Posts Tagged ‘Ohio medicaid program’
Nov 23rd, 2010 | by
A health care home – or medical home – model works best when all parties that touch the health care system are involved. That means having a collaborative effort among providers, patients and insurance. The overriding goal of a health care home model is to keep patients healthier while reducing the cost of care. This is a model that we support, certainly. But more importantly, it’s a model we are putting to practice in a number of ways.
Our recent alignment with the Ohio chapter of the American Academy of Pediatrics (AAP) is an ideal example of how collaboration can lead to better outcomes and improved quality. The CareSource Foundation recently awarded a signature grant of $75,000 to the Ohio chapter of the AAP supporting an asthma quality improvement initiative. As a result of the CareSource grant, CareSource will widen its focus on asthma quality improvement opportunities for physician practices throughout Ohio.
Currently, CareSource works with 13 practices in Ohio in a Medical Home pilot where physicians and CareSource as working together to identify patients whose asthma may not be well controlled. These practices include community health centers, hospital-based systems and private practices. Together, we have formed a medical collaborative to address issues of asthmatic children from birth through 18 years old among other conditions addressed.
Goals of the grant are to decrease hospitalizations, identify treatment options and form strategic asthma control plans to improve health outcomes for all children.
Collaboration Equals Results
Through our association with the Ohio Chapter of AAP, and the medical home pediatric offices, we are striving to educate and change behaviors in asthmatic patients. This is done through a combination of hands-on coordination and helping the patient and his/her family be more aware of the condition, and how to deal with it. A CareSource case manager is assigned to each practice, and is responsible for helping the patient carry out the instructions/recommendations that the doctors communicate.
Specifically, our pilot medical home teams are doing the following:
- Surveying patients and their families about asthma triggers
Doctors start by documenting with the patient and his/her parent or guardian the triggers that cause an asthma episode. By understanding what causes the episode, the hope is that the patient and family seek ways to avoid those incidences. Also, by knowing what the triggers are, families can make changes to their living environments to remove anything that causes an asthma episode. Episodic documentation is also part of the ongoing relationship between doctor and patient as unforeseen triggers can often arise.
- Consistent Care
Children with asthma do better by seeking regular care for their condition. So as a service to our members, we work hard with providers and patients to make sure patients are being seen regularly. We encourage doctors to keep a breathing peak-flow record of the patient so changes in the condition can be recognized and addressed. We also encourage doctors to assess and review changes in lung function on a regular basis to more effectively care for the child.
- Create an Action Plan
Working with the doctor and patient, we collaborate on an asthma action plan that strives to keep the patient healthy and avoid unnecessary doctor or emergency room visits. The action plan includes consistent doctor visits, prescription instructions, lifestyle/behavioral actions, ongoing monitoring, etc.
And We’re Seeing Results
Ohio currently ranks seventh in pediatric asthma incidences with nearly 10 percent of children suffering from asthma. For children living in poverty and of certain races, that number nearly doubles. So it’s easy to see why it’s important that we as a health care community strive to address asthma within the Medicaid population. Although our pilot program is in its infancy, we are already seeing positive results.
Of the children that see pediatricians in the pilot area practices, there has been a 30% drop in emergency room visits (when comparing 2008 to 2009). The overall awareness of asthma within the communities where the pilot program is taking place has also been raised. And lastly, since we are championing this alongside the Ohio Chapter of the American Academy of Pediatrics, we are removing many of the barriers of access to care.
As time goes on, we expect these results to be even stronger. We also anticipate adding provider practices to the pilot program as our results continue to deliver positively.
Some Fast Facts About Children with Asthma
- Ohio ranks seventh in pediatric asthma incidences with nearly 10 percent of children suffering from asthma
- Pediatric asthma accounts for 14.7 million days of school missed by children nationally each year and workdays missed by parents who stay home to take care of their children
- Acute asthma encounters can cost $400 per emergency department visit and $5,000 for inpatient care
Aug 12th, 2010 | by
On behalf of the 844,000 Medicaid consumers we serve, we thank you, Congress, for extending $16 billion in enhanced Medicaid funding to assist states who are experiencing the worst budget shortfalls in history. Our government did what’s right and necessary for people who are desperate for help today.
