Sonoma County Child Health Care Access Health Care Coverage for Every Child Ages 018 Years at 300% o

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Sonoma County Child Health Care Access-Health
Care Coverage for Every Child Ages 0-18 Years at
300 of Poverty and Under

• Norma Doyle, BSN, MPA
• Director of Maternal Child Health
• County of Sonoma

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Background

• Sonoma County has a population of 500,000 with
  112,000 Children ages 0-18 years.
• 8,000 children are estimated to be without health
  care coverage.
• The majority of these children are below 200
  poverty, age 12 and older, Hispanic, living in a
  single parent family with a woman as
  head-of-house.
• Lack of health care coverage limits access to
  health care, impacts the early diagnosis and
  treatment of health conditions or developmental
  concerns and appropriate linkage with resources.

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Child Health Problem Analysis
SOCIETAL/POLICY LEVEL/TERTIARY PRECURSORS
Public insurance programs have complex
regulations, slow or faulty eligibility
determination process
Societal belief that undocumented families dont
deserve health care
Health system has minimal providers who take
children under public insurance
Health systems may have staff who show disdain
for families using public insurance
Stigma attached to using Medi-Cal
FAMILY/INSTITUTIONAL LEVEL/SECONDARY PRECURSORS
Complexity to application process and annual
redetermination for eligibility makes retention
of coverage difficult for family
Family leaves USA seasonally and drops insurance
Family may have lack of knowledge about the
importance of preventative health care
Family has working parent(s) but no access to
insurance through work
Cultural perception that when health care is
needed parent will pay for it or use a public
program
Medi-Cal seen by family as government aid rather
than insurance
Family may be very mobile or homeless and misses
mailed notification of need to re-establish
insurance eligibility
Medi-Cal seen by family as government aid rather
than insurance
Seasonal work creates changing income and may
impact families eligibility for coverage
Family may have children under different
insurance coverage and had difficulty
understanding varied retention and utilization
policies
Family has difficulty making health insurance
payments
INDIVIDUAL LEVEL/PRIMARY PRECURSORS
Child is able to get free immunizations thus
doesnt need health coverage
School age children appear healthier or less in
need of care then their young siblings
Child is undocumented
Child appears well, and not in need of health care
Targeted Indicator Children under 18 at 300
poverty or less need health care
insurance Consequences Less preventive care,
exacerbation of higher levels of disease and
misuse of emergency room
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Objectives

• Create a community plan with key participants to
  provide policy development, fund raising and a
  detailed work plan for outreach, enrollment and
  retention of uninsured children in health
  coverage. (3-6 months)
• Contract with a plan administrator for a product,
  which covers children who are uninsurable under
  public programs. (6-9 months)
• Enroll children through a single portal, which
  links health care coverage and education on
  appropriate uses of health care. (9 months and
  ongoing)

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Anticipated Results

• Maximize enrollment of children in health
  insurance plan by three years.
• Maximize retention within the health plan.
• Improve use of preventive care and reduced use of
  emergency room use.
• Long term funding identified to maintain
  available health insurance products .

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Steps in Creating the Initiative

• Key leaders met regarding the lack of health care
  coverage in Sonoma County.
• They focused their efforts on children.
• Contractor helped obtain funds for planning and
  creation of the system.

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Key Partners

• Health Services Department
• Human Services Department
• Redwood Community Health Coalition (coordinating
  agency for community clinics)
• Family Action (childhood advocacy group)

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Health Services Role

• Convener
• Provision of key staff
• Administrative support
• Processes contracts
• Media Releases
• Quality assurance
• Evaluation

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Early Accomplishments

• Business plan with enrollment projections,
  proposed expenses and revenues
• Outreach and media plan
• Funding plan
• Incorporation of other like-minded local efforts

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Current Coverage

• Medi-Cal
• Healthy Families
• Kaiser
• California Kids

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Training Plan for Assistors

• 12 hours state sponsored training
• Training on new product
• 1 week with a mentor on applications
• Monthly meetings with other assistors
• Access to Retention Specialist

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Intake Flow Chart
1. Outreach/ Inreach and information referral
5. Post-enrollment education retention
4. Enrollment or denial follow-up
3. Product enrollment
2. Program Screening including education
application assistance
Medical EW
800
Healthy Family
Family
Utilization
Referral
Resource Education
Family
Cal Kids
CHI Representative
CHI Rep
Kaiser
800
Outreach
CAA
New Product

• OVERSIGHT ENTITY
• Oversight for CAA/CHI Rep - Training
• Regular information sharing meetings - Ongoing
  support
• Troubleshooting team

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Family Applies
Legend MC Medi-Cal K Healthy Kids CK
CalKIDs K Kaiser HF Healthy Families TPA
Third Party Administrator
Family comes into HSD seeking services. Reception
screens to see what they want to apply for

• Family wants a Childrens Health Program only
• Family wants a Health Program and Food Stamps

Onsite CAA assists family with Childrens Health
program application(s), provides benefit
information and directs family to mail premium to
TPA and provide verifications to assigned EW.
Family is interviewed for all programs by an EW.
Family is directed to provide verifications to
assigned EW. Family is directed to pay premiums
to TPA.
Application is referred to HF, CK or K
Application MC or HK is passes on to Mail in EW
(MIM) for eligibility determination. EW certifies
eligibility for ? Medi-Cal or Healthy Kids EW
sends (faxes?) Healthy Kids certification to TPA
or carrier. HK information is entered into
database. ? Healthy Families referral made if
appropriate.
Intake EW determines eligibility for Food Stamps
and MC and HK programs. EW sends notices to
family. EW makes HF referral if appropriate. EW
sends certification to HK or TPA or carrier.
Case information is forwarded to CAA or Clerk
Typist for retention activities.
Case is passed to continuing worker.
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Insurance Retention

• Address updates with consumer at every contact
• Consumer friendly and accessible documents
• Reminder letters, postcard and/or phone calls for
  annual redeterminations
• Consistent relationship with assistor

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Major Accomplishments

• Funding from endowment for implementation and
  program coordination
• Formation of a steering committee with high level
  decision makers for credibility, sustainability
  and funding
• Formation of an operations Committee for detailed
  direction to the Coordinator on implementing
  multiple activities
• Formation of a Single Portal Committee who design
  the methodology for identifying, enrolling and
  retaining children on health insurance

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Major Accomplishments (continued)

• Release of a RFP to obtain a product and project
  administrator for coverage of those children who
  are ineligible for public programs
• Release of a RFP to obtain a funding consultant
  and media plan
• Identification of additional funding

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Lessons Learned

• Have the right people at the table
• Plan for time intensity within first year
• Identify crucial information and take advantage
  of opportunities rather than delaying actions
• Fix the current system before enhancing it

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Barriers

• People who believed this couldnt be done
• Lack of status as a Managed Care County
• Complexity and rigidity of Medi-Cal eligibility
  and redetermination system
• Decreasing level of available health care
  services
• Changes occurring in the California Medi-Cal
  system
• Lack of a product for uninsurable children

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Overcoming Barriers

• Involve those who are doubtful
• Work with state regarding options of becoming
  Managed Care
• Involve Human Service staff in personalizing
  eligibility
• Use family planning residents across local health
  care clinics
• Reframe the issue based on the audience while
  maintaining the vision
• Use the available products and heighten
  enrollment and retention efforts

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Evaluation

• Measure all progress by
• Sustainability
• Effectiveness
• Efficiency
• Will our children be better insured and better
  able to access health services than before?

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Sonoma County Child Health Care Access-Health
Care Coverage for Every Child Ages 0-18 Years at
300 of Poverty and Under
Thank you