The Latino Health Insurance Program A community-based model to increase access to medical care for Latinos in Massachusetts Milagros Abreu,, MD Department of Epidemiology, Boston University School of Public Health Tel: 617-638-6727, mabreu@bu.edu Sponsors: MetroWest Community Health Health Care Care Foundation, AVANCE, The The Iglesia IglesiaCristiana Nueva Nueva Vida, Vida, Assembly of of God God Bethesda, First First Brazilian Baptist Church of of Framingham, Igreja IgrejaMethodist Unida Unida de de Saugus, Saint Saint Mary Mary Parish Parish of of Waltham, and and the the Hispanic Academy
Race/Ethnicity of Uninsured Massachusetts residents % Uninsured 18 16 14 12 10 8 6 4 2 0 17 15 13 14 10.2 7.4 5.8 6.3 4.9 5.1 4 4.5 4.6 2.3 3.1 2000 2002 2004 2006 2008 Latinos Blacks Asians Whites (Source: Health Insurance Status of MA residents/ MDHCF(2000-2006))
Health Community Discussion December 29, 2008 (Health Reform)
Barriers to medical care for the Latino community Lack of access: of the 46 million uninsured in the US, Latinos are 32%. Lack of information. Awareness is one major issue, a lot of people are qualified and don t know. The complexity of health care systems, eligibility, what does that pay for, how to navigate the system) o Health care providers do not understand differences in immigration rules (special status residents) Provide education, cultural competency trainings High costs ( teach them how to avoid bills ) There s a circle: we are sick and not seeking help until we can t stand anymore, so we go to the emergency room. Our system invests heavily in expensive care but not in prevention
Barriers to medical care for the Latino community Doctors related issues: Hospitals and health centers not taking new patients (waiting lists) Number of primary care physicians not taking MassHealth or Commonwealth Care Plans Illiteracy issues/ Language barriers: (prescription drugs, discharge instructions, MassHealth Commonwealth Care communication notices) Affordability issues: Can not afford to pay for insurance premiums. Insurance Premiums change too often (From $34 to $180) Education: Insurance premiums, deductibles and co-payments -People go for the cheapest insurances without knowing that they have a lot of deductibles
Barriers to health insurance for Latinos and Brazilians (2008) System problems: A known diabetic and hypertensive couple said, We were uninsured When we applied for MassHealth, we were informed: you are not eligible for anything.
The Latino Health Insurance Program (LHIP) Primary Goal: Increase enrollment of Latino children and adults in health insurance programs in Massachusetts
The Latino Health Insurance Program (LHIP) Objectives: 1. Recruit and train Latino community leaders. 2. Provide health insurance eligibility training sessions to recruited Latino residents in how to obtain, maintain or reapply for health insurance. 3. Enroll uninsured children and adults in health insurance programs. 4. Conduct follow-up for enrolled participants and assist with insurance maintenance, renewal, and connect them to primary care providers.
Findings and results from 2006 5 community leaders trained as case managers 5 seminars on basic insurance eligibility information conducted May - September, 2006 230 participants applied for MassHealth 100 children were enrolled in MassHealth 73.6% of of children are USA citizens 33% of of adults were enrolled on on the state new health insurance program (Commonwealth Care)
Most Uninsured Racial/Ethnic Groups in Metrowest, MA (BRFSS 2004-2006) 25 % Uninsured 20 15 10 5 0 18 6.2 5 21 8.8 7 Metrowest MA Latinos Overall Whites
Open house of LHIP in MetroWest (Framingham 6/12/2008)
Preliminary findings and results from LHIP in MetroWest June-October 2008 4 community leaders trained as case managers 3 seminars on basic insurance eligibility information, chronic diseases prevention, and health screenings (June - November, 2008) 383 participants were enrolled into subsidized and non-subsidized health insurance programs 100 children were enrolled in MassHealth 86.6% of of children are USA citizens 100 households were referred to to hospitals, health centers, dentists, specialty clinics, Board of of Health in in Framingham, and Free Clinics for for medical care.
LHIP Accomplishments LHIP expanded to other cities and towns (Waltham, Saugus 2008, and Jamaica Plain, 2009) 1700 families have been enrolled into medical coverage Dr. Abreu was awarded for this intervention in December,2008 for Color Magazine -Nominated for 2 leaderships awards -She will be Honor in June, 2009 from MIRA
LHIP New Sites
Recommendations Culturally Competent Community-based Model Reduces or eliminates racial/ethnic disparities in access Improves use of primary and preventive care rather than emergency room Provides important source of information for Brazilians, Latinos and providers in Massachusetts Source of training and employment for community leaders Model for insuring uninsured children and adults from other immigrant groups and cities in Massachusetts Quality requires equality (Schiff et al 1994)