a medical and dental home we had several accomplishments during fiscal year 2003-04, including: Providing Medi-Cal/Healthy Families Application Assistance to 1,679 families Answering an average of 800 calls per day from families and adults seeking information and enrollment assistance from CCHS Financial Counselors Receiving and assisting a total of 1,647 callers who contacted us directly through the Health Access Line (1-877-503-9350) Enrolling 1,902 babies in Medi-Cal at the time of their birth to ensure continuous coverage during their first year of life Assisting 628 pregnant women to obtain Presumptive Eligibility Medi-Cal thus enabling them to receive prenatal care Enrolling and providing services to 6,584 children through the CHDP Gateway program Contra Costa Health Services Family, Maternal & Child Health Page 1
Telephoning and welcoming 6,411 new member households to Contra Costa Health Plan Hosting the Health Access to Care Summit in January 2004 BACKGROUND A May 2004 report stated that 6% of the population in Contra Costa was uninsured, 10% were covered by Medi-Cal, 1% by Healthy Families and 1.6% use County health programs 1. Approximately one in five children (1.85 million) in California has no health coverage. Children with no health coverage are more likely than insured children to go without needed health care services, even when they have serious conditions. One in four uninsured children has no regular source of health care. Children need a consistent medical provider where they can receive immunizations, regular preventive care, and treatment for acute illnesses and injuries. Children without a regular provider get sick more often as babies, are less likely to be immunized as toddlers, and are less likely to get treated for routine illnesses that can turn into serious health problems. BASIC HEALTH CARE Basic Health Care is the safety net health insurance program for low-income (up to 300% of the Federal Poverty Level) residents of Contra Costa County who are uninsured and do not qualify for other programs such as full-scope Medi-Cal and Healthy Families. During fiscal year 2003-04, the Basic Health Care program averaged 1,225 new members per month, with approximately 10% being children who are ineligible for full-scope Medi-Cal or Healthy Families. The Financial Counselors of Contra Costa Health Services oversee the Basic Health Care Program. Financial Counseling staff determine eligibility for the County s Basic Health Care Program; assist with the completion of applications and forms for enrollment in programs such as Medi-Cal, Healthy Families, AIM, Presumptive Eligibility, newborn enrollment, Breast and Cervical Cancer Treatment Medi-Cal and Tuberculosis Medi-Cal; and provide eligibility and enrollment information. These tasks are performed over the telephone and/or through a face-to-face interview process. Effective July 1, 2003, the financial counseling process was centralized, allowing clients to be screened for health insurance before a medical appointment is made. The Information Technology department created an Enterprise-wide Master Person Index (empi) to help identify callers who may not have health insurance or program coverage. Residents of Contra Costa County may dial a tollfree telephone number and be connected to a telephone call distribution system (ACD), which interfaces the empi. The empi automatically determines if the caller is a member of the County s Basic Health Care Program, Contra Costa Health Plan or a Medi-Cal beneficiary. If the caller does not appear to have health insurance, he or she will be routed to a financial counselor. When residents call our Central Appointment Unit/ACD for a medical appointment, they are asked to use their touch-tone phone to enter a unique identifying number. It may be a medical record number, a health plan ID number or a Medi-Cal (MEDS) ID number. This allows uninsured patients to have their calls routed directly to a financial counselor for application assistance and information regarding available health insurance programs. To improve the coordination of services and application assistance offered to clients, Certified Application Assistors (CAAs) were transitioned to the Financial Counseling Unit in 2002. As a result, Financial Counselors utilize the Health Services scheduling system, Cadence, to schedule faceto-face interviews for application assistance with the CAAs. Individuals or families may apply for 1 Overview of the Uninsured Contra Costa County 2003, Insure the Uninsured Project, May 2004 Contra Costa Health Services Family, Maternal & Child Health Page 2
