2009 Model Practice Application (Public)

311 Get Health Care Hotline

Baltimore HealthCare Access, Inc.

Based on U.S. Census and Maryland Health Care Commission reports, Baltimore City’s rate of uninsured residents is 17.7 percent, far higher than the statewide rate of 13.7 percent. A little more than half of the city’s 111,751 uninsured residents are living below the federal poverty level, making them potentially eligible for at least limited health coverage through Maryland’s Primary Adult Care program or full coverage through the Medical Assistance for Families program. Reaching these individuals and assisting them through the application process and into health coverage is paramount. The goal of the hotline is to enroll Baltimore’s uninsured residents into any available health coverage. Although the 311 Hotline was started in conjunction with a citywide marketing campaign designed to enroll families in a new Medical Assistance program, the intent of the hotline has been to try to assist all uninsured callers. Staff were educated on available health coverage plans in Maryland including Medicaid, Maryland Children’s Health Program, Primary Adult Care, the Maryland Health Insurance Program, Children’s Medical Services, Baltimore Bridge, and Medical Assistance for Families. They were also educated on available community resources including but not limited to prescription discount cards, Medbank, Federally Qualified Health Centers, city clinic services, free cancer screening programs, and more. Each caller is then assisted individually to find a best match with health coverage and community resources. Furthermore, hotline workers assist callers by filling out applications on the phone for a number of programs, including Medical Assistance programs, where eligibility is processed in-house and can be tracked through a central database. Callers are also provided an option to meet face-to-face or by home visit. Callers who do not complete and return applications and who we are not able to reach for follow-up are provided at least one home visit to assist. Baltimore Health Care Access/Baltimore City Health Department further assists by helping individuals to obtain and pay for needed documentation including birth certificates and IDs. Three attempts are made to provide further assistance to clients either by phone, face-to-face, or home visit. The use of an existing city help line, 311, was advantageous as it was already well known thoughout the community. Since the inception of the project on July 1, 2008, through February 28, 2009, 2,848 people have called the hotline. Three thousand nine hundred seventy-six uninsured clients clients were identified through those callers as we identified others in the home without coverage and sometimes entire households without coverage. Nine hundred fifty-seven individuals were enrolled in some type of heath coverage during that time. Based on client needs identified during initial calls, local community resources were identified. Each client was informed of their closest Federally Qualified Health Center for immediate help and if they did not qualify for health coverage they were provided with a copy of Baltimore Health Care Access/Baltimore City Health Department’s Guide to Low Cost No Cost Health Care and Resources on Baltimore City, a comprehensive up-to-date guide offering clinic information, disease specific programs, vision, dental, and prescription programs.

A recent Families USA report reiterated what prior reports have already made clear about the uninsured in America: The uninsured are less likely to have a usual source of care outside of the emergency room. The uninsured often go without screenings and preventive care. The uninsured often delay or forgo needed medical care. The uninsured pay more for care—and so do the rest of us. Uninsured Americans are sicker and die earlier than those who have insurance. In urban areas like Baltimore, poverty compounds the problems of the uninsured. More than half of the uninsured in Baltimore are living below the poverty level. The Baltimore Hotline seeks to assist Baltimore residents to find health coverage and if covered through Medicaid or the Maryland Children’s Health Program help them to navigate the health system to get the care they need. Almost all callers to the hotline are eligible for some type of health coverage. Data were collected on on how callers heard about the Baltimore Hotline. “Word of mouth” is tracked when callers identify “Friends, Family, or Neighbors” as how they heard about the hotline. This represents the second largest category behind radio ads and is steadily growing. The hotline has been directly responsible for almost 1,000 newly covered individuals in just eight months. Almost 1,000 Baltimore residents have gained health coverage directly attributable to their call to the Baltimore Hotline. All callers were informed of community resources to help them get needed care regardless of whether they were eligible for coverage. Callers are given one-on-one attention to assist them through every part of the application process. A search of available programs was made through the Families USA Health Assistance Partnership: http://www.familiesusa.org/issues/medicaid/making-it-work-for-consumers/consumer-health-assistance-programs.html. Profiles of existing programs were reviewed. Contact was made with programs that seemed similiar to the Baltimore Hotline to determine program specifics. Baltimore Health Care Access/Baltimore City Health Department also searched Internet city health department and government sites for similiar programs. Although there are other insurance hotlines across the country, none bring all of the resources and services together like the Baltimore Health Care Access/Baltimore City Health Department Hotline. From initial call to enrollment to community health resources to navigating the health care system, no other program in the nation provides the level of service Baltimore Health Care Access/Baltimore City Health Department have been able to bring to the Hotline. Boston’s Health Care for All program employs five full-time counselors to assist consumers with navigating Massachusetts’ health care system and assisting with applications. They do not provide home visits or process eligibility, critical components of Baltimore Health Care Access/Baltimore City Health Department’s Hotline. Maine’s Consumers for Affordable Health Care (CAHC), a nonprofit advocacy organization, provides a wider array of services but does not process eligibility for Medicaid or SCHIP in their state. In-house eligibility processing provides for seamless services to our clients and assures that cases are not lost in the system, a frequent complaint with the local Department of Social Services (DSS) offices. Finally, the Tennessee Justice Center offers assistance to the uninsured and those enrolled in Tenn Care. They do not offer the level of personalized assistance that BHCA is able to provide, such as home visits or do they process eligibility. The hotline received 2,848 calls during its first eight months of operation. More than 3,900 uninsured were identified during these calls. Since the program began, nearly 1,000 Baltimore residents have acquired health coverage through the direct actions of the Hotline and Baltimore Health Care Access/Baltimore City Health Department staff. Many others have submitted applicati

