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Medicaid alternative slowly attracts members

(Published October 18, 1999)


Special to The Common Denominator

One year into providing the Districtís working poor with badly needed health insurance coverage, the D.C. Healthy Families programís biggest challenge still appears to be just getting the word out.

The program expands the limits of the Medicaid program to provide for children and their parents who live above the federal poverty level but still cannot afford health insurance.

"Weíre at 44 percent of out target (enrollment)," said Lynda Flowers, Medicaid policy specialist with the D.C. Department of Health. But Flowers said she is "very pleased" about the enrollment levels, given the challenge of reaching people at all.

There were more than 11,000 adults and children enrolled in the D.C. Healthy Families program as of the end of September. There are 7,000 adults and more than 19,000 children remaining who are eligible for either Medicaid or D.C. Healthy Families who are not yet enrolled

Staff shifts within the program have complicated the startup programís efforts to get off the ground quickly. Director Jane Thompson recently departed from the managed care division at the Districtís Department of Health. There is currently no deputy director to oversee the office monitoring the cityís contracted HMOs. Donna Folkemer, director of the departmentís policy unit, is filling the gap until a replacement can be found. Thompson moved over to Marylandís Medicaid office.

At the same time, Greater Southeast Community Hospital is having major financial problems. It filed for Chapter 11 protection from its creditors last May and could be forced into liquidation soon. The hospital, which contracts with five of the seven HMOs providing health care services to the cityís Medicaid and D.C. Healthy Families participants, will either close or be sold.

"I think Greater Southeast will be sold Ė thatís the likely scenario," said Folkemer. Even if the facility closes, she says, it will not affect the services provided to Medicaid and D.C. Healthy Families participants. All of the seven HMOs contracting with the health plan have several hospitals included in their networks, all the HMOs are required by contract to provide transportation services to participants, and "thereís an enormous hospital capacity in this city," said Folkemer. In an emergency situation, she said, other hospitals are not far away.

Children and their parents qualify for D.C. Healthy Families benefits if the parent is working, uninsured and earns under 200 percent of the federal poverty level, which is $33,400 annually for a family of four, or $22,120 for a family of two. The District contracts with seven HMOs to provide services to enrollees, including Advantage Healthplan Inc., American Preferred Provider Plan, Capital Community Health Plan, D.C. Chartered Health, George Washington Health Plan, Health Right and Americaid.

After filling out an application and being approved, a family gets information on all of the HMOs and chooses one to join. If the family does not choose one, it will be enrolled in a health plan by the program staff. Currently, D.C. Healthy Families has a 75 percent rate of self-selection for HMOs, high compared to similar programs around the country.

The physicians available to participants through the health plans range from doctors participating in all-Medicaid HMOs, like Americaid, to those that are part of larger plans, such as GW Health Plan. Each HMO has lists of providers available for consideration when participants are making the decision about which plan to join. There is no "lock-in," says Flowers, so a family can switch HMOs at the end of any month if it chooses to.

Children are eligible for benefits above and beyond Medicaid through the Balanced Budget Act of 1997, which reformed the welfare system and established the federal Childrenís Health Insurance Program, or CHIP. States and territories were also allowed to craft their own plans to expand Medicaid and include the parents of those children in the benefit packages, combining federal and local funding. The Districtís plan was approved by the federal government in September 1998.

Since then there have been rigorous marketing efforts underway to get the word out to eligibles about D.C. Healthy Families. There is a hotline that people can call for information (1-800-666-2229 or MOM-BABY). D.C. Healthy Families has relationships with the D.C. Public Schools, as well as churches and service organizations.

September 19 was declared "D.C. Healthy Families Sunday" by Mayor Anthony A. Williams. The programís office sent information to 400 churches citywide and organized 100 volunteers to speak to congregations.

"Weíre always looking for volunteers to help us get the word out," said Flowers. "Itís not something thatís going to happen unless the community owns this program."

On Nov. 6 there will be a Gospel Explosion at the Israel Baptist Church at 1251 Saratoga Ave. NE, hosted by the program. It will be a "friendly competition" between junior and senior high school choirs, as well as an opportunity to give out information about the free health insurance program. D.C. Healthy Families is also teaming up with the D.C. Public Schools in November, sending home information in every studentís report card on Nov. 17.

To reach the cityís large immigrant population, the program has an immigrant task force that meets monthly to address the needs of that population. Applications for the program are available in English and Spanish, and information is available in English, Spanish, French, Amharic, Chinese and Vietnamese. The programís goal is to enroll more than 16,000 children and their parents.

Copyright 1999, The Common Denominator