Nearly 3.3 million more people were enrolled in Medicaid in June 2009 when compared to June 2008 (based on Kaiser Commission on Medicaid) and states are financially strapped – three-fifths of them have expressed a critical need for assistance with its Medicaid programs. Plus, many families continue to feel the burden of the Great Recession as demonstrated by the U.S. unemployment rate of 9.7% (June 2010). It is our obligation as a country that believes in providing opportunity for all to take care of those that need help. And that’s what Congress did this week by a vote of 247 to 161.
Again, thank you, Congress for leading our nation out of the Great Recession.
Aug 2nd, 2010 | by
In this tumultuous and uncertain political year, some things are very clear. State budgets are facing serious deficits. For millions of Americans, the Great Recession is not over. We see it firsthand here at CareSource. In fact, as the nation’s second largest Medicaid health plan, we know there are 844,000 CareSource members who are faced with the realities of the economic downturn each day. Subsequently, this has increased the demand for Medicaid and other important services families need to survive. Simply put, Washington must do more to address the devastating impact of these tough economic times.
Every day, we see the consequences of high unemployment in our states. With more people out of work, more families are relying on Medicaid to provide essential medical care. Any delays may force families who are already struggling to maintain basic necessities to forgo the health care coverage they fundamentally deserve and more importantly – the coverage they desperately need.
Yet efforts in Congress to approve a six-month extension of higher federal Medicaid assistance to the states are being blocked. Instead of voting as if the economy is strong, Congress should take the pressure off states by passing this temporary extension now. Otherwise we could see drastic cuts in health care for the most vulnerable, education, and other critical services. These cuts will only delay the day that we will see the economy actually recover.
Jul 22nd, 2010 | by
Dear President Obama,
Thank you…thank you for the release of the Patient’s Bill of Rights. This public proclamation that describes how patients will be protected by the rising costs and complexities of the health care system is exactly what this country needs. It is fundamentally consistent with the philosophies of our nation. The Patient’s Bill of Rights builds a foundation that allows opportunities to exist, opportunities open to all, and most notably our country’s underserved population.
Underserved people continue to suffer in our country. And one of the most profound challenges to this demographic is having the forum to voice opinion. Underserved communities struggle to be heard…struggle to tell their stories…struggle to instill empathy in those most able to be helpful.
The Patient’s Bill of Rights gives the underserved a voice. It protects them from elements that have been traditionally uncontrollable. It protects our children, it protects those with pre-existing conditions, and it protects women. But most importantly, it protects the integrity of our country and the goodwill we extend to our citizenship.
So thank you, Mr. President, for embracing our country’s underserved, and moving hope to what is tangible. And we’re happy to answer your request and spread the word about the new Patient Bill of Rights.
The Patient’s Bill of Rights
“Starting in September, some of the worst abuses will be banned forever. No more discriminating against children with pre-existing conditions. No more retroactively dropping somebody’s policy when they get sick if they made an unintentional mistake on an application. No more lifetime limits or restrictive annual limits on coverage. Those days are over.” – PRESIDENT BARACK OBAMA
President Obama announced a Patient’s Bill of Rights made possible under health reform—a basic set of consumer protections.
The Patient’s Bill of Rights:
- Prevents insurance companies from canceling your policy if you get sick. Right now, insurance companies can retroactively cancel your policy when you become sick if you or your employer made an unintentional mistake on your paperwork.
- Stops insurance companies from denying coverage to children with pre-existing conditions. Beginning in September, discrimination against children with pre-existing conditions will be banned—a protection that will be extended to all Americans in 2014.
- Prohibits setting lifetime limits on insurance policies issued or renewed after Sept. 23, 2010. No longer will insurance companies be able to take away coverage at the very moment when patients need it most. More than 100 million Americans have health coverage that imposes lifetime limits on care.
- Phases out annual dollar limits on coverage over the next three years. Even more aggressive than lifetime limits are annual dollar limits on what an insurance company will pay for your health care. For the people with medical costs that hit these limits, the consequences can be devastating.
- Allows you to designate any available participating primary care doctor as your provider. You’ll be able to keep the primary care doctor or pediatrician you choose, and see an OB-GYN without referral.
- Removes insurance company barriers to receiving emergency care and prevents them from charging you more because you’re out of network. You’ll be able to get emergency care at a hospital outside of your plan’s network without facing higher co-pays or deductibles or having to fight to get approval first.
Apr 1st, 2010 | by
It’s that time of year again. Census time. Yes, this year we have to take 10 minutes out of our busy schedules and answer 10 easy questions… and we’re done – for 10 years! Simple questions that determine how $400 Billion – yes, that’s BILLION -get distributed to each state.
