Association for Utah Community Health

As a community pediatrician at an urban community health center (CHC) in Salt Lake City, UT, I often find myself struggling to provide access to specialty care services for uninsured patients. CHC providers see a higher proportion of uninsured patients than many clinics because of the CHC mission to provide primary care “regardless of the ability to pay.” Access to sliding scale payment can be a disincentive to apply for insurance. When asking parents why their eligible children are not enrolled in Medicaid, I have heard similar answers repeatedly: “I applied but I never heard back,” “We were rejected but I don’t know why,” “I couldn’t obtain supporting documents.” Over time it became clear to me that many parents need patient advocates to support them through the application process.

A search of the CATCH Grants Database showed me what other pediatricians had done to address this issue, which is so pertinent to the CATCH mission. I contacted Arthur Andrew, MD, of the El Rio CHC in Tucson, AZ, whose CATCH grant started the El Rio Eligibility Outreach Workers program. I spoke with one of the social workers and learned about the program’s start-up and how it has since grown to more than 15 workers who assist patients in locating available resources for health care. I then looked around my clinic system to see what resources we had available to us, and with the support of my clinic director Jennifer Thomas, we planned a program to use AmeriCorps workers as Medicaid/State Children’s Health Insurance Program (SCHIP) caseworkers.

AmeriCorps workers who are committed to health care service were available because the Association for Utah Community Health (AUCH), Utah’s primary care association, operates an

AmeriCorps program dedicated to serving the medically underserved. Between applying for a CATCH Implementation Grant in January 2009 and receiving funding, the Hatch-Kennedy Serve America Act was passed, increasing the number of national service participants by 50%. The timing was perfect to provide the project with the AmeriCorps workers we needed.

The CATCH Implementation Grant funded a pilot project to establish case management by AmeriCorps workers at our intervention clinic, Central City CHC. Our project evaluation included comparison of enrollment rates at a nonintervention CHC that serves a similar population. Both clinics had state-employed outstationed eligibility workers housed in the clinics and yet about 25% of the pediatric patients were uninsured despite being eligible for Medicaid or SCHIP. Parents in the nonintervention group received a paper application and instructions on how to apply, but no further contact until they were surveyed about their application process at the end of the pilot. At Central City CHC, the AmeriCorps workers assisted the families in obtaining documentation, scheduling/attending interviews with state eligibility workers, communicating by telephone or electronically, and staying on track to complete the process. With the help of Dick Shane, a volunteer software engineer, we also developed a project database designed for intuitive data entry and equipped with basic enrollment process automation features to guide the AmeriCorps workers through the interview, documentation gathering, and follow-up processes. After a 3-month period of case management and data collection, 54% of cases in the intervention group and 19% of the nonintervention cases were enrolled (P < .001). We assessed reasons for non-enrollment in both groups and found that 56% of the nonintervention parents never submitted an application, while 100% of intervention parents did submit applications.

In partnership with Alan Pruhs, associate director of AUCH, we included the CATCH pilot data in our application for Children’s Health Insurance Program Reauthorization Act (CHIPRA) Outreach and Enrollment grant funding to expand the project to 8 CHC clinics throughout Utah. We received our grant funding for the CHC Patient Enrollment Assistance Program in September 2009 and are now in our second quarter of case management at all 8 clinics. The program case managers are full-time enrollment specialists who are integrated into clinic flow and processes. Now when I come across an eligible uninsured child in clinic, I call my enrollment specialist on the walkie-talkie and he comes into the examination room to explain the application process and benefits of enrollment, within the context of the patient-doctor relationship. This allows the provider, caseworker, and parent to advocate for the child’s health care as a team.

The Utah Navajo Health Systems has recently received its own CHIPRA Outreach and Enrollment grant to expand its caseworker program in 4 rural clinics in southeastern Utah. We are sharing our database and experiences with it to support the start-up. It pleases me to think of the fruits of the CATCH project dispersed to 12 different clinics throughout Utah serving vastly different populations—urban, immigrant, homeless, and rural. Thousands of children are benefiting from their parents’ collaboration with a team of dedicated caseworkers. As options for coverage increase with the passage of the Patient Protection and Affordable Care Act, the need for enrollment support will also increase. Thanks to the CATCH Program, the infrastructure to provide enrollment support for Utah’s vulnerable families is growing. The seed grant has taken root and we are so grateful to CATCH.

Reprinted with permission from: