Partnering with Communities: How Funders can Reach and Enroll
Eligible but Uninsured Children Grantmakers for Children, Youth and
Families Conference October 10, 2012
Slide 2
Various foundation outreach and enrollment strategies Varying
roles that foundations can play in this enterprise Partnering with
community- based entities
Slide 3
Three Colorado foundations The Colorado Health Foundation The
Colorado Trust The Telluride Foundation
Slide 4
Source: Waters-Boots, Shelley, Improving Access To Public
Benefits, April 2010
Slide 5
Organizational capacity builder Policy/ Advocacy Research and
evaluation Direct services Education and awareness Systems
infrastructure Benefits access
Slide 6
Nationally Between 2008 and 2009, witnessed an increase in
Medicaid and CHIP (Childrens Health Insurance Program)
participation (82.1% to 84.8%); between 2008-2010, uninsured rate
for children fell from 9.7% to 8.5% Reduced eligible but not
enrolled (EBNE) by 340,000 Still an estimated 4.3 million EBNE
children (total 6.6 million uninsured in 2009) Sources: Urban
Institute, Gains for Children: Increased Participation in Medicaid
and CHIP in 2009, August 2011 SHADAC, Keeping Kids Covered: Number
of Children with Health Coverage Increases During Economic
Downturn, August 2012 Colorado In 2010, 132,000 (10.3% of Colorados
children) were uninsured, 82,000 EBNE children Hispanic children
disproportionately affected Hispanic children comprise 31% of all
Colorado children but account for nearly 2/3 of EBNE children
Source: Colorado Health Institute
Slide 7
Uninsured children 5x more likely to have an unmet need for
medical care, especially heightened with special needs children 3x
more likely not to get a needed prescription drug Less likely to
receive preventive services (immunizations, dental and vision care)
Almost 1/3 less likely to receive medical treatment if theyre
injured 2009 Johns Hopkins study: seriously ill uninsured children
are 60% more likely to die than if they didnt have insurance
Source: InsureKidsNow.gov
Slide 8
Onerous application process Awareness and education
Disconnected data systems Accessibility and capacity of assistance
Stigma Language and/or cultural barriers Transient populations
Failed or inconsistent recruitment strategies Onerous renewal
process Complex eligibility determination
Slide 9
Source: Colorado Covering Kids and Families, Colorados Maze to
Enrollment in Medicaid and CHP+, June 2012
Slide 10
Federal CHIPRA 2009 reauthorization provisions Accountable Care
Act Under full ACA implementation, Medicaid enrollment expected to
increase by 39% BUT even with this increase, an estimated 38% of
those uninsured would be eligible for Medicaid or CHP but not
enroll (Urban Institute, Gains for Children: Increased
Participation in Medicaid and CHIP in 2009, August 2011) State
Enrollment simplification Presumptive eligibility Continuous
eligibility Express lane enrollment Foundations RWJF MaxEnroll and
Covering Kids and Families Local and state foundations Partnering
with community
Slide 11
What did you learn and what advice would you share with other
funders?
