Transcript Document

OUTREACH &
ENROLLMENT
STRATEGIES FOR
LATINOS UNDER THE
AFFORDABLE CARE ACT
Rodolfo Vega, JSI
Manuela McDonough, NCLR
Clancey Bateman, JSI
Jim Maxwell, JSI
1
BACKGROUND
 Hispanics are disproportionately uninsured
 31% of non-elderly Hispanics are uninsured nationally
 Among 15.6 million uninsured Hispanics:
 58% (8.9 mil) may be eligible for coverage through Medicaid expansions
(≤138% FPL)
 38% may be eligible for subsidized coverage (139-399% FPL)
 In 5 states, Hispanics accounted for at least 50% of low-
income uninsured ≤138% FPL
 Arizona, California, Nevada, New Mexico, Texas
Sources: Kaiser Family Foundation, April 2013, based on data from the
American Community Survey (2011)
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IMPORTANCE OF CHCS AND CBOS IN
PROVIDING COVERAGE UNDER ACA
 Medicaid expansions will have a significant impact on
uninsured Hispanics
 24 states plan to expand, including 3 states with significant Hispanic
populations (AZ, CA, and NY)
 Nearly 40% of low-income uninsured Hispanics are in states NOT
expanding
Sources: Kaiser Family Foundation, April 2013, based on data from the
American Community Survey (2011)
3
STATUS OF MEDICAID EXPANSIONS AS OF
JULY 1, 2013
Source: Kaiser Family Foundation. http://kff.org/medicaid/stateindicator/state-activity-around-expanding-medicaid-under-the-affordablecare-act/#map 2011
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IMPORTANCE OF CHCS AND CBOS IN
PROVIDING COVERAGE UNDER ACA
 Existing outreach & enrollment efforts may not meet the needs of
Hispanics
 Complex process
 Do not reach hard-to-reach populations
 Require significant effort on the part of the individual
 May be particularly hard for those with limited English proficiency
 Health centers and CBOs are well-suited to reach Hispanics with
targeted strategies
 Linguistically & culturally appropriate information and services
 Information from trusted sources – e.g., PCPs
 Provide education & services for enrollment, navigating care, and
reenrollment
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OBJECTIVES
 To describe the:
 Characteristics of the organizations and the people they serve
 What NCLR affiliates are doing with regards to outreach and enrollment in public
health insurance or subsidized coverage programs
 How NCLR affiliates are providing assistance to patients in using the healthcare
system
 Challenges their clients face in enrolling in coverage
 Challenges affiliates face in providing these services and additional resources they
need
 To discuss outreach and enrollment experience among participants
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METHODS
 Online survey to NCLR Health Affiliates & health centers in states with
large Latino populations (AZ, CA, CO, NM)
 With support from primary care associations in AZ, CA, CO, and NM
 Organizational sample included:
 83 community health centers (FQHCs and non-FQHCs)
 52 community-based organizations
 Respondents in 23 states
 96 in states that will expand Medicaid
 34 in states that will not expand Medicaid
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RESPONDENTS
Position
CHCs
CBOs
Chief Executive Officer
27
9
Executive director
12
11
Chief operating Officer
3
0
Director
12
9
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WHO WERE THE RESPONDENTS?
The respondent served at least:
 2.3 million People
 1.3 million Hispanics
 135,166
Farmworkers
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FAMILIARITY WITH THE
ENROLLMENT PROCESS
10
PERCENTAGE OF RESPONDENTS ESTIMATING DEGREE
OF FAMILIARITY WITH STATE’S ENROLLMENT PROCESS
30%
25%
25%
20%
15%
13%
10%
11%
CHC
CBO
7%
5%
0%
Extremely familiar
Not familiar
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OUTREACH & ENROLLMENT ACTIVITIES
Develop
knowledge
and
awareness
Identify and
outreach to
populations
Enrollment
Engagement,
navigation,
and
retention
Renewal
12
OUTREACH & ENROLLMENT ACTIVITIES
Develop
knowledge
and
awareness
Identify and
outreach to
populations
Enrollment
Engagement,
navigation,
and
retention
Renewal
13
EDUCATION AND RESOURCES PROVIDED TO
COMMUNITY MEMBERS ON ACA COVERAGE
EXPANSIONS
% of Organizations Providing
Education and Resources
100
90
80
70
60
50
40
30
20
10
0
56.94% (41)
40.54% (15)
Community-Based Organization (N= 37)
Community Health Center (N= 72)
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OUTREACH & ENROLLMENT ACTIVITIES
Develop
knowledge
and
awareness
Identify and
outreach to
populations
Enrollment
Engagement,
navigation,
and
retention
Renewal
15
CURRENT OUTREACH METHODS PROVIDED TO ELIGIBLE
PATIENTS TO PROMOTE AWARENESS OF INSURANCE
PROGRAMS
CHC (N=68)
CBO (N=37)
Media campaign (TV, radio, print)
16.18%
10.81%
Social media campaign
14.71%
16.22%
Home visits
8.82%
16.22%
Phone calls
19.12%
10.81%
Participating in health fairs or other community
events
52.94%
54.05%
Involve key leaders in the community in outreach
campaigns
36.76%
40.54%
What types of outreach assistance do you
currently provide to eligible patients?
