Eligibility Screening, Application Assistance & Enrollment Models
Screening Tools for Eligibility
The chart below can be used by outreach staff, promotoras and front reception staff as a screening tool to determine whether children from a family may be potentially eligible for either Children's Medicaid or CHIP. The chart shows the maximum amount of family income (monthly or yearly) allowed by number of family members for each program. However, this chart is just a guide and should not be used to determine absolute ineligibility for a family. All families should be encouraged to apply even though it appears they may just be over the income limits. There are many exemptions and/or deductions that may be allowed for certain family circumstances that may qualify the children for benefits.
Outreach materials are available free of charge from the Health & Human Services Commission at http://www.chipmedicaid.com/cbo/.
Application Assistance
One of the single most important strategies in Texas to help families enroll in public programs for which they are eligible is to provide them with comprehensive application assistance. TACHC emphasizes this to its health center members and supports its state and local partners to increase state resources to expand this service to families.
For example, the state launched a pilot project with the Food Bank of Texas to help better meet federal timelines to provide food stamps to eligible families. Food Bank employees were all trained to provide comprehensive application assistance. Families are told beforehand about all the documentation to bring before they meet with the food bank staff. The completed application is then sent electronically to a local eligibility office. A sample of these applications showed that 100% of them were approved for benefits compared to 88.4% of applications that were not part of the pilot project. This clearly illustrates that application assistance is effective.
Promotoras/es
Promotoras/es are outreach workers in predominantly Hispanic communities who are responsible for raising awareness of health and educational issues. They are extremely effective in their outreach efforts because promotoras/es are usually from the same communities as the population they serve, and are therefore trusted sources of information and respected by their peers. Promotoras/es serve as the bridge between the community and the health care system. They can increase access for services, preventive care, follow-up care and a wide range of other non-health care services.
Many promotoras/es are trained and certified in specialized areas of chronic conditions such as diabetes, hypertension, cardiac, asthma and mental health. Many promotoras/es can also be trained to provide comprehensive application assistance to families, which is critical in enrolling potentially eligible patients into public benefit programs such as Medicaid, CHIP, SNAP and cash assistance programs. Particularly important in this regard, promotoras/es can help dispel some of the public charge myths or allay the fear that mixed-citizenship families may have that prevent them from enrolling their U.S. citizen children into public programs.
Certification of Promotoras/es
Senate Bill 1051 (77th Texas Legislative Session) directed the Texas Department of State Health Services to establish and operate a training and certification program for persons who act as promotoras/es or community health workers (CHWs), instructors and sponsoring institutions/training programs.
The Promotor(a) or Community Health Worker Training and Certification Program provides leadership to enhance the development and implementation of statewide training and certification standards and administrative rules for the Promotor(a) or Community Health Worker (CHW) Training and Certification Program
For more information on the certification of promotoras/es, please contact the Department of State Health Services Office of Title V and Family Health at 512-458-7111, extension 2208 or via email at chw@dshs.state.tx.us. You can also visit: http://www.dshs.state.tx.us/mch/chw.shtm.
OEWs
Revenue from insured patients is crucial for the financial viability of community health centers. The Federal Out-stationed Eligibility Worker Program offers a way to bring Medicaid revenue to community health centers and provide the community with an important resource for client access to public benefits. The Social Security Act specifically requires states to place Out-stationed Eligibility Workers (OEWs) at each Disproportionate Share Hospital (DSH) and each Federally Qualified Health Center (FQHC) participating in the state's Medicaid program. As facilities that experience a high volume of service to children and pregnant women, the federal government encourages states to place OEWs at each FQHC (health center) site. As a State Medicaid Director letter dated January 18, 2001 states, "... many people, such as homeless persons, frequently do not consider health coverage until a need for health care services arises. The opportunity to apply at the provider site can greatly facilitate enrollment in these circumstances. The regulations, however, provide a great deal of flexibility in how states implement their individual out-stationing programs.
The OEW is a state employee rather than an employee of the health center. This distinction is key because only state employees can certify a person eligible for public benefits. An OEW at the health center can assist clients with the application process and certify them eligible for those public benefits. OEWs at health centers primarily certify children and pregnant women for Medicaid benefits.
OEWs are also required to certify clients eligible for TANF, Food Stamps, and Medicaid – any program for which women and children are eligible. Whether or not the OEW actually certifies all these programs varies from center to center and region to region, depending on regional administration of the program. Beyond processing new Medicaid applications, all OEWs are also required to certify Medicaid renewals for health center clients. Typically, OEWs in health centers focus on Medicaid programs and the CHIP Perinate Program. They do not certify applications for the Children's Health Insurance Program (CHIP), but can, however, assist clients with these applications and refer these cases to the state for certification.
In Texas, in order to better comply with the federal guidance, HHSC developed the first-worker free policy for all FQHCs. The policy states any FQHC that does not already have an OEW at their site can get their first worker free of cost, which means the worker's salary, benefits and automation will be covered by state/federal resources. The number of OEW placements in Texas FQHCs almost doubled after the state's implementation of this policy.
Currently, the OEW Program is undergoing changes at the state level and health center placements have been temporarily suspended pending further evaluation and budget decisions made by the upcoming 82nd Legislature.
Pilot Programs of Enrollment Models
Other models to ensure health center patient access to public benefits are currently being evaluated by TACHC and the Health & Human Services Commission, including designating an eligibility worker at the local office and/or allowing health centers to electronically send completed applications to a designated eligibility worker at a local office. The new models will not work without a strong application assistance effort by health centers, which would include utilizing outreach workers, community health workers and/or promotoras/es to provide their patients with comprehensive application assistance.
The enhancement of Texas health center's enrollment systems will result in an increase in the enrollment of eligible health center patients into Medicaid, CHIP and Public Health Exchange Programs. To meet the growing demand and need for increased enrollment, as more currently uninsured patients become eligible for health coverage programs ,will require a paradigm shift to expand the types of eligibility and enrollment models in place in all FQHCs. TACHC is advocating for changes to state policy to create a pilot program that will allow FQHC staff to enroll uninsured patients into Medicaid in addition to state employees or OEWs placed in health centers. Health center enrollment systems will be enhanced by improving electronic screening and enrollment options available to health center staff to allow for more effective and efficient screening of a patient's eligibility for public coverage programs and more robust application assistance activities. Once an application is completed, the health center staff would submit the applications directly to the state Medicaid office through a portal linked to the state's eligibility system to be fast tracked for final approval.
