Transcript Presentation title | location | Date

Welcome
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Health Care Reform Webinar
January 21, 2011
We will begin promptly @ 1PM EST
Event Host
John Lozier
Executive Director,
National Health Care for the
Homeless Council
This presentation is supported through a Cooperative Agreement with the
Health Resources and Services Administration.
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Health Care
Reform:
An Overview for HCH
Grantees
January 21, 2011
Health Care & Housing Are Human Rights
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Presenters
Barbara DiPietro, PhD
Claire Goyer, M.Ed
•Director of Policy,
National Health Care
for the Homeless
Council
•Director of Policy,
HCH of Baltimore, MD
• Technical Assistance
Program Coordinator,
National Health Care for
the Homeless Council
•Executive Director
(Retired), Duffy Health
Center
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Tom Andrews, BS
•President, St. Joseph’s
Mercy Care Services
•President, Board of
Directors, National Health
Care for the Homeless
Council
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Overview of Today’s Presentation

Current status of Health Reform law

Medicaid expansion

Remaining uninsured

Advocacy opportunities

Health Center funding opportunities

A Grantee perspective
Health Care & Housing Are Human Rights
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Current Status at Federal Level
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PPACA has been in effect for 10 months, but
confusion remains among general public and
controversy continues
Courts: Mixed federal court decisions regarding
“individual mandate”; possible Supreme Court
determination
Congress: Incoming Congress has pledged to
repeal or reduce law’s impact/implementation
Administrations: HHS implementing current
provisions and planning for future changes
Health Care & Housing Are Human Rights
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Current Status at State Level
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States vary widely in political/policy philosophy
and stages of planning; 20 states are part of
federal lawsuit
Establishing State Exchange systems
Applying for federal planning grants &
demonstration projects
Projecting impact of law on rate of uninsured,
budget, and existing health care structure
Evaluating changes needed
Health Care & Housing Are Human Rights
+ Medicaid Expansion
 Expands
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Medicaid to 133% Federal Poverty Level*
$14,400/year for individual (in 2010)
$24,300/year for family of 3
Allows for 5% MAGI
 Expect
16 million to 23 million new enrollees
 Federal
reimbursement to states for newly eligible
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100%: 2014-2016
95%: 2017
94%: 2018
93%: 2019
90%: 2020 and thereafter
Health Care & Housing Are Human Rights
+ Medicaid Expansion (cont’d)
 Maintenance
of Effort: states cannot reduce Medicaid or
CHIP eligibility, increase premiums or enrollment fees, or
otherwise restrict enrollment
 Violations:
Lose all federal matching funding for the entire
Medicaid program until corrected
 Benefit
Package: Unknown how benefits for newly eligible
will compare to those available to currently eligible
 Option
 Early
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for Early Expansion (even at incremental levels)
Implementers to Date
Connecticut
DC
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+ Medicaid Expansion (cont’d)
 Benefits
of early expansion:
 Reduces
administrative burden in 2014 (“ramp up”)
 Extends health care to those most in need
 Reduces use of emergency departments and other highcost venues
 Early expansion factors for states to consider:
 Current eligibility/participation
 Balance cost of newly eligible with previously eligible
 “Expansion

States”
Different considerations for Arizona, Hawaii, Delaware, Maine,
Massachusetts, Vermont, New York due to existing waiver for
single adult coverage
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A Brief Mention of the State Exchanges