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FUTURE OUTREACH METHODS PROVIDED TO ELIGIBLE
PATIENTS TO PROMOTE AWARENESS OF INSURANCE
PROGRAMS
CHC (N=68)
CBO (N=37)
Media campaign (TV, radio, print)
45.9%
32.43%
Social media campaign
47.06%
32.43%
Home visits
36.76%
40.54%
Phone calls
54.41%
40.54%
Participating in health fairs or other community
events
Involve key leaders in the community in outreach
campaigns
45.59%
27.03%
47.06%
27.03%
What types of outreach assistance do you
currently provide to eligible patients?
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OUTREACH & ENROLLMENT ACTIVITIES
Develop
knowledge
and
awareness
Identify and
outreach to
populations
Enrollment
Engagement,
navigation,
and
retention
Renewal
18
CURRENT METHODS OF ENROLLMENT ASSISTANCE
CURRENTLY PROVIDED TO ELIGIBLE PATIENTS BY
ORGANIZATION TYPE
What types of enrollment assistance do you
currently provide to eligible patients?
CHCs (N=68)
CBOs (N=37)
Notifying existing patients of potential eligibility
status for new programs in filling out paperwork
Spanish-language enrollment forms and assistance
Assistance in filling out paperwork
Assistance completing enrollment forms in
Spanish
Culturally appropriate enrollment materials or
resources for the Latino population
70.59%
48.65%
88.24%
83.82%
48.65%
54.05%
77.94%
54.05%
Eligibility determination
Assistance in completing enrollment applications
77.94%
86.76%
45.95%
Monitoring status of applications for coverage
77.94%
-
Assistance in enrolling in a managed care plan
57.35%
35.14%
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FUTURE METHODS OF ENROLLMENT ASSISTANCE
PROVIDED TO ELIGIBLE PATIENTS BY ORGANIZATION
TYPE
What assistance do you anticipate providing for the
expansion populations in the future?
CHCs
(N=68)
CBOs (N=37)
Notifying existing patients of potential eligibility status
for new programs in filling out paperwork Spanishlanguage enrollment forms and assistance
Assistance in filling out paperwork
Assistance completing enrollment forms in Spanish
27.94%
37.84%
16.18%
17.65%
32.43%
29.73%
Culturally appropriate enrollment materials or
resources for the Latino population
22.06%
35.14%
Eligibility determination
Assistance in completing enrollment applications
20.59%
17.65%
35.14%
Monitoring status of applications for coverage
23.53%
-
Assistance in enrolling in a managed care plan
39.71%
32.43%
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OUTREACH & ENROLLMENT ACTIVITIES
Develop
knowledge
and
awareness
Identify and
outreach to
populations
Enrollment
Engagement,
navigation,
and
retention
Renewal
21
TOP 3 PATIENT CARE ENGAGEMENT STRATEGIES UTILIZED BY
COMMUNITY HEALTH CENTERS
% CHCs Utilizing Engagement
Strategies
100
95.45 % (63)
90
89.39% (59)
80
70
60
48.48% (32)
50
40
30
20
10
0
Appt. Reminders
via Phone
Scheduling Routine Screenings
For Preventive Services
Appt. Reminders
via Mail
Types of Engagement Strategies
22
OUTREACH & ENROLLMENT ACTIVITIES
Develop
knowledge
and
awareness
Identify and
outreach
populations
Enrollment
Engagement,
navigation,
and
retention
Renewal
23
% CHCs Utilizing Assistance Strategies
TOP 3 PATIENT ASSISTANCE STRATEGIES FOR
COVERAGE RENEWAL UTILIZED BY COMMUNITY
HEALTH CENTERS
100
90
80
70
65.15 % (43)
60
45.45 % (30)
50
36.36% (24)
40
30
20
10
0
Patient Assistance in
Completing Renewals
Renewal Reminders via Phone
and
*Communication Through
Clinical Staff or Providers
Types of Assistance Strategies
Database Maintenance and
Tracking of Renewal Dates
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BARRIERS
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BARRIERS PEOPLE FACE IN ENROLLING IN
PUBLIC HEALTH INSURANCE OR SUBSIDIZED
COVERAGE PROGRAMS
What are the most important barriers or challenges
your patients face in enrolling in public health
insurance or subsidized coverage programs? Check all
that apply
CHC (N=66)
CBO (N=44)
Lack of awareness of eligibility
92.42%
84.38%
Lack of awareness of enrollment
83.33%
78.13%
Documentation issues
83.33%
62.5%
Literacy
78.79%
68.75%
Difficulty of application process
75.76%
65.63%
Technology , e.g. computer literacy
71.21%
71.88%
Language
69.7%
84.38%
Transportation
-
65.63%
Cost
-
62.5%
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EMERGING THEMES
Individual
Organizational
Language
Complexity
Systems
Geography
Migration
Tracking
application
Mistrust
Staff Training
Uncertainty
Literacy
Transportation
Funding
Reimbursement
Documentation
Bilingual Staff
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BARRIERS FACED BY ORGANIZATIONS
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BARRIERS: MISTRUST & FEAR
 Agencies viewed patients’ mistrust and fear as a significant barrier
 Documentation verification - burden and unease of this process
 Stigma associated with being a public charge
 Documentation issues
 Especially among mixed status families
“Convincing
patients we want
to care for them,
not turn them in.”
