Model Proposals - Illinois Maternal and Child Health Coalition

Sometimes the best way for a foundation to improve health care access-especially when addressing the needs of a large population or problem-is to encourage efficient utilization of an existing resource. Such is the case with the following proposal prepared by the Illinois Maternal and Child Health Coalition (IMCHC). Based on findings from a previous study, the proposal plans to increase enrollment in KidCare and FamilyCare by identifying qualifying families at the time when they are seeking access to care, either in the emergency room or in the walk-in clinic. Further, by training a nurse coordinator at each of the sites, the clients will receive immediate health assessments, and Kid- and FamilyCare enrollment will become a part of the site's institutional operations and will be maintained beyond the term of the IMCHC grant.

This proposal was approved in full by the VNA Foundation Board at its February 6, 2003 board meeting. We are pleased to offer it as the Proposal of the Quarter for the quarter ending June 30, 2003.

PROPOSAL NARRATIVE

A. Background

The Illinois Maternal and Child Health Coalition (IMCHC) is a 90 member statewide coalition dedicated to promoting and improving the health and well being of infants, children, women, and families through advocacy, education, community empowerment, and policy development. Members of the Coalition consider equality, social justice, and fair access to care to be fundamental human rights. The Coalition supports that belief through coordinated efforts designed to overcome critical barriers, such as poverty and racism, that prevent achievement of maternal and child wellness. Founded in 1988 as an outgrowth of an ad hoc advocacy group that supported Medicaid expansion for pregnant women and children, the Coalition is an affiliate of the National Healthy Mothers, Healthy Babies Coalition.

IMCHC meets quarterly in three parts of the state and heads four major projects:
1) The Chicago Area Immunization Campaign works to raise immunization rates among children 0-2 years of age through public awareness and provider education. When this project started in 1991, children under the age of 3 in Chicago had a 35% immunization rate. Today over 70% of these children are immunized

2) The Prematurity Project aims to reduce the percentage of pre-term low birth weight by disseminating new prevention information to women at risk and health providers. Two years ago, the project produced an educational video on new findings to share with physicians and community groups and has distributed 92 copies to date.

3) The Illinois Coalition for School Health Centers is a broad based group of organizations and individuals united to educate the general public and public officials about the efficacy of the school health center model and to sustain existing centers through advocacy and technical assistance. This project has increased the number of school health centers in Illinois from 35 to 43 and has succeeded in doubling state funding for these centers.

4) Covering Kids and Families Illinois (CKF-IL) aims to increase the number of children and adults covered by KidCare and FamilyCare in Illinois. IMCHC serves as the lead agency for CKF-IL. FamilyCare Press Conference CKF-IL is a statewide coalition that works to enroll all eligible children and their families in Medicaid, KidCare, and FamilyCare health plans. The Coalition brings together leaders in health, education, business, government, faith, and social service organizations to educate working families about state funded health insurance programs. CKF-IL coordinates, monitors, and provides technical assistance to local projects in Cook County and the Central Illinois region. Coalition meetings are held on statewide and local levels every other month and provide an opportunity for members to discuss policy, network resources, share promising practices, troubleshoot program issues, and develop an advocacy agenda.

In 1999, IMCHC was awarded a grant from the Robert Wood Johnson Foundation (RWJF) to coordinate statewide KidCare outreach and enrollment efforts. IMCHC's grant with RWJF was renewed this past year to continue the Coalition's work through December 2005.

KidCare is designed to provide low-income working families with health insurance. KidCare is for children up to age 19 whose family income is at 185% of the federal poverty level (FPL) or below, and for pregnant women whose family income is up to 200% of the FPL. FamilyCare, a recent extension of KidCare, covers parents and caretakers of children currently enrolled in KidCare whose family income is at 49% of the FPL.

The Robert Wood Johnson Foundation set new goals for the next four years for Covering Kids and Families. They are: 1) Reduce the number of uninsured children who are eligible for Medicaid or KidCare coverage, but remain uninsured. 2) Reduce the number of adults who are eligible for Medicaid or FamilyCare coverage, but remain uninsured. 3) Build knowledge, experience, and capacity to achieve an enduring national and regional commitment to sustain the enrollment and retention of children and adults beyond the grant period.

Support from the VNA Foundation over the past year has helped CKF-IL enroll 19,730 children and pregnant women into KidCare since January 1st 2002. As of December 1st, 197,030 children and pregnant women were enrolled in KidCare and could access much needed clinical care.

In May, our "Faith, Health, and Unity" month coordinated outreach efforts with leaders in the faith community to tie the importance of health care into their sermons and services. On August 2nd, we kicked off our Back-to-School Enrollment Campaign, which organized our 90+ coalition members throughout the state to inundate every available media, community, and business outlet with information about KidCare. There were over 130 KidCare outreach events held in August alone and there was almost a 10,000 KidCare case increase in enrollment from August 1st to