Basic Health Care, Medi-Cal or Healthy Families over the telephone or receive face-to-face application assistance. The CAAs are located in the Richmond Health Center one day per week, Pittsburg Health Center five days per week, Brentwood Health Center one day per week and Concord Public Health two days per week. In fiscal year 2003-04, financial counselors and CAAs provided Medi-Cal and Healthy Families application assistance to 1,679 children and families. The CAAs answered an average of 183 calls per month and the financial counselors answered an average of 800 calls per day from families and adults seeking information and enrollment assistance. HEALTH ACCESS LINE (HAL) 1-877-503-9350 Contra Costa County has a toll-free Health Access number that any County resident may call for health insurance information and assistance. Persons calling this line are connected to all available resources including community-based clinics, Kaiser Kids health plan, AIM, Healthy Families, Basic Health Care, and all Medi-Cal programs. The Health Access Line received an average of 183 calls per month in the past year for a total of 1,647 calls. NEWBORN REFERRALS CONTINUOUS ELIGIBILITY Babies born to mothers who are Medi-Cal beneficiaries are deemed eligible for Medi-Cal through their first birthday. The Eligibility Worker (EW) must be notified of the child s birth. This notification can be done by the parents direct communication with the EW or by completing a Newborn Referral Form and submitting it to the EW. In an effort to ensure that all babies born in Contra Costa County have health insurance, CCHS (Financial Counseling, Medical Records, Public Health), and EHSD (Medi-Cal Unit) developed a seamless process to enroll newborns on Medi-Cal. Newborn Referral Forms are completed with the parent(s) at Contra Costa Regional Medical Center (CCRMC) immediately following the birth of the child by Financial Counseling staff. Public Health Nurses, who visit new moms and babies in the home, complete the forms for babies discharged from CCRMC without a completed form and for those infants born at other hospitals in the County. Our coordinated efforts enabled us to enroll 1,902 babies in Medi-Cal this past year. As a result, two-thirds of the babies born to women on Medi-Cal now have Medi-Cal during their first year of life (see table below). FY 0304 Newborn Referrals FACILITY Births Alta Bates Hospital 56 Doctor's Hospital 72 John Muir Hospital 2 Kaiser Permanente 1 Sutter Delta Hospital 5 San Francisco 1 St. Luke s Hospital 1 Unidentified 194 CCRMC 1,570 Total 1,902 Contra Costa Health Services Family, Maternal & Child Health Page 3
PRESUMPTIVE ELIGIBILITY MEDI-CAL The Presumptive Eligibility (PE) program allows Obstetrician/Gynecologist providers to grant immediate, temporary Medi-Cal coverage for ambulatory prenatal care and prescription drugs for conditions related to pregnancy for low-income, pregnant patients, pending their formal Medi-Cal application. The PE program is designed for patients who are pregnant, do not have health insurance for prenatal care and do not have Medi- Cal coverage. Contra Costa Health Services Healthy Start staff initiates the PE application during the intake interview and Financial Counseling staff follows up with the women to assist with completion of the Medi-Cal application. We completed 628 PE applications this past year as compared to 197 for FY 02-03 and 180 for FY 01-02. CHILD HEALTH AND DISABILITY PREVENTION (CHDP) PROGRAM CHDP has paved the way for access to health care programs for children throughout the State of California through the CHDP Gateway Program. In Contra Costa County, CHDP strives to be the leader in providing access to health care for all children. We do this by providing opportunities for families and caregivers to get the information they need to make informed decisions regarding health care for their children. During the past year, public health nurses, community health workers and administrative support staff have participated in numerous outreach activities, which are highlighted below. Outreach Materials The CHDP Program has incorporated a wide variety of health care coverage program information in all outreach materials produced by our program and in Public Health as well. In collaboration with the Health Access Coalition, The Health Coverage Programs for Children & Youth brochure was updated in June 2004. This brochure included information about Basic Health Care, CHDP Gateway, Medi-Cal and Healthy Families. These brochures are available in Spanish and English and have been utilized in parent mailings, health fairs, and a variety of outreach efforts. Community Provider Presentations The CHDP staff met with several staff from key programs that provide services to children, including WIC, Alcohol and Other Drugs Services, Healthy Start Program at Mt. Diablo Unified School District, and Community Services Head Start Program. The purpose of these meetings was to present to front-line staff the appropriate information to encourage the families they work with to become enrolled in the CHDP Gateway Program. Other agencies that received similar presentations include STAND!, Family Stress Center, CC Food Bank, YMCA, Project Second Chance, Rubicon Services, Shelter Inc., Consumer Credit Counseling, and Child Support Services. Contra Costa Health Services Family, Maternal & Child Health Page 4
