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, MPADirector of Maternal Child Health

County of Sonoma

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.

Child Health Problem Analysis

Family may have children under different insurance coverage and had difficulty understanding varied retention and utilization policies

Child is able to get free immunizations thus doesn’t need health coverage

School age children appear “healthier or less in need of care: then their young siblings

Child is undocumented

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

INDIVIDUAL LEVEL/PRIMARY PRECURSORS

Family has difficulty making health insurance payments

Family may be very mobile or homeless and misses mailed notification of need to re-establish insurance eligibility

Child appears well, and not in need of health care

Seasonal work creates changing income and may impact families eligibility for coverage

Complexity to application process and annual redetermination for eligibility makes retention of coverage difficult for familyMedi-Cal seen by family as

government aid rather than insurance

Family leaves USA seasonally and drops insurance

Cultural perception that when health care is needed parent will pay for it or use a public program

Family has working parent(s) but no access to insurance through work

Family may have lack of knowledge about the importance of preventative health care

Medi-Cal seen by family as government aid rather than insurance

Public insurance programs have complex regulations, slow or faulty eligibility determination process

Stigma attached to using Medi-Cal

Societal belief that undocumented families don’t 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

FAMILY/INSTITUTIONAL LEVEL/SECONDARY PRECURSORS

SOCIETAL/POLICY LEVEL/TERTIARY PRECURSORS

Objectives

1. 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)

2. Contract with a plan administrator for a product, which covers children who are uninsurable under public programs. (6-9 months)

3. Enroll children through a single portal, which links health care coverage and education on appropriate uses of health care. (9 months and ongoing)

Anticipated Results

1. Maximize enrollment of children in health insurance plan by three years.

2. Maximize retention within the health plan.

3. Improve use of preventive care and reduced use of emergency room use.

4. Long term funding identified to maintain available health insurance products .

Steps in Creating the Initiative

1. Key leaders met regarding the lack of health care coverage in Sonoma County.

2. They focused their efforts on children.3. Contractor helped obtain funds for

planning and creation of the system.

Key Partners

• Health Services Department• Human Services Department• Redwood Community Health Coalition

(coordinating agency for community clinics)

• Family Action (childhood advocacy group)

Health Services Role

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

Early Accomplishments

• Business plan with enrollment projections, proposed expenses and revenues

• Outreach and media plan• Funding plan• Incorporation of other “like-

minded” local efforts

Current Coverage

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

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

Intake Flow Chart1. Outreach/ Inreach and information & referral

2. Program Screening including education & application assistance

5. Post-enrollment education & retention

4. Enrollment or denial follow-up

3. Product enrollment

Inreach

Outreach

Family

Eligibility Worker

CHIRepresentati

ve

CAA

800#

Medical EW

Healthy Family

Cal Kids

Kaiser

New Product

Family

CHI Rep

Resource Education

Utilization Refe

rral

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

800#

Family AppliesFamily comes into HSD seeking

services. Reception screens to see what they want to apply for:

Onsite CAA assists family with Children’s Health program

application(s), provides benefit information and directs family to mail premium to TPA and provide

verifications to assigned EW.

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.

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.

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 is passed to continuing

worker.

Case information is forwarded to CAA or Clerk Typist for

retention activities.

1. Family wants a Children’s Health Program only

2. Family wants a Health Program and Food Stamps

Application is referred to HF,

CK or K

Legend:MC = Medi-Cal K = Healthy KidsCK = CalKIDs K = KaiserHF = Healthy Families TPA = Third Party Administrator

Insurance Retention

1. Address updates with consumer at every contact

2. Consumer friendly and accessible documents

3. Reminder letters, postcard and/or phone calls for annual redeterminations

4. Consistent relationship with assistor

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

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

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

Barriers

• People who believed this couldn’t 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

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

Evaluation

• Measure all progress by:– Sustainability– Effectiveness– Efficiency– Will our children be better insured

and better able to access health services than before?

Sonoma County Child Health Care

Access-Health Care Coverage for Every Child Ages 0-18 Years at 300% of Poverty

and Under

Thank you