Online marketplaces designed to help individuals and small
employers obtain private-market coverage; Focused on
individual and small group markets; does not apply to selfinsured plans (typically those offered by large employers)
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Must be implemented by January 1, 2014
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Subsidies and credits, based on income (which can fluctuate):
100%-400% FPL
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Must contain insurance with “Essential Health Benefits” (yet to
be defined), which may be less than current state requirements
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Medicaid Expansion (cont’d)
 State challenges in planning for 2014
 Handling large influx of enrollment
 Determining newly eligible from previously eligible
 Ensuring state Exchange and Medicaid are able to integrate
and provide seamless transition
 Boosting provider availability
 Budgeting for rate increases
 Unknowns:
Impact of Medicaid expansion on other
mainstream funding programs (e.g., block grants);
specifics behind enrollment procedures; breadth of
required services
Health Care & Housing Are Human Rights
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Remaining Uninsured
 In
2016: 21 million non-elderly left uninsured
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Medicaid eligible, but un-enrolled: 10-11 million
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Undocumented: 7 million
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Non-participating: 4 million
 Penalty:
Individual penalty payments are based on the
income of the tax return. Those below filing threshold
are exempt from penalty.
Sources: Congressional Budget Office (CBO), March 20, 2010. Letter to Speaker Pelosi.
CBO, Payments of Penalties for Being Uninsured Under the PPACA, April 22, 2010.
Health Care & Housing Are Human Rights
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Advocacy Opportunities
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Encourage your state to consider advance
implementation of the Medicaid expansion (even at the
lowest FPL levels), greater benefits & ongoing services for
those remaining uninsured
Implement assertive outreach and enrollment, reach as
many as possible to minimize the uninsured population;
establish best practices for teams
Participate in State Implementation Task Forces/
Councils/Committees: attend meetings, provide
comments, educate policymakers about needs of
individuals experiencing homelessness
 Conduct site visits!! 
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Health Center Funding
 Allocates
$11 billion in health center funding over 5 years
(in addition to annual appropriations)
 Operations
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FY2011:
FY2012:
FY2013:
FY2014:
FY2015:
 Capital
Funding: $9.5 billion total
$1 billion
$1.2 billion
$1.5 billion
$2.2 billion
$3.6 billion
Funding: $1.5 billion
 National
Goal: Increase number of health center
patients from 20 million in 2010 to 40 million in 2015
Health Care & Housing Are Human Rights
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Anticipated Funding Opportunities
 New Access
Points
 New
service delivery site for the provision of
comprehensive primary and preventive health care
 New Starts
 Satellite Applicant
Expanded Services
 Medical
 Behavioral Health
 Enabling
Health Care & Housing Are Human Rights
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Maximizing Funding Opportunities:
Be Ready!
Have
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a clear organization-wide plan
What’s your long range vision?
How have you identified your priorities?
What are your strategic objectives?
What will your outcome measures be?
How will you evaluate your programs?
What’s the process for continuous improvement?
What constitutes success?
Health Care & Housing Are Human Rights
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Readiness: Target Population and
Community Landscape
 Who
is homeless in your local area?
 What
are the most prevalent health care needs?
 Who
is un-served or underserved?
 What
makes up your health & safety net?
 What
are the gaps?
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Readiness: Key Relationships
Examine
your current partnerships
 Local
hospital
 Discharge planning sources
 Referral sources
 Emergency responders – police & fire
 Political leaders
 Business community
 Continuum of Care

Don’t be afraid to “step out of the box”!
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Readiness: Patient Centered Medical Home
Current
Status of:
 Team
functioning
 Consumer voice
 Comprehensive services
 Certification processes
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Readiness: Meaningful Use
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EMR Status
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Outcomes Development and Management
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Clinical Measures
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Readiness: Stating Your Case
 Document
your ideal service delivery model and
identify what you need to get to that goal
 Integrated
care model status
 Implementation of Evidence Based Practices
 Staffing Needs
 Facility
 Utilization Trends
 Finances
Health Care & Housing Are Human Rights
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Readiness: Quality Improvement/
Quality Assurance
 How
are you collecting data?
 How
are you using data to improve?
 How
are you doing in terms of HRSA’s Clinical
and Financial Performance Measures?
 How
are you measuring consumer satisfaction?
Health Care & Housing Are Human Rights
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Readiness: Governance
 330
compliance
 Board
membership
 Board
functioning
 Consumer
input
Health Care & Housing Are Human Rights
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Readiness: Finances
 Financial
Management
 Policies
and procedures
 Billing and collection systems
 Systems for collecting, organizing and tracking key
financial performance data
 Payment
 Global
Reform
payments
 ACOs
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Grantee Response:
Anticipating Funding Opportunities
 Updated
Needs Assessment – Local School of Public
Health Student Project
 Safety-Net
Initiative (4 FQHC’s & Public Hospital) –
Supported by Local Foundations
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Access to primary care – formal assessment – School of Public
Policy
Creation of new open access clinic to divert emergency room
visits and refer patients to patient centered medical home
Possible Accountable Care Organization (ACO)
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Grantee Response:
Anticipating Funding Opportunities (cont’d)
 Capital
Campaign & Expansion Project
 Purchase
of new mobile coach – ARRA funding
 Addition
of diagnostic services (radiology/ultrasound) –
ARRA funding
 Addition
 EMR
of vision services – private funding
in all clinics and EDR recently installed
Health Care & Housing Are Human Rights
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Grantee Response:
Maximizing Funding Opportunities
 New Access
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After-hours/weekend clinic - partnership with local public hospital
and homeless women’s service provider
Diversion from ED, walk-in and outreach
Patient navigator – Referral to medical home (private funding)
 Expanded
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Point Application – December, 2010
Services Application – January, 2011
Behavioral health (integrated model) – two clinics
Add 4 new mobile clinic locations with new coach
 New
Ryan White Funding – Expand Early Intervention
Clinic
Health Care & Housing Are Human Rights
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Grantee Response:
Readiness: Community Landscape, Target Population & Key
Relationships
 Launching

