Enrollment under the Affordable Care Act in state and federal exchanges ended as of March 31, but Americans now eligible for Medicaid can continue to enroll throughout the year, meaning for many healthcare providers – federally qualified health centers in particular – enrollment efforts are ongoing.
FQHCs are on the front line for enrollment of underserved populations into public health programs such as Medicaid, and while there are challenges posed by the nature of where FQHCs are located, the populations they serve and mandated reporting, there are simple steps FQHCs can take to make the enrollment process easier, reduce pressure on staff and secure grant funding and prompt provider reimbursement.
An example of a successful enrollment program can be found in the efforts of Pasadena, Calif.-based Community Health Alliance of Pasadena (ChapCare), which provides more than 55,000 medical, dental and behavioral health visits annually in the San Gabriel Valley area of Los Angeles County.
To reach out and screen all Medicaid populations (Medi-Cal in California), ChapCare has embarked on a multi-pronged community outreach effort including video announcements on public buses and the use of eligibility screening on portable tablets with a 90-second screening quiz clinic workers can take out to their communities.
Enrollment is a three-step process
While ChapCare recognizes there is no magic button for enrollment, the organization has developed a process that combines an involved and educated clinic staff with cloud-based mobile-enabled technology.
- Screening – Patients need assistance with readily identifying which program(s) they may qualify to receive. For many community clinics, this includes Medicaid, as well as county programs that help single pregnant women, displaced workers and immigrants awaiting legal status.
- Enrollment – Signing up for a plan or program is often complicated and time-consuming, as it may involve providing verification of income, proof of residency and proof of identity with a driver's license or birth certificate. This process can be daunting for many underserved populations, but can be made easier with supportive staff members and easy-to-use technology.
- Eligibility – This step ensures patients become enrolled. This measure is of most interest to providers because it guarantees that claims will be compensated by third-party payers.
When an uninsured patient comes into the facility, or when facility staff members meet uninsured patients in the community, clinic workers walk the patients through five screening steps that cover basic information, such as:
- residence
- employment status
- demographic information
- income
- special health conditions (due to special programs based on health conditions)
With an early fall 2013 enrollment in California, ChapCare's outreach staff screened an average of 200 people per month over six months. Close to 70 percent of the people they screened were successfully enrolled in an appropriate health plan.
Through detailed reports provided by the eligibility software, the organization was also able to meet reporting demands while maintaining and even securing additional grants.
A three-step enrollment strategy
Taking a page from ChapCare, the following three strategies can help FQHCs and other community clinics serving underserved populations build on their current enrollment efforts.
- Develop partnerships with other local community health clinics and providers. Collaborations could include a shared database and combined outreach opportunities.
- Expand community-based and localized enrollment by attending health fairs and local events. Use a tablet or electronic-based medium to screen potential patients.
- Use a simple screening program to quicken the insurance process in the field and at the office – this screening program should be accessible by computer and tablet so that it can be utilized at multiple locations.
Continuing to reach out to the nation's uninsured throughout 2014 will help patients secure their medical home and just as important, help clinics' bottom lines. The result of such efforts not only will greatly help uninsured patients, it benefits busy office staff who don't have to take time away from patient care or other duties to manage uninsured patients and also ensures providers of healthcare services secure prompt reimbursement.