A Walk in Her Shoes

Jul 20th, 2011 | by CareSource

Guest blogger – Katelyn Bertke, Intern from Miami University

As a summer intern at CareSource, I had the unique opportunity to experience firsthand the challenges that our more than 870,000 members encounter daily. CareSource, in collaboration with Think Tank Inc., offers “A Walk in My Shoes – A Poverty Simulation,” to help employees better understand the realities of poverty.

During the simulation we were assigned a new identity and asked to assume the role and perspective of our character as accurately as possible.

Before the simulation began, I am a 22-year-old college graduate working full-time and living with my parents. My only worries in life are paying my bills, my student loans and planning my weekends with friends. When I learned my new identity was a 45-year-old pregnant woman living in poverty, my world took a turn.

My new name was Kayla and I lived in a one-bedroom apartment with my unfaithful husband, Ken, who was played by another intern. I never graduated from high school and Ken had a criminal record.  We both worked part-time in the fast-food industry earning a meager $1,200 per month.

During the simulation, our month was broken down into four, 15-minute “weeks.” Each week we had to travel to different stations to go to work, pay our bills, and go to the doctor. We were lucky to start off with two jobs, a car and $40 dollars in cash, but despite our best efforts to strategize, Ken and I realized immediately that everything was going to be more difficult than we anticipated.

Ken and I had to pay all of our bills with cash and in person because we did not have a credit card or checking account. Even though we had transportation, it was difficult to find the time to get to each place. In general, we found that the actual act of getting the bills paid was just as difficult as coming up with the money. We waited in long lines and were turned away when businesses closed at 5:00 p.m.

 With only one car, it was difficult to make it to work on time. When I needed to go to the doctor or Ken had to check in with the probation officer, we argued over who would have to walk or pay to take the bus.

 By the end of the “month” Ken and I had managed to buy groceries and pay all of our rent. We were unable to pay our utilities and my prenatal prescription was never filled because the money simply wasn’t there. We were also unable to chip away at any of our loans and thus would be behind at the start of the next month.

After the simulation, I felt relieved and thankful that we did not have to play another month – I couldn’t handle the stress. I felt defeated and hopeless. From the beginning of the simulation I had anticipated we would run out of money, maybe even get evicted from our apartment, but I didn’t expect to feel constant worry caused by the challenges and frustrations we faced each week. We had worked and planned to get ahead, but we always ended up behind.

Our family, as well as many others, realized that in trying to stay on top of our bills, the only thing we thought and talked about was money. In addition, none of us knew just how hard it was to apply for public assistance, and many of us were completely unaware of the resources available to help.

In the end, these realizations are what the poverty simulation is all about. When we see poverty, we only see the end result. It wasn’t until I took a walk in “Kayla’s” shoes that I recognized poverty as a constant daily struggle.

Other participants described this simulation as “devastating, heart-wrenching, frustrating, and inconceivable,” and I simply couldn’t agree more. Through this eye-opening experience, not only did I come face to face with the emotions of defeat and despair, I quickly grasped the truths of living in poverty and gained a greater appreciation for those facing socioeconomic hardship.

In a time when the social, economic and environmental future of the world is looming, it is vital for members of my generation to open our eyes and begin to analyze the sustainable challenges ahead from a variety of angles. Simulations like these are designed to sensitize and educate people about the social disruptions that threaten the well-being of people globally.  

Through the poverty simulation, CareSource has provided me and the other interns with the opportunity to recognize and discuss the potential for change within our communities and the world, and has led us one step closer to acting on our ethical responsibility to improve poverty, social justice and human equality.

Health Care Collaboration Produces Real Results for Children with Asthma

Nov 23rd, 2010 | by OurHealthCareSource.com

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

CareSource Clinical Practice Registry – The Perfect Tool to Streamline Your Practice

Nov 16th, 2010 | by OurHealthCareSource.com

Earlier this year, we launched an innovative, online tool for provider practices called the CareSource Clinical Practice Registry. We’ve seen adoption of the tool really take off mainly because the kind of information that the Clinical Practice Registry provides has traditionally been elusive when it comes to Medicaid patients.

