Posts Tagged ‘underserved’
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.
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 20th, 2010 | by
The passing of health care reform means a lot of good things for underserved populations throughout our country – most notably, an increase in both Medicaid eligibility and Medicaid reimbursement rates for primary care providers in the next few years.
But with every up side – our most vulnerable population being taken care of as an upside in this case – there is always a downside. And unfortunately, providers see the increase in Medicaid eligibility as potentially having a downside impact on their businesses. It’s not because doctors don’t want to help those that can’t afford care. Doctors have consistently absorbed the costs of seeing economically-challenged patients, whether the patient is on Medicaid or not. The downside, to put it bluntly, is about reimbursement rates.
The Downside Dissected
Currently, doctors simply do not get reimbursed as much for services rendered to a Medicaid patient. State Medicaid programs, out of fiscal necessity, have negotiated lower rates with providers and hospitals than commercial insurance plans offer because of the scarce resources available to fund public health programs. And as a Medicaid managed care plan, we aren’t in a position to provide the same level of reimbursement to doctors that commercial plans can offer because our revenue is based on the Medicaid fee schedule. We already allocate over 90 percent of our revenue to medical care and keep our administrative costs around five percent and it still only pays providers about 85 percent what Medicare pays.
But that doesn’t mean there aren’t other ways for Medicaid managed care plans to help doctors see the value in dealing with Medicaid patients and plans. Some states embrace Medicaid managed care over fee-for-service because Medicaid plans have the flexibility to create services and programs specifically designed to help doctors better engage with his or her Medicaid patients– something fee-for-service simply can’t accomplish.
At CareSource, we have been working closely with our provider networks in Ohio and Michigan to reduce administrative barriers and bring the added-value services providers need to better engage with our members. And paying over 95% of our clean claims quickly is a key focus because we recognize that providers rely on us to keep their doors open.
But we have introduced other programs too…
Health Care Home – A Pilot Program on the Rise
We are piloting a program called Health Care Home. This program truly bridges the gap between the patient, the practice, and the health plan. We offer a unique set of services to assist the practice, the patient and their family. For example, we assign a case manager to work with each practice, sharing data, clinical information, immediate access to after-hours nurse triage information, and assistance with office resources. We can assist physicians by identifying areas of need and cooperatively enhance practice capabilities. Health Care Home also allows for outcome-based reimbursements beyond negotiated Medicaid reimbursements to incent providers to prioritize Medicaid patients.
Putting Technology to Work
In addition, we have created similar online administrative tools to those that commercial plans offer to their provider networks. This includes online preauthorization forms, online claims submission and tracking. Unlike commercial plans, we initiated the availability of online member profiles. The CareSource Member Profiles give providers a detailed medical history of their CareSource patients – a typically elusive piece of information since Medicaid patients tend to access the health care system in spontaneous and unpredictable ways.
A Resource for Your Patients During Off Hours
We also have in-house 24-hour nurse and triage call centers that have been URAC Accredited for our members. This benefits providers because obviously their offices are not open 24-hours a day. “CareSource 24” – as we call it – provides a resource for members who face medical issues when their primary care provider’s office is closed. The goal is to provide comprehensive and coordinated services, 24 hours a day, 7 days a week. Our focus is to make sure services are available whenever they are needed.
Combating the ‘No Show’ Issue
Because Medicaid plans work with many families who may not have access to reliable transportation, we offer transportation as a covered service. Providers can take more comfort in knowing that their Medicaid patients will have a greater likelihood of showing up for appointments because plans like CareSource offer this benefit in a way that is more accessible to its members than the fee-for-service system. A simple call to our member services line puts them in touch with our transportation vendor. In addition, CareSource case managers provide direct education to members about the importance of keeping their appointments and the impact no-shows have on a doctor’s office. Another way to break down barriers that preclude access and make a provider’s job a little easier.
Growing in the New Era of Health Care
The important point to this article is this – Medicaid will always guarantee providers some form of reimbursement for the medically necessary services they render to eligible members. But plans like ours prioritize the development of resources that help providers in ways that don’t cost them more money and potentially save them administrative costs – online tools, call centers, integrated support services like case management, transportation…these are the services that, when absent, can make serving Medicaid patients more expensive for a provider. But programs like these are at the foundation of our business as we continue to grow in this new era of health care.
Providers reading this article – What would make dealing with Medicaid plans like ours more appealing? What can be done to make the relationship better given the constraints of reimbursement levels?