Outreach to Families in WIC Program Classes on How to Access Care were offered to over 5,000 participants of the WIC program throughout the county. Each presentation described the Gateway process as well as highlighted the different types of health care coverage programs available in Contra Costa. Many of the women participating in WIC already had some type of health insurance coverage for their children. Outreach to Schools The CHDP Program provided resources and information to the Mt. Diablo Unified School District, Pittsburg School District, West Contra Costa Unified School District, and the John Swett School District to enable school district staff to become child health advocates and encourage parents to obtain health care coverage for their children. Meetings with the Pittsburg Unified, West Contra Costa Unified, and John Swett Unified School District Superintendents resulted in a collaborative initiative between each school district and the CHDP Program. The goal of the initiative is get 100% of the eligible students in their schools enrolled in a health insurance program. The initiative will take place during the school year 2004-05, and one to two schools in four different districts will participate in a special school outreach project. The essence of the project, involves mailing a mini-survey to all parents to assess their current insurance status and providing them with the opportunity to obtain assistance in applying for a health coverage program. CHDP staff will follow up with all families who indicate an interest in receiving assistance. Additional strategies involve attending Back-To- School events, publishing mini-articles in school newsletters and participating in public health campaigns. Future meetings to discuss this project will be held with the Mt. Diablo Unified School District. CHDP Gateway According to a recent report from the State CHDP office, more than 675,000 children were pre-enrolled through the Gateway during the last year. As of June 2004, the CHDP Gateway in Contra Costa had enrolled 5,822 children in Medi-Cal. In addition, 6,584 children were seen through the Gateway program in this year. CHDP staff made 7,911 contacts to families via phone conversations, one-on-one home visits, resources mailed or messages left. The CHDP Foster Care staff made almost 8,000 contacts with caregivers and children through mailings, phone conversations or home visits, and health and nutrition education outreach. In addition, 2,117 calls came in to the Family, Maternal and Child Health toll-free call line inquiring about CHDP. CONTRA COSTA HEALTH PLAN RETENTION ACTIVITIES The Contra Costa Health Plan is implementing several approaches to ensure that Medi-Cal and Healthy Families members retain their health coverage. Below is a description of these efforts. New Member Welcome Calls: The purpose of this effort is to reach out to all new members (non-bhc) and welcome them to the Health Plan. During the call, members are educated on who to call to choose or change doctors and how to set up appointments, and Contra Costa Health Services Family, Maternal & Child Health Page 5
have their questions answered about using Contra Costa Health Plan. These calls are done monthly by the Member Services and Marketing Units. During FY03-04, Contra Costa Health Plan reached 6,411 households. Healthy Families Open Enrollment Calls: During the annual Open Enrollment period, Healthy Families Program (HFP) members are called and advised on a packet they will receive in the mail from the State. The purpose of this call is to identify any potential problems/issues the member might have. Staff offer solutions, refer to the proper department for resolution, and can identify any other potential HFP members and educate the parents about the benefits of enrolling in the HFP. A total of 1,150 HFP members households were reached. Good Health Check-Up: This new initiative, started in June 2004, has reached 561 households and set appointments for over 166 Medi-Cal members. This is a quality initiative of the CCHP in partnership with CCRMC and the County Health Centers designed to improve IHA scores and HEDIS rates and increasing 2005 capitation rates, which are based on number of member visits. CCHP Medi-Cal children, with a special focus on teens, are contacted and encouraged to make a Good Health Appointment for either an Initial Health Assessment or a Well Visit check as