AS MEDICAID EXPANSION PROGRESSES:
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1 AS MEDICAID EXPANSION PROGRESSES: New Opportunities & Challenges Connecting Homeless Clients to Coverage & Care May 9, 2015
2 STATE OF AFFAIRS 29 states + DC have expanded Medicaid under ACA As of January 2015, 70 million now enrolled in Medicaid 11.2 million more since October 2013 (19% increase) Enrolling clients into benefits (many under managed care) Connecting people to broader range of care Managing a changing financial & operational landscape Addressing limitations of coverage, gaps in service, and ongoing need for complementary funding Maximizing new partnerships & broader interest in special populations & social determinants of health
3 Percent of Visits with Insured Clients 100% 90% 91% 88% 90% 91% 87% 83% 89% 90% 80% 70% 60% 50% 40% 30% 50% 50% 50% 46% 48% 44% 41% 41% 51% 25% 54% 47% 32% 33% 57% 57% 51% 52% 43% 41% 42% 36% 20% 10% 0% 2% 3% 4% 3% 7% ABQ Baltimore Chicago
4 PRESENTERS Kevin Lindamood, MSW, President & CEO, Baltimore HCH, Maryland Matias Vega, MD, Medicaid Director, Albuquerque HCH, New Mexico Sheena Ward, BA, Benefits and Entitlements Supervisor, Heartland Health Outreach, Chicago, Illinois
5 Baltimore: Project Snapshot Established in 1985 Now in 30 th Year Multi-Disciplinary Services, Education, Advocacy Medicaid Expansion State, Managed Care Fee-for-Service Strategic Planning in 2012 for Plan Budget $13 Million $15 Million $17.8 Million Staff Clients Served 7,000 8,600 21% increase (Q1) Total Patient Visits 78,000 90,000 21% increase (Q1) % Uninsured 70% ~10% ~10%
6 Post-Expansion Environment Growth based on need Specialty care access Service sustainability (60%/40%) Strengthened infrastructure Maryland hospital system reforms
7 New Challenges Beyond fee-for-service: Focus on quality and clinical outcomes Cost savings: Broadening health interventions Sustainable growth: Leveraging billing & grants to meet comprehensive needs Tentative partnerships: Moving ahead in uncertain times
8 Notable Successes Outreach & Enrollment Transformed Business Model PCMH Accreditation Service Expansion Strengthened Unfunded Services Supportive Housing
9 Chicago: Project Snapshot Number patients/visits (2014): 7,661/32,945 Two service locations: N & W side of Chicago Medical Primary care & dental, nutrition education and counseling Specialty care for chronic illnesses: diabetes, HIV/AIDS, mental illness and more Community Support Services Assistance with transportation to medical visits through your insurance Onsite Laundry and Shower Behavioral Health Same day crisis intervention Psychiatry
10 Chicago: Post-Expansion Environment MCO transitions More access to health care Better opportunities for health education PCMH-patient more involved in healthcare Make better decisions around care ER versus PCP
11 Chicago: New Challenges Missed redeterminations Confused about MCOs and how it pertains to coverage Pending Medicaid budget cuts Retention of patients Adapting to MCO environment as an agency
12 Chicago: Notable Successes Opening the new clinic site in 2014 on the West side 460 individuals enrolled or re-enrolled since March 2014-March 2015
13 Albuquerque: Project Snapshot Started in 1985 Patients/visits (2014): 4,349/20,183 Service locations: 1 campus site and 12+ outreach sites Services offered onsite: Integrated Medical/Behavioral Health Primary care: chronic, acute & urgent care; substance use services; psychiatric services; counseling, crisis intervention; pharmacy in-house Specialty Clinics: DM, Vision, Accudetox Dental Case Management Housing Harm Reduction including syringe exchange services ArtStreet: community art studio/art therapy
14 Albuquerque: Post-Expansion Environment Section 1115 Waiver (started 1/2014) Yearly benefit renewal 50% increase in enrollment 4 MCOs with separate Medical/BH/Dental contracts (12 total) BH carved-in Assignment issues: not listed as PCPs but as urgent care MCOs unable to identify homeless status If listed as PCPs, non-homeless patients assigned Adult dental services added to benefits package Comprehensive Community Support Services model (not traditional CM, which works better for high risk patients)
15 Albuquerque: New Challenges FQHC rate does not cover costs Potential loss of State primary care/dental grants CM & dental services not reimbursed Pharmacy issues Decreased demand, varying formularies, both in-house & commercial challenges, transportation Referral & lab management issues (prior approval, IT/EHR) Initial decrease in patients/visits due to patients trying mainstream healthcare systems Mainstream healthcare systems not welcoming to our patients
16 Albuquerque: Notable Successes Increased enrollment to 42% currently overall in AHCH 60% in Medical program now Increased access to a wider variety of covered services for patients Lower referral wait times initially, but slowing down again Patients needing higher level of services can get most of them Nursing homes, assisted living facilities, hospice AHCH changed to a longer transition time period for post-hln using critical time intervention model Adult dental services in benefits package Improved Medicaid revenue stream
17 QUESTIONS, ANSWERS & DISCUSSION Kevin Lindamood, MSW, President & CEO, Baltimore HCH, Maryland Matias Vega, MD, Medicaid Director, Albuquerque HCH, New Mexico Sheena Ward, BA, Benefits and Entitlements Supervisor, Heartland Health Outreach, Chicago, Illinois
18 A FEW RESOURCES Kaiser Family Foundation: Report 1: Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion (September 2012) Report 2: Early Impacts of the Medicaid Expansion for the Homeless Population (November 2014) National HCH Council Health Reform: Policy briefs, webinars, government documents, other resources
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