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
Nov 24th, 2009 | by
The holiday season is now upon us. And while this time of year is supposed to be a joyous time spent with family and friends, I find myself reflecting on the lives of people that find the holiday season to be just another reminder of their economic circumstance. The underserved – particularly those at or below the poverty level – will experience the holidays in a much different way. With more and more families facing job loss as a result of the recession, many will not have Thanksgiving feasts…many will be struggling to find ways to “make the season bright” for their children. Many are turning to the social services available within their community just to make it through another month.
Throughout my time at CareSource and with Ohio’s Medicaid program, I’ve learned to have a deep appreciation for the challenges faced by the underserved. Sure, we can try to conceptualize what a day in the life of someone living in poverty is like, but CareSource has exposed me to a much more profound way to think about the priorities of the underserved…and they did this by proactively organizing an interactive event for CareSource employees called the “Poverty Simulator.”
Because our company prides itself on helping the underserved better their lives by improving their health care, our organization does some pretty unique things to help us appreciate the challenges our members face each day – and how they prioritize getting their most basic needs met. This Poverty Simulator – organized by Think Tank, a non-profit organization that strives to build communities where all people can thrive – does just that…it allowed us to put ourselves in the shoes of our members through role-play, to gain a fuller appreciation of barriers that often preclude them from accessing health care services responsibly. It’s all done in an effort to teach us why our members make the decisions they make; ask the question they ask; need the support services they need; and where their health care fits in to the grand scheme of things they consider vital… Why? All so we can better serve them.
We’ve held this event four times this year for our employees who have described the event as “heart-wrenching,” “mind-blowing” and “eye-opening.” The simulator has been so enlightening that we included it as part of an event we hosted on Capitol Hill that allowed health care experts and interested parties to experience it firsthand. The purpose was for those following and influencing the health care debate to gain a better understanding of how poverty impacts the way people prioritize and access health care – even if it is made available to them at no cost.
It’s so easy to make general assumptions about why people make the decisions they make. But quite frankly, until you actually walk in the shoes of the underserved, it is very difficult to appreciate the complexities of living in poverty. Please take a few minutes to see what the Poverty Simulator is all about. I think you’ll find it offers a unique and profound approach for helping organizations understand the needs of its customers, and how CareSource excels at building a culture of compassion, dignity and excellence.
Oct 14th, 2009 | by
The US Senate Finance Committee just approved a health care plan that includes a provision that would significantly expand Medicaid. This is great on so many levels. However, it has one flaw. That being, the full expansion wouldn’t actually start until 2014. Is it just me, or does that seem to contradict the whole idea of protecting the most vulnerable first?
Yes, it’s true that we’ve been trying to fix the health care system since at least 1948. So from one point of view, spending another few years trying to get it right doesn’t seem out of line. But imagine if all you hear around you is that health care reform is going to make a difference in the lives of the 47 million uninsured Americans right now, but then you find out that you have to wait longer than everybody else. Then, to make matters worse, your income is among the lowest in America and is the primary reason you are uninsured in the first place.
The unfortunate truth about this health care plan is that once again, those who are most in need are expected to wait longer than the rest of us. This includes hard working people with low incomes who just don’t happen to have dependent children – the current ticket for most people to qualify for Medicaid. And parents who are doing all they can to make ends meet for their children who are blocked from Medicaid coverage because their very limited income is deemed too high for them to qualify. The list goes on.
Where’s the justice in waiting to expand Medicaid until 2014? Or, maybe more pragmatically, where is the preventive care and coordination that is going to enable the right care at the right time in the right setting – you know, rather than causing the first stop to be in an emergency room after waiting until the cancer spreads, the diabetes worsens, or the heart attack occurs.
Doesn’t it make sense to have health care coverage for those that need it most first?
Oct 1st, 2009 | by
Last week, I sat down with the anchors at WDTN-TV, Dayton, OH. The topic of our discussion was around health care reform and how it will affect the underserved population that currently access public programs, like Medicaid.
In the TV interview, I also discussed the broad questions people have regarding health care reform. People want to know, “What does health care reform mean for me?” Will I be able to keep the coverage I have?
For health care reform to be effective, it must cover all individuals and provide those faced with poverty the supports they need to access care appropriately. Giving someone a health insurance card is only one part of the equation – albeit a considerable part. However, getting them to their regular provider on a regular basis is the essential factor for ensuring the outcomes health care reform promises.
There are still many people that do not qualify for Medicaid, and would benefit tremendously from having access to ongoing health coverage. It’s great that we are covering our children through Medicaid (one out of every five), but that coverage needs to extend to the parents and childless individuals as well.
What do you think are the biggest opportunities for health care reform? Who needs to benefit most? How do you think Americans in poverty could benefit most from health care reform?