determined by HEDIS measures and regulatory standards. As an incentive, $10 Toys-R-Us gift certificates or movie passes are mailed to members who keep their appointments. Members are sent appointment reminder cards, family appointment availability, and complete forms for school and sports activities. Case Management: Contra Costa Health Plan s Utilization Management unit identifies members with complex and/or chronic health needs. The purpose is to assure appropriate health care services are delivered in a cost effective manner. This service is not limited to Healthy Families or Medi-Cal members. Advice Nurse Unit Follow-up Calls: The purpose of this initiative is to follow up with patients who have received telephone advice. This quality review assures that the patient complies with the given advice. The Advice Nurse unit reaches 2,300 patients monthly in this fashion. This service is provided to all CCHP members. Health Sense Newsletter: The newsletter is a bi-annual mailing to all CCHP members. The newsletter contains health related topics and describes changes in services or programs. Linguistic services: Interpreter services and/or materials are offered in the language preferred by the member. Contra Costa Health Services Family, Maternal & Child Health Page 6
HEALTH ACCESS COALITION The Health Access Coalition provides 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. During this fiscal year, the members of the Coalition hosted a very successful Access to Care Summit on January 13, 2004 with more than 80 county and community agency representatives in attendance. The purpose of this all-day Summit was to work together to design strategies to increase access to health care for children, individuals and families in Contra Costa County. Kaiser Permanente, Blue Cross, and Blue Shield provided funding. The following one-year goals were identified for the Strategic Plan: 1) Educate and assist parents in gaining access to health care resources; 2) Increase the number of medical and dental providers willing to accept low income clients; 3) Increase advocacy and education efforts locally and in Sacramento to ensure access to health care; 4) Consolidate resources and improve collaboration; and 5) Develop a simplified system for clients to access health care. Several six-month objectives were developed for each goal. Since the Summit, Health Access Coalition members have created committees to implement many of the activities in the Strategic Plan: The Community Education Committee collaborated with the Contra Costa County Online Resource Database (CORD) to update their Quick Picks pamphlet, which is distributed throughout the county. In addition, the committee coordinated a health access training with the Home Visiting program supervisors and a half-day workshop with fathers highlighting their roles in securing health coverage for their families. The committee has created a media campaign, It s No Secret, to encourage parents to obtain health coverage for their children. To the right is a draft of the campaign flier. The committee is seeking funds to print and distribute the flier throughout Contra Costa. The Provider Committee is actively recruiting pediatricians and dentists to become Medi-Cal and Denti-Cal providers as well as CHDP providers. This committee is working closely with the Dental Health Action Group of Contra Costa in identifying opportunities for educating providers about health access issues for children and families in our county. Improving Systems Committee has created a survey to obtain feedback from CCHS, Community Services, and Community Clinic staff about possible solutions to barriers identified by their clients. Outreach and Education Committee has focused their efforts in educating and sharing information with legislators as well as sharing statewide news, which will have an impact on low-income families in Contra Costa. Coordination Committee is planning trainings, which highlight the changes to health coverage programs such as Medi-Cal, Healthy Families, and Kaiser Cares for Kids. An events calendar, newsletter and a page on CCHS s website (www.cchealth.org) are being planned as a means to share information with community agencies and residents. Currently, the Health Insurance page is visited frequently as can be seen on the table below: Contra Costa Health Services Family, Maternal & Child Health Page 7
Health Insurance Website, FY 03-04 PAGE VISITS Insurance [main page] 6216 Insurance > Adults 3284 Insurance > Youth 1335 Insurance > Pregnant 671 CHDP 39 Basic Health Care 174 WIC 1291 Total 13,010 The Health Access Coalition continues to be a place for community agencies to gather, network and share information on important issues on access to care. Contra Costa Health Services Family, Maternal & Child Health Page 8