Community Insight
"Trusted Hands" Enroll More Children in Public Health Insurance
Sue Williamson
Deputy Director, Client and Community Relations,
Colorado Department of Health Care Policy and Financing
As a result of the economic recession, a record number of Colorado families lost their health care coverage when they lost their employment. However, having a job doesn't always guarantee access to health care coverage – a large number of working families can't afford the health care they need.
Fortunately, families may be eligible for coverage through Medicaid and the Child Health Plan Plus (CHP+), public health insurance programs administered by Colorado's Department of Health Care Policy and Financing. Many families are not aware of the existence of these programs or that they may qualify. The Department has a rich tradition and continues to focus its outreach strategies to eligible-but-not-enrolled (EBNE) families by working with local community partners. These partners include schools, health care providers, employers and community-based organizations – from youth programs to churches and public agencies, like local recreation centers and libraries. By using the Trusted Hand approach, families are much more likely to apply for public health insurance programs and submit a completed application to their local county department of human/social services or medical assistance site for eligibility determination. The premise of the Trusted Hand model is that people are much more likely to apply for public health insurance programs when they have someone in their local community who is knowledgeable and able to guide them through the process.
Let me share a story that illustrates how this approach works. During a summer festival in Simla, Carolyn Juranek, the Plains Medical Center Service Coordinator, brought a portable putt-putt golf game along with free pens and sunscreen packets as a way to begin a conversation with people to inform them about the clinic and its services. The Campbell family happened to stroll by the booth and pick up a brochure. A couple of months later, Gary Campbell lost his job as a heavy equipment operator for a construction company and desperately needed help affording dental care. Thanks to the neighbor-to-neighbor contact at the Simla fair, he remembered Juranek, who ultimately helped him fill out an application for Medicaid and CHP+. He later received a grant from a separate organization to defray costs for extensive dental work, and his wife and five children received health coverage through CHP+.
We need to continue working with partners like the Plains Medical Center and others who are "on the ground" statewide. We know that what works in Simla may be very different from what works in San Luis or Cortez or Craig. The advantage of the Trusted Hand model is that each community can design and develop an outreach plan that works for their particular community based on their unique needs and resources.
When CHP+ began in the late 1990s, Colorado used the Trusted Hand approach to enroll children in this new health coverage program. In 2000, we partnered with community health clinics, local public health departments and other community-based organizations, which served as Satellite Eligibility Sites (SED). Workers at these sites generated awareness of the program and assisted families in completing the application process. At that time, they were also able to enter the applicant's information into the eligibility system which expedited the application processing time. These partnerships proved highly successful and at its peak, approximately 35% of new enrollments were generated through SEDs. Unfortunately, the economic recession and state budget challenges in the aftermath of 9/11 resulted in the elimination of outreach funding and an enrollment cap on the program. In 2004, the state implemented the Colorado Benefits Management System, the new eligibility system for all public health insurance programs, which limited the types of organizations that were able to perform the application processing activities.
With the passage of Amendment 35, the tobacco excise tax, funding was created to support marketing programs to educate families about their coverage options, as well as restore and expand CHP+ coverage to children and pregnant women. In 2005, we contracted with Maximus to implement a $1.3 marketing and outreach plan. Some of the funding was used to promote CHP+ through traditional marketing such as television and radio ads. However, much of the funding was used to re-invigorate the grassroots Trusted Hand model through the use of Regional Outreach Coordinators (ROCs) that worked with local community-based organizations to create awareness of the CHP+ program. With the infusion of new funding, together with the funding from private funders like The Colorado Trust, we were able to support the efforts of our local community partnership to reach our EBNE population.
While there is value in creating awareness of our programs through established marketing channels, actual enrollments are more likely to be generated when a Trusted Hand is working with a family to assist with the application process. Through their established connections and relationships with the people in their community, our community partners are able to remove barriers and address the challenges that our families face when applying for our programs.
We are now serving more than 70,000 children and pregnant women through CHP+. This remarkable program enables states to insure children from working families whose incomes are too high to qualify for Medicaid, but too low to afford private health insurance. To find these children, we are continuing to support our existing community partners as well as expanding our partnerships with new groups. Our partners range from schools and faith-based organizations to Head Start programs, child care centers, county health workers, private medical providers and community health centers, just to name a few.
The application process can feel like a daunting task to many families, especially those who have little or no previous experience accessing benefits through a government program. Thanks to support from The Trust, we now have a dedicated staff person to connect with our partners. Our Community Help Desk provides technical assistance, training and other support to outreach workers statewide.
The Help Desk will also be instrumental in assisting partners with the Program Eligibility and Application Kit (PEAK), a new online application tool for people applying for our programs. Currently, anyone who has access to a computer is able to self-screen to see if they might be eligible for any of our public health insurance programs. In the summer of 2010, applicants will be able to apply online for our family and children's programs. We also see PEAK as a tool that our community partners can use when working with potential applicants, eliminating the need for submitting a paper application and reducing the application processing time.
Colorado is a recognized leader among states in its use of creative, comprehensive approaches to reach families needing health care coverage. We are on the leading edge in our efforts to assist families through the entire lifecycle of a client – from creating awareness of our programs to the eligibility and enrollment determination process to accessing health care benefits in appropriate settings. As we begin to implement the Healthcare Affordability Act, which will expand coverage to 100,000 previously uninsured Coloradans, we will continue to rely on our community partners as our Trusted Hand ambassadors to reach those EBNE expansion populations. With the passage of national health care reform, there will be new opportunities for our partners to teach families the value of health care coverage and how to access appropriate health care services.
We know that health care coverage is important for many reasons. Uninsured people receive less medical care and less timely care. As a result, uninsured people tend to have worse health outcomes than those who are insured. Conversely, children with health coverage have a greater likelihood of receiving regular visits that can prevent illnesses and disease before they require more costly treatment. When children are covered and are linked to a medical home, we can promote vaccinations and the maintenance of healthy weight. Health care coverage gives parents peace of mind, knowing their children can obtain health care when it is needed. Ultimately, healthier people create stronger communities.
Evaluation: The University of Colorado Denver Health Sciences Center, Department of Health and Behavioral Sciences is conducting a three-year (2009-2012) evaluation of public insurance outreach and enrollment programs in community-based organizations funded by The Colorado Trust. The evaluation will determine the programs' impact on enrollment, retention and utilization of Colorado's public health insurance programs. For select grantees, the team is also conducting a cost analysis to examine the cost per client of implementing a case management approach to CHP+ and Medicaid outreach, enrollment and retention.