Slide 12
Grantmakers for Children, Youth and Families Conference October
10, 2012
Slide 13
Who we are Our vision is to make Colorado the healthiest state
in the nation. Statewide foundation $2.2 billion in assets In 2010,
we provided $97 million in community benefits Grantmaking, policy,
communications and graduate medical education
Slide 14
How we do it
Slide 15
Health Coverage
Slide 16
Increase Benefits Simplify Enrollment Ensure Access Optimize
coverage available through Medicaid, CHP+ and other public
programs
Slide 17
Simplify enrollment and renewal processes Automating the
process (Enrollment Strategic Assessment, PEAK) Changing the
culture of eligibility workers to one that prioritizes enrolling
all eligible individuals rather than serving as gatekeepers
(Colorado Eligibility Process Improvement Project Phase I and II)
Streamlining administration of Medicaid and CHP+ (Covering Kids and
Families) Pursuing policy changes that simplify the eligibility and
renewal processes (All Kids Covered, Continuous Eligibility,
Express Lane Eligibility)
Slide 18
Increase eligibility and expand benefits Pursuing policy
changes that increase eligibility for Medicaid, CHP+ and Medicare
subsidy programs (Childrens Campaign, Colorado Coalition for the
Medically Underserved, Colorado Center on Law and Policy)
Supporting efforts to expand benefits in Medicaid, CHP+ and other
public coverage programs, including mental and dental health
services (Colorado Consumer Health Initiative re: SB12-108)
Slide 19
Ensure access to covered health care services Increasing the
number of providers willing to treat people covered by Medicaid,
CHP+ and other public programs (Colorado Childrens Healthcare
Access Program) Providing case management to enrollees on how to
access needed services and maintain coverage (Servicios de La
Raza)
Slide 20
What has worked Foundation partnership with state Medicaid
administration Learning collaborative among advocates and
enrollment sites Regional and state coalitions Partnership among
community-based organizations, county and state (e.g. FQHC, county
and HCPF) Regional planning Strong advocacy partners
Slide 21
Challenges Changes in administration Policy implementation
Sustainability of enrollment sites/lack of funding Placement of
local enrollment sites Colorado Benefits Management System
Confusion among consumers about what sites provide
Slide 22
Thank you Erica Snow, Senior Program Officer
[email protected] (303) 953-3656
Slide 23
Deidre Johnson The Colorado Trust Trusted Hands: Partnering
with Community-Based Organizations to Reach and Enroll EBNE
Children
Slide 24
Source: Waters-Boots, Shelley, Improving Access To Public
Benefits, April 2010
Slide 25
Grantee Partners - Trusted community organizations with
established relationships with the target EBNE population In-Reach
Medicaid Childrens Health Plan Plus (CHP+) Services - Comprehensive
enrollment assistance including: Eligibility Determination
Application Assistance Throughout the Enrollment Process
Utilization of Services Redetermination Assistance
Slide 26
Community Grants (2009-2011) $3.4 million investment 19 CBOs
received 3-year grants Community Clinics School District Head Start
County-wide collaborations Drop-in/After-School Programs Agencies
Serving Low-Income Families, Homeless Families and Abused Children
Affordable Housing Provider Hospital Emergency Department American
Diabetes Associations Ventanilla De Salud
Slide 27
Technical Assistance Department of Health Care Policy and
Financing (Colorado Medicaid) Community Outreach Specialist Online
Outreach and Enrollment Mapping Tool Colorados Maze to Enrollment
in Medicaid and CHP+ Colorado Covering Kids and Families
Slide 28
Evaluation (2009-2012) University of Colorado Denver Client
Assistance Tool (CAT) Reach: Which populations do CBOs reach and
not reach? Implementation: What outreach and enrollment strategies
are CBOs using? Effectiveness: What is the impact of these CBO
models and strategies on enrollment, renewal and use of benefits?
Cost Analysis Sustainability
Slide 29
Grantees reached more than 35,000 children to determine
eligibility Grantees provided application assistance to 30,812
families applying for Medicaid or Child Health Plan Plus 85%
Medicaid Applicants 15% CHP+ Applicants The HCPF Community Outreach
Specialist Department point of contact for 19 grantees Provided
training and certification to 381 community-based enrollment
assistance sites in 50 counties. With this training, these sites
are better able to outreach to families and help them successfully
complete applications.