A provider in our network – Dr. Barb Bennett, Family Practice Physician and past president of the Ohio Osteopathic Association – was kind enough to provide her points of view regarding the tool, and how it helps her organize her practice.

The primary benefit of the CareSource Clinical Practice Registry is population management. Providers can quickly and easily sort their CareSource membership into actionable groupings. It is a proactive approach to patient care and helps place emphasis on the need for preventive care.

For example, a Primary Care Provider (PCP) can sort the list to identify all of those with chronic conditions like diabetes. From the list of diabetics in the practice, the provider can identify those who need to come in for a visit, and proactively call to schedule an appointment. The report is color coded, so the provider can identify areas of focus. It can also be downloaded as a PDF or in an Excel spreadsheet format.

The Registry also impacts HEDIS scores. It helps identify many HEDIS mandated screenings, including women’s health and well-child screenings. By identifying the HEDIS screenings through the Registry, HEDIS quality scores improve, and most importantly, so do the health of our members.

A Year of Milestones

Oct 6th, 2010 | by OurHealthCareSource.com

This year has marked a series of milestone anniversaries for many of our nation’s most well known public programs. Programs that have become synonymous with stability, security and health care. They are: Social Security, Medicare and Medicaid. And, let’s not forget one of the most significant pieces of legislation our nation has seen in the last 20 years – the Americans with Disabilities Act (ADA).

You may be wondering why a large health plan like CareSource would care about the ADA or public programs in general. It’s actually pretty simple. It’s because each of our members is touched by at least one of these programs every day. Moreover, our members have tenaciously navigated the pitfalls of bureaucracy to secure and retain a benefit that is fundamental to their sheer existence. And, a good portion of them are just beginning to realize the opportunities that now lay before them as a result of the ADA (which, by the way, strives to remove significant barriers for individuals with disabilities. More on this later.)

Social Security – Celebrating 75 Years of Security
Despite being well past the age where most Americans can begin to receive benefits, the Social Security program is still viewed as one of the most important programs in our country. In fact, according to the AARP, nine out of ten adults held this view consistently in 1995, 2005 and 2010. Social Security underscores the importance of many of the values we advocate for today – independence, safety and financial peace of mind. As technology and innovation allow us to live longer, these values will remain essential to a more secure and productive tomorrow.

Medicare and Medicaid Turn 45
When Lyndon B. Johnson signed Medicare and Medicaid into law in 1965, do you think he ever dreamed it would result in health coverage for more than 100 million Americans just 45 short years later?

It’s a dream that many of us are proud to fathom. It’s a fiscal challenge we’d like to forget. But without these two programs, America would be a very different place. While not necessarily perfect, these programs have driven us as a society to build a health care system that allows us to live longer, employ millions of Americans and provide the strength a nation needs to forge ahead. Yes, some might agree that we have lost our footing along the way, but the passage of the Patient Protection and Affordable Care Act will be a milestone that will be celebrated just four short years from now.

ADA Celebrates 20 Years
July 26, 2010 marked the 20th anniversary of this historic legislation enacted to break down barriers in housing, the workplace, schools, malls, telecommunications and public transportation for people with disabilities. Despite its worthwhile advancements, leading advocates realize there is still much more work to be done. Our nation has focused heavily on supporting disabilities financially and medically, but not really as much on merging these ideals in a way that fosters inclusion and independence.

As we reflect on the needs of the more than 65,000 members with disabilities we serve in Ohio and Michigan, it is with great humility that we continue our advocacy to extend our reach to cover more individuals with disabilities. Doing so will ensure that they receive health care in a way that is person-centered, comprehensive, coordinated and in a setting where they can thrive and succeed.

Charting New Milestones
As a non-profit health plan, we recognize the foundation these programs have established for the current generation and for generations to come. The programs mentioned above as well as countless others have truly inspired the advent of companies like ours that are adamantly focused on supporting the underserved. In this commemorative year, we want to take this opportunity to honor each person who works tirelessly every day to help our nation’s most vulnerable reach their next important milestone. Happy Anniversary!

Health Care Reform is easy…isn’t it?

