Enrollment campaign in Massachusetts helps drive uninsured into Medicaid, other state programs
Massachusetts Enrollment Drive
December 31, 1997
Spurred by a coalition of groups representing health care providers and consumers, the state of Massachusetts has been conducting a major marketing and outreach effort that has helped drive up its Medicaid rolls by 65,000 clients since July 1.
Eligibility for the state’s Medicaid program was expanded to include residents with household incomes up to 133% of the federal poverty level (FPL) as of July 1. A coalition of provider and consumer groups praised the expanded eligibility, but warned that it wouldn’t necessarily lead to enrollment without a determined outreach effort to identify those who qualify and assist them in enrolling. About 57,000 children and 46,000 adults were expected to be newly eligible for the program as a result of the expansion.
The coalition offered the state assistance in developing a marketing campaign to enroll people in MassHealth and the Children's Medical Security Plan, a program for children who are not eligible for MassHealth. The Coalition included the Massachusetts Hospital Association, the Massachusetts League of Community Health Centers, the Mental Health Corporation of Massachusetts, and the Alcohol and Drug Abuse Association.
Provider groups help outreach
Sharon Torgerson, director of external relations for the DMA, said the agency is working with coalition members as well as the Massachusetts Medical Society and other groups in conducting the statewide enrollment campaign. Among the efforts:
•Fliers have been distributed to all schoolchildren in the Commonwealth with the message, "There is no reason why a child or teen in Massachusetts should go without health care." The flier stresses that different kinds of programs are available depending on family income and that eligibility does not depend on immigration status. Gov. Paul Cellucci signed legislation Nov. 26, providing medical assistance or medical benefits to pregnant women, infants, children, and adolescents through age 18 if their household income is below 200% of FPL. The state's Division of Medical Assistance (DMA) estimates that the latest eligibility expansion could bring another 35,000 people into the program.
•A brochure called MassHealth Facts, which explains the different MassHealth programs and eligibility criteria, is being widely distributed through community health centers, other community-based organizations, and primary care providers. Promotional materials also have been distributed through organizations that participated in the Oct. 26 Massachusetts Summit: The Promise of Our Youth, modeled on the Presidents' Summit for America's Future held earlier this year in Philadelphia. One of the five goals for the Massachusetts Summit was that all children have health care coverage.
•The DMA, in cooperation with the state Department of Public Health and the Health Care Policy Administration, will be awarding mini-grants of $10,000 to $25,000 to community-based organizations so that they can help enroll hard-to-reach populations. They will target areas that have a high utilization of health services for preventable health conditions or low birthweight babies.
•While the agency has had significant media coverage and received free advertising space in rapid transit vehicles in the Boston area, it is likely to contract with a media consultant to produce public service announcements and also may buy some broadcast, print, and billboard advertising if sufficient free space and time is not forthcoming.
•The Massachusetts Hospital Association has agreed to supply outreach materials for its members to use in emergency departments and waiting rooms, and the Massachusetts Medical Society will provide materials for primary care providers and will train physician office staff members who are likely to have contact with those who could be enrolled.
Hospitals enroll uninsured
The enrollment drive in Massachusetts also is being fueled by hospitals, particularly two urban hospitals that have formed managed care plans to serve the Medicaid population. During intense negotiations over reforming the state’s uncompensated care pool earlier this year, hospitals agreed to try to steer the uninsured to Medicaid or other insurance programs instead of merely billing the uncompensated care pool.
Now that the Boston Medical Center and Cambridge Health Authority have their own managed care plans, they also are expected to enroll many previously uninsured patients into the state’s Medicaid program, providing major relief to the uncompensated care pool.
The Boston Medical Center and Cambridge Health Authority have hired Medimetrix Consulting, a national health care consulting firm, to help them build the capacity and skill needed to enroll the previously uninsured in MassHealth.
MassHealth has a two-step enrollment process. Patients must first complete a 12-page enrollment form. Once they are enrolled, they are referred to a health benefits advisor who explains their options and helps them select a managed care organization or join the primary care clinician program. The state is hoping to steer as many people as possible into the managed care program.
Thomas P. Traylor, Vice President for Federal, State, and Local Programs of the Boston Medical Center, said his organization has hired 60 outreach workers to assist potential clients to complete the enrollment forms at 12 BMC sites and 11 community health centers. So far, he said, the workers have completed 8,000 applications and are processing 800 a week. He believes that is the peak level of effort for BMC sites. A greater volume would start to interfere with providing health services at the sites, he believes. Mailings have gone to BMC patients to encourage them to come in and enroll. Those who have physician appointments are telephoned and asked to bring the necessary documentation so they can enroll during their visit.
Kathy Brown, a consultant in the Medimetrix Boston office, said her firm had helped design and adapt the information management systems in the two health systems so they could track and report on their patients. The firm also helped the outreach workers develop proficiency in completing applications so more people could be enrolled each week.
Under a special financing arrangement, Boston Medical Center and Cambridge Health Authority, will receive a higher reimbursement for MassHealth enrollees than other plans participating in the program. Both health systems are counting on retaining many of their patients because of the good relationship they have had with them in the past. The future success of these urban health systems clearly is related to the success of their managed care organizations. Mr. Traylor said it is too soon to tell how many people will enroll in the BMC managed care program.
A future challenge for the state will be to enroll eligible families in the Insurance Reimbursement Program. The goal of the program is to increase the number of low-income workers who have employer-sponsored coverage by making health insurance more affordable for both employers and employees. The program will subsidize employer-sponsored insurance coverage for residents with incomes below 200% of FPL in two ways—.the state will pay employers a credit for offering and contributing to the cost of health insurance for low-income employees and employees will be given a subsidy to assist them in paying their share of the premium costs.
—John Hope
Contact Ms. Brown at 617-266-6201; Ms. Torgerson at 617-210-5680; Mr.Traylor at 617-638-6730.
Enrollment campaign in Massachusetts helps drive uninsured into Medicaid, other state programs
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