During the 2000 Census collection, over 70% of Americans sent their surveys back as instructed. But many surveys had to be completed with the help of U.S. Census workers who traveled door to door canvassing the streets to find individuals who just couldn’t find the time to make this a priority. And why shouldn’t they just wait for a knock on the door?
Get this: For each percentage point we can raise the response rate, the feds reportedly will save about $85 million on door-to-door workers. Isn’t that reason enough?
But the population that traditionally struggles to complete their Census forms is the people we serve each day here at CareSource. Why? Because this population tends to be transient – not typically staying at one residence for any prolonged period of time. They also may not have an official address, or they may be homeless, or they live in a communal living situation. Whatever the case, during this census period, it’s extremely important that we get the people in our underserved communities counted.
That’s why CareSource is joining the national effort to reach out to our members to reinforce the importance of completing their census form. Our 820,000+ members qualify for Medicaid coverage and have income below 200 percent of the poverty level. Because the deadline is quickly approaching, we are posting information to our Web site as a reminder for both members and our vast provider network (22,000+ providers, 210 hospitals). We’re also adding a hold message on our customer service line (pending state approval) to encourage our members to “Be Counted” and why it’s so important.
But we didn’t stop there. As a large employer, we have also encouraged our 900 employees to complete their census forms and have reiterated why it’s so important for a publicly funded, not-for-profit company like CareSource to support this national endeavor. Recurring messages will be sent to employees to provide constant reminders prior to the April 15th deadline.
According the NAACP and the federal government, here is why it is so important to get everyone counted – especially families struggling with poverty:
- Federal Funds: For each 100 people not counted, a community risks losing an estimated $1.2 million over the next decade for federally funded programs including: Medicaid, public housing assistance, child health programs, Head Start, transit programs, and more.
- Political Representation: States use census numbers to redraw all political boundaries and determine which states gain or lose representation, including Congressional Districts, state house and senate districts for city councils, school committees and county board.
- Public Infrastructure: All levels of government rely on census numbers to locate vital public works like schools, health centers, public transportation, highways, and affordable housing.
- Private Investment: Businesses large and small use census numbers to identify new markets, select sites for operations, make investment decisions and determine the goods and services offered.
When families do not participate in the census, it means their communities lose access to money, resources and power. On behalf of our country’s underserved communities, please encourage the families and organizations you interact with to complete and return their census form. It’s easier than ever. The 2010 Census form asks 10 questions and takes about 10 minutes to complete. But the key is – IT MUST BE MAILED BACK TO BE COUNTED. Simply mail it back using the postage-paid return envelope by April 15, 2010. Telephone assistance in filling out the form is also available by simply calling 1-866-872-6868.
For those who do not respond, census workers will visit households that do not return forms to take the count in person. But don’t forget – the higher the participation rate, the cheaper the census will cost taxpayers. Just think – if we increase the rate of response from 70 to 80 percent, that’s an estimated $850 million in savings!
It’s easy. It’s important. It’s safe. For more information about the 2010 Census and the “Take 10″ initiative, visit www.2010census.gov.
Mar 16th, 2010 | by
Ohio’s underserved population got a positive boost this past week from our Federal government and Governor Ted Strickland. The first was Ohio receiving over $700-million in federal assistance for Medicaid. The second is our Governor’s commitment to U.S. Health and Human Services Secretary Kathleen Sebelius’ challenge to get all eligible children enrolled in Medicaid/State Children’s Health Insurance Program (SCHIP) and keep them covered longer. These are tremendous strides that our Federal and State governments have taken to further its commitment to America’s children.
In Ohio, where we have an unemployment rate of 10.8% and a multi-million budget gap, we are seeing more and more people needing the many social services that help keep our Ohio families afloat. Medicaid is one program in particular that has experienced a surge in enrollment. So receiving more federal assistance is extremely helpful in keeping Medicaid enrollees covered and making sure they are accessing the health care system responsibly.
Next, our Governor’s commitment to making sure every child eligible for Medicaid/SCHIP is enrolled is also greatly needed. There are 77,000 children in Ohio that are currently uninsured but actually eligible for Medicaid/SCHIP today. The income limit for children to receive health care through Medicaid/SCHIP is currently capped at 200% of the poverty level (or a little over $44,000 for a family of four). So we stand equally committed to finding these children, and making sure they all get access to primary and preventative health care.