Aug 26th, 2010 | by OurHealthCareSource.com

Earlier this summer, our company hosted a retreat which included two national speakers– Dr. David M. Cutler and Thomas Dehner, JD. We invited these leading health care experts to meet with us because of their insights into health care reform, and the transformation that is currently taking place in this industry.

A little background on Dr. Cutler – he is a Harvard professor, and he served on the economic council during the Clinton years. More recently, he was senior health care advisor to President Obama. And, he is intimately involved in strategies around financing health care in our country. So his points of view were particularly eye-opening.

As the Massachusetts Medicaid director, Thomas Dehner led efforts related to the Medicaid components of the Massachusetts Health Care Reform Law. Now a principal with Health Management Associates, Inc., his viewpoints on lessons learned and future implications were also very enlightening.

There was a point in the presentation where Dr. Cutler gauged the difficulty for the health care industry to convert. He proclaimed the following:

• Insurance reform is easy
• Coverage expansion is more difficult (he called it Medium)
• Improving the value of care is the most difficult (or Hard)

It was an interesting assessment, and it sparked a lot of conversation.

Insurance Reform is Easy
First off, none of what needs to happen within the health care system is easy to change. But what makes insurance reform “easier” than transforming other aspects of the health care system is because insurance reform relies heavily on policy and laws. The introduction of federal policy allowing parents to keep their children on their health plan until age 26 is a perfect example of how policy can quickly affect immediate change.

Coverage Expansion is Medium
Expanding health coverage to more Americans is certainly a more difficult goal to achieve. Two reasons expansion is harder:

1. The exchange could create a mass rush to the health care “storefront”. People who have not had access to health care will now be eligible, and that may empower a lot of people to act. How will our system react?
2. At the same time, it’s also difficult to get people to enroll. Dehner said this is “a close-to-impossible job” despite the federal dollars set aside for outreach. Communication and promotion will be the key to educating the public about the availability to get coverage. But even with substantial outreach, there will be plenty of people that are eligible for public health care programs and subsidies, but just won’t know it or don’t recognize ongoing health coverage as a priority. So finding these people and getting them into the system presents a challenge.

Improving the Value of Care is Hard
This is by far the most difficult area to transform—but not impossible. All players within the health care arena are being pressured to find ways to reduce cost while increasing quality…and that can sometimes appear to be an oxymoron. But we are already seeing solutions that will help move this goal along:

• Technology
  The more we integrate technology into the health care system – and that includes technology that provides information, not just devices – the better coordinated the system will be, and the better doctors will be at providing the right kind of care at the right time and place.
• Case Management/Coordination
  What case management and health care coordination does is put prevention and wellness at the center of caring for patients. By integrating case managers more into the system, patients, providers and insurance companies can be held more accountable, helping increase quality of care. Also, case management ensures that patients are using the health care system responsibly, and that lowers cost.
• Streamlining Administrative Duties
  It’s estimated that highly trained registered nurses spend one-third of their time charting patient status and there are more administrative personnel on staff than nurses. That’s a lot of resources being devoted to what could be considered “lost productivity.” The industry needs to continue pursuing automation and streamlining this aspect of the business-side of health care.

Hard, Harder, Hardest – But Worth the Pursuit
There are many challenges ahead for this industry. But so much progress has already been made in a very short time. As long as the players within the health care industry continue to collaborate, we will reach our goal. And once we’ve reached our destination as an industry, we’ll look back and understand that the pursuit was worth it. Because we’ll all eventually benefit from the transformation of health care.

What do you think are the hardest aspects of health care reform to further implement?

Medicaid Extension Provides Much Needed Relief

Aug 12th, 2010 | by OurHealthCareSource.com

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.

Medicaid Extension is Vital to the Underserved

Aug 2nd, 2010 | by OurHealthCareSource.com

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.

Sincerely,
Janet Grant
External Affairs
CareSource

Moving Hope To Reality

Jul 22nd, 2010 | by OurHealthCareSource.com

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:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.

The 2010 Census – It’s easy. It’s important. It’s safe.

Apr 1st, 2010 | by OurHealthCareSource.com

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.

A Commitment To Our Children

Mar 16th, 2010 | by OurHealthCareSource.com

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?