Baltimore Health Care Access/Baltimore City Health Department operate and manage the Hotline. Interagency staff are used as needed for processing eligibility, providing home visits, answering hotline calls during peak usage times, and assisting hotline staff with identifying needed resources. Interagency stakeholders including the Department of Health and Mental Hygiene were involved in planning the Hotline from its infancy. Baltimore Health Care Access/Baltimore City Health Department collaborated with the Mayor’s office to incorporate the Get Health Care message into the existing 311 Information Line. Baltimore Health Care Access/Baltimore City Health Department collaborates with Baltimore Recreation and Parks, Federally Qualified Health Centers, public libraries, and City clinic sites to provide informational materials to clients about calling 311. Baltimore Health Care Access/Baltimore City Health Department employees touted the program at community events throughout the eight months of Hotline operation and ongoing. Community training is also offered.

July 1, 2008–June 30, 2009: $150,000 grant dollars; approximately $40,000 in kind including space, furniture, phone, outreach staff, supplies and postage.

Baltimore Health Care Access/Baltimore City Health Department partnered with a the city 311 information line, a well-known Baltimore information line. Two staff (one bilingual in Spanish) were hired and trained on available coverage options and Baltimore Health Care Access/Baltimore City Health Department services that were integral to the Hotline. Data collection information was defined and put into format for the Hotline workers to collect as they spoke with callers. Media releases and advertising was planned including billboards and print media that were placed at community sites including public libraries, Baltimore City Recreation and Parks sites, Hispanic service organizations, laundromats, Federally Qualified Health Centers and Maryland Qualified Health Centers, and city clinic sites. The project was planned in six months.

Interagency stakeholders including the Maryland Department of Health and Mental Hygiene are thrilled with the Hotline. There has been discussion of expansion to a statewide hotline, although with the current economy this is not likely this year. Baltimore Health Care Access/Baltimore City Health Department have solicited and obtained a committment from the hotline’s initial funders, The Weinberg Foundation and the Stulman Foundation, to operate and expand the hotline for an additional year. Funding for next fiscal year will include a full-time outreach worker along with additional dollars for printing and postage.

Initially staff were instructed to send applications to clients. We found, after about three months of operation, that many callers were not returning applications despite repeated follow-up from hotline staff. Three new practices were put into place to address applications not being returned for processing. Callers who had not returned completed applications were provided a home visit attempt in addition to phone contact. Hotline workers began completing applications over the phone with each client. Completed applications were then sent to clients for signature in a self-addressed stamped envelope. Clients were offered a home visit and or onsite visit to help with completing applications. Billboards were an ineffective marketing tool in Baltimore City. Only 100 calls were received a a result of the billboards. Far more effective were urban radio, TV (news media and the Mayor’s Channel 25), and word of mouth. Media dollars for next fiscal year will focus on radio and TV ads. Perhaps more importantly, a full-time worker will be hired for on the ground outreach and liaison activities.

Information was not provided in 2009