“Mistrust of patients
[is] secondary to
documentation
issues”
“Gaining trust so this
population will come to
us if there are issues
prior to them becoming
major problems with
their health plans and
coverage.”
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BARRIERS: LACK OF AWARENESS
 Patients are not aware of coverage options
 Patients not aware of eligibility status
“Lack of awareness of
coverage plans. This is
especially crucial with the
ACA, with polls showing
up to 80% of people in
California are not aware
of the Exchange. “
“Lack of
knowledge if they
or children are
eligible.”
“Clients do not understand
insurance is necessary.”
“No prior knowledge of the
[healthcare] system.”
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BARRIERS FOR CHCS
 Complexity of process and eligibility system
 Lack of information from state about plans, rules, and regulations
 Unsure of status of Medicaid expansions in some states or states not
expanding
 Keeping abreast of ACA-related changes and plans
 Documentation status of patients
 “Suspect we have a high number of undocumented clients, but not sure since we do
not ask about legal presence.”
 Transitioning patients to new insurance
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BARRIERS FOR CBOS
 Lack of capacity among staff
 Need for enrollment staff
 Lack of funding for community-based organizations
 Tight timeline for enrolling Latino patients
“We are not
trained in the
process.”
“…we currently
have no funding
support to provide
additional services.”
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STATE-SPECIFIC BARRIERS
 “Our state is not expanding”
 Uncertainty about state’s plans
for Medicaid expansion or
Exchanges
 Enrollment happens at County
level – disconnect between
enrollment staff and county
processes (e.g. delays)
“The County is the only entity
that can enroll patients into
Medi-Cal and the County is the
only entity that can enroll
patients into LIHP. Patients don't
follow through due to amount
of paperwork required. Patients
are required to provide all
documentation every 3 months.”
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STATE-SPECIFIC BARRIERS
 Different rules for Maryland,Virginia, and DC
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AND FOR THAT MATTER…
35
INDIVIDUALS AND FAMILIES SEEKING CARE IN
THE FOUR CORNERS
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RESOURCES NEEDED - INFORMATION
 State-specific training related to
ACA coverage options and
enrollment processes
 State Exchange
 Information about Medicaid and
subsidized coverage options
 Materials for patients/clients
“We will need additional
resources to reach out
to rural, frontier, border
families with no vehicles
or telephones, and
whose barriers are
outside of their control.”
 Spanish language
 Culturally appropriate
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RESOURCES NEEDED – STAFF & FUNDING
 Funding – esp. for CBOs
 Additional enrollment staff and outreach workers
 Training for existing enrollment staff
 Capacity
 In geographic area
 Enough PCPs
“Grants for this do not
pay the total price of
outreach, enrollment, and
reenrollment costs.”
“Having enough bilingual
primary care doctors and
nurses to meet the
demand of newly covered.”
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EXEMPLAR RESOURCES
 NLBHA operates Ventanillas de
Bienestar a webinar training to
CBBHOs on effective outreach
and enrollment of uninsured
Latinos.
 http://www.nlbha.org/
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DISCUSSION
40
QUESTIONS?
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ACKNOWLEDGEMENTS
 Thank to you to the NCLR affiliates who participated in the survey!
 Thank you to the PCAs who sent the survey to their members
 Arizona Alliance for Community Health Centers
 California Primary Care Association
 Colorado Community Health Network
 New Mexico Primary Care Association
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CONTACT INFORMATION
 Manuela McDonough, NCLR
[email protected]
 Rodolfo Vega, JSI
[email protected]
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