Slide 30
The relationship between outreach and systems change Capacity
of grantees to impact service utilization The need for technical
assistance not only on how to execute a new function but also on
how to integrate it into existing business processes Efficiency of
enrolling children in multiple benefits at once rather than
focusing solely on health coverage The importance of data: Client
Assistance Tool (CAT) Enrollment events can be effective under
certain conditions
Slide 31
Partnering with Communities: How funders can reach and enroll
eligible but uninsured children Lessons learned from
community-based entity Grant makers for Children, Youth and
Families Conference October 10, 2012
Slide 32
Telluride Foundation Community foundation Grants Capacity
building Initiatives (run programs) Southwest Colorado Serve 13,000
population; 4 people/sq. mile; rural $2.8 million grants annually
$1.5million unrestricted grants $1.3 million foundation
partnerships/DAFs grants 32
Slide 33
Tri-County Health Network 501c3 supporting organization of
Telluride Foundation Programs Entitlement Assistance Kids oral
health Immunization registry Medical shuttle Chronic disease care
management outreach Population health management 33
Slide 34
Why Entitlement Enrollment? Rural southwest Colorado has some
of the highest rates of uninsured children not only in Colorado but
also the nation ~ 32% of children in three county region were
Eligible But Not Enrolled (EBNE) ~ 43% of all children attending
school are on Free & Reduced Lunch/National School Lunch
Program 34
Slide 35
Elements to Success: Partnerships School Districts Childcare
Providers County Social Services Medical Community Advocacy Groups
for minority populations State Department of Health & Human
Services Local non-profits Faith-based Organizations 35
Slide 36
Elements to Success: Enrollment Navigator Employ local
community members who live and are active in their communities
Become Certified Application Assistors (CAAs) Be mobile performing
outreach efforts in the field not in an office behind a desk
Regionally located Navigators are considered a trusted hand in
their communities Must be persistent! 36
Slide 37
Elements to Success: Tracking System System to electronically
document/track: applicant demographic information tracking
enrollment process work storing legal documentation and application
daily task list associated with uncompleted applications tickler
system for annual renewals type of outreach activities resulting in
highest enrollment rates System that can interface with the State
enrollment verification system to easily confirm successfully
enrolled applicants 37
Slide 38
Barriers to Success Trust Cultural differences Language and
literacy Geographical isolation Perceived stigma Complexity of
application process Procrastination Confusing approval &
renewal letters 38
Slide 39
Program Costs Staffing Plan based on geography & population
Travel Budget Application Tracking Software license/maintenance
Laptop/printers Supplies (paper/printer ink) Postage Funds to
assist in securing birth certificates Business cards/enrollment
brochures 39
Slide 40
Measuring Success Monthly reporting Number of people assisted
Number of applications processed Number of applications approved
Number of renewals approved The Networks success to date: Over 800
individuals enrolled/retained eligibility 40
Slide 41
Funders Role: Policy Change Provided under the Childrens Health
Insurance Program Reauthorization Act of 2009 (CHIPRA), the Express
Lane Eligibility (ELE) option gives States new processes to ensure
a fast and simplified process for determining Medicaid/CHP+
eligibility for children. Through ELE, States can use eligibility
findings from other public benefit programs (i.e. SNAP, School
Lunch, WIC, etc) to determine childrens eligibility in Medicaid or
CHIP/CHP+ States must receive approval (State Plan Amendment) from
CMS in order to be designated as ELE 41
Slide 42
States with ELE 42 Source:
http://www.kff.org/medicaid/8272.cfm
Slide 43
Funders Role: Proactive RFP Develop RFPs specific to
Entitlement Enrollment Activities Ask about existing partnerships
Staffing plan that includes community members Strategy to partner
with County & State Knowledge of existing E&E efforts
Provide multi-year funding 43
Slide 44
Contact Information Lynn Borup Executive Director, Tri-County
Health Network 719.480.3822 [email protected] Paul Major
President, The Telluride Foundation 970.728.8717
[email protected] 44
Slide 45
Questions What role(s) can funders play to ensure that
children, especially the most disadvantaged and least-resourced,
have access to public health insurance programs? What have you
already done and learned? How can funders engage community partners
in their endeavors? How are you thinking about community? The 2 Ss
Sustainability and Scale. How do funders support sustainability
and/or scale? What can philanthropy do?