strategic planning process – 1st Quarter, 2011
Build on needs assessment - new five year plan
 Expanded
relationships with public hospital (NAP), other
FQHC’s and Morehouse School of Medicine (behavioral
health services)
 New
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relationships for mobile clinics sites
Transitional and supportive housing
Evening clinics at shelters
Health Care & Housing Are Human Rights
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Grantee Response:
Readiness: Patient Centered Medical Home, Meaningful Use
& Quality Improvement
 Initiated
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medical home education program
Clinics sites
Outreach activities
Collaboration with other homeless service providers
 Service Area
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Competition Application (November, 2010)
Clinical Performance Measures focused on criteria related to
Patient Centered Medical Home
Financial Performance Measures focused on Meaningful Use
Health Care & Housing Are Human Rights
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Grantee Response:
Readiness: Patient Centered Medical Home, Meaningful Use
& Quality Improvement (cont’d)
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Patient navigators – Two-Three Clinics (Americorp)
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Linkage to partner agencies for referrals (public hospital, other service
providers)
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SSI and patient assistance programs
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Referrals for other services
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Enabling services
Discussion with PCA to move into IT network
 Support all EHR applications/Meaningful Use requirements
 Lower cost
 Health Information Exchange with public hospital & other FQHC’s
Health Care & Housing Are Human Rights
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Grantee Response:
Readiness: Governance & Finance
 Bylaw
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changes – December, 2010
New 330 governance requirements
Term limits and some change in leadership
 Expanded
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activities for Client Advisory Committee
Focus groups
Expanded volunteer and staffing opportunities
 New
Market Tax Credit
 Participation
in all managed care programs & proactively
communicating with patients on medical home
Health Care & Housing Are Human Rights
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Grantee Response:
Medicaid Expansion
 Status
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Current eligibility does not include most homeless
Participating in federal lawsuit/new Governor on record as
opposing expansion
 Other
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of Georgia – NOT GOOD
opportunities
SSI benefits – Patient navigators
Expanded FQHC access/collaboration - ACO
Other advocacy efforts: mental health funding & incarceration
discharge planning
 Future
programs: Readiness activities in “Blue” states
Health Care & Housing Are Human Rights
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More Information
The National Health Care for the Homeless Council is a
membership organization for those who work to improve the health
of homeless people and who seek housing, health care, and adequate
incomes for everyone.

Additional health reform materials at:
http://www.nhchc.org/healthcarereform.html
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NHCHC offers free individual memberships at:
http://www.nhchc.org/council.html#membership

Sign up for advocacy-related Mobilizers at:
http://www.nhchc.org/mobilizer.html

Next webinar: Meaningful Use on January 26 at 2:00 EST.
To register: http://www.nhchc.org/Webinars/DMUwebinar.html
Health Care & Housing Are Human Rights
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Questions & Answers
Barbara DiPietro, PhD
Claire Goyer, M.Ed
•Director of Policy,
National Health Care
for the Homeless
Council
•Director of Policy,
HCH of Baltimore, MD
• Technical Assistance
Program Coordinator,
National Health Care for
the Homeless Council
•Executive Director
(Retired), Duffy Health
Center
Tom Andrews, BS
•President, St. Joseph’s
Mercy Care Services
•President, Board of
Directors, National Health
Care for the Homeless
Council
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