But finding all children eligible to be enrolled with Medicaid/SCHIP is a little trickier than you might think. In addition to concentrated grassroots outreach, we need Ohio’s Medicaid program to implement new strategies that lessen the barriers to entry. Here are three strategies to consider:
- Express Lane Eligibility – Essentially, this will help get children covered when their families opt to receive assistance through other public programs like school lunch or food stamps. States can use the relevant findings from these other public programs to determine their eligibility for Medicaid/SCHIP without requiring the family to resubmit and/or re-verify their personal information.
- 12-month Continuous Coverage – In Ohio, families with children receiving Medicaid/SCHIP need to re-apply every 12 months to maintain their coverage. During this 12 month period, a child can become ineligible for Medicaid/SCHIP for a variety of reasons. Most notably, is not keeping their redetermination appointment for other public assistance programs (e.g., cash assistance or food stamps). This causes children to inappropriately lose their coverage. By guaranteeing 12 months of coverage to children, we ensure our eligible kids don’t lose coverage while ultimately improving overall health outcomes.
- Presumptive Eligibility – Allows trained qualified entities to screen a child or pregnant woman’s eligibility for Medicaid/SCHIP. If presumed eligible, a child or pregnant woman can receive all health services covered under Medicaid until a final determination is made. Presumptive eligibility would allow uninsured children and pregnant women to begin the Medicaid application process, obtain needed medical services while also ensuring the health care provider is reimbursed for services rendered.
It’s clear that needless administrative barriers are simply making health care access harder and harder for underserved populations. These three strategies are common sense approaches that will ensure the nation’s underserved get the coverage they need – when they need it.
Questions for our readers – What do you think of the Federal and state measures described above? Is it a good use of federal dollars to help states with their Medicaid programs? Are these suggestions for CHIP enrollment enough to capture all the children eligible for the program?
Article TagsExpress Lane Eligibility • Federal Government • Governor Strickland • Kathleen Sebelius • Medicaid • medicaid ohio eligibility • Ohio medicaid • ohio medicaid eligibility • Ohio medicaid program • ohio medicaid providers • poverty • Presumptive Eligibility • SCHIP • State Children’s Health Insurance Program • U.S. Health and Human Services • underserved • underserved population • Unemployment
Feb 24th, 2010 | by
So there are some Democrats threatening to use reconciliation to get a health care plan passed (CNN article). Well, first things first. Let’s get through the President’s summit and see how it goes. Who knows what surprises may be in store? They may actually be “welcomed” surprises for a change.
This entire debate has been one surprise after another. As a result of this summit, we may actually see a few members of the minority party decide that the President’s plan (albeit not perfect) is currently the best option we have given the times. What do the Dems have to lose? Reconciliation should be used as a last resort and quite frankly, that is exactly what they seem to be doing. All we ask is – just do something – and do it soon – and don’t make it a band-aid approach.
So much debate and finger pointing and arguing and going back to the table threatens to completely dilute any meaningful reform. Despite the fact that the majority of Americans have said that reform is what they want and what America needs. Meanwhile, another $25-billion in Medicaid relief has been included in the President’s budget proposal to states that are seeing current enrollment numbers rise due to our economic environment.
The President’s plan has some really good aspects that will change the course of the health care system today and we finally have the momentum to actually make the health of our nation better. Why stop now?
Why stop when it includes a meaningful expansion of Medicaid so that our most vulnerable citizens can get the monetary relief and care they need to stay healthy? Why impede the development of an insurance exchange to make it easier for Americans to purchase health care? Why prevent important insurance reforms from taking place? Why dilute a requirement that says all of us have to buy coverage to ensure the health care system will be there when we need it and not bankrupt the nation in the process? And why in the world would we want to encumber a real focus on managing high-cost chronically ill populations?
All of these things that make a lot of sense are included in the President’s plan, and can be passed with or without reconciliation.
It will be interesting to see what plays out with the President’s health care summit. Perhaps some consensus can be met that may not address everything, but will at least garner enough votes to put something meaningful in place that we can build upon over the next decade.
A couple question to our readers – Do you think imposing reconciliation is the right way to go? Do you think the President’s health care summit will prove productive?
Feb 11th, 2010 | by
We all hear “Presidents Day” and think “Washington and Lincoln.” Banks and post offices are closed and for some, another well deserved federal holiday. But that’s just habit.
This year, we might do well to remember another group of presidents–those who have done their best to establish a better health care system for the nation. Every president for the past 75 years has been part of the struggle, yet we still have a system that not only bankrupts individual citizens without regard, it decimates state budgets and paralyzes the federal government from making substantive improvements to the nation’s economy.
While Lyndon Johnson gets much of the credit for getting Medicare and Medicaid passed into law, the true hero of Medicare was John F. Kennedy, who worked, negotiated, and hammered out a solution that would help Americans – and actually found a way to get it approved by Congress.
Medicare has worked fairly well for fifty years—but at the time, the same doubts were voiced that we are hearing today—the bill’s imperfections were too great. At a rally in New York to support health care for the elderly, Kennedy confronted the question: “We’ve got great unfinished business in this country,” he said, “and while this bill does not solve our problems in this area, I do not believe it is a valid argument to say ‘This bill isn’t going to do the job.’ It will not, but it will do part of it.”
The comprehensive health care reform we need today is even more critical than when Kennedy spoke those words in 1962. No, it may not be entirely accomplished by the plans now being discussed in Congress. Yes, it’s imperfect, but the cost of doing nothing is unacceptable. Turning our backs now, when we have a solid plan that insures over 90 percent of Americans; that bends the health care cost curve; that brings down premiums and that strengthens Medicare for seniors, is simply irresponsible. This plan is the closest we’ve ever come to true reform.
There’s no need to give up. Let’s call upon Congress to deliver a bill to the President in recognition of President’s Day. Moreover, for all the presidents before him who have fought tirelessly to get Americans a health care system that will move us one step closer to handling this country’s “unfinished business.”
What do you thing has been the most significant achievement in reforming health care up until now, and which President do you think gets the most credit?”
Article TagsAbraham Lincoln • congress • George Washington • health care • Health Care Presidents • health care reform • JFK • John F. Kennedy • Lyndon Johnson • Medicaid • Medicare • Medicare costs • michigan medicaid • Ohio medicaid • Ohio medicaid program • Presidents' Day • reforming health care • support health care
Jan 26th, 2010 | by
There’s really only one thing that worries me about the Massachusetts election. I’m not troubled by the fact that the Democrats lost filibuster-proof control of the Senate. Control shifts back and forth as often as who is going to host the Tonight Show on NBC.
It doesn’t worry me that Senator Elect Scott Brown will try to block any potential of health care reform. We’ve come too far over the past year…really over the past half century…to turn back now.
I’m also not concerned that the Democrats will try to force through a health care reform policy -just to get it done. Forcing through policy doesn’t always go over well to voters in an election year – especially those with long-term memories. However, a recent poll by the Kaiser Foundation indicates the American public, including skeptics, become more supportive of health care reform after being told about many of the major provisions in the bills.
But what is worrisome…troubling…concerning to me is that momentum will waver, and the true ideals of health care reform will be lost. We must be sure the following elements of health care reform stay in place:
- Increase Medicaid eligibility – whether its 133% or 150% (which I would prefer), we need to make sure reform protects our most vulnerable citizens
- Protect our children – CHIP programs work…that’s why so many of our policy-makers rose to the occasion to protect in the current bills – Sen. Casey, Sen. Rockefeller, Sen. Reid, etc.
- Affordable Coverage for All – Don’t let purchasing health insurance be burdensome to the majority – continue with plans to provide government assistance through subsidies to those under 400% of the national poverty level
- Use of a state based health care exchange to act as a transparent clearinghouse for consumers to purchase coverage
- Cost containment to bend the unsustainable curve of health care costs
- Medicare & Medicaid benefit integration and financing for dual eligibles within a managed care model to rebalance the long-term care system to increase use of home and community based support services. Shifting more of this high-need population into coordinated managed care arrangements could produce significant savings while ensuring options for consumers where they desire to reside.
Sure, CareSource is a non-profit health plan that believes there is always room for improvement, but we support health care reform. Give non-profits wider opportunities to control costs, enable insurance companies to accept anyone with pre-existing conditions, include an individual mandate so that we all pay our fair share and, reimburse for positive outcomes, etc.
So to do my part in making sure Congress knows that I don’t want the momentum to subside in Washington, I used this source to send Congress – and my local newspapers – a letter:
This one is for Ohio citizens…but if you live outside of Ohio, you can go to FamiliesUSA to send your own letter to Congress.
Please let Congress know that we cannot afford to take our eye off the goal just because of one election. We must move forward with health care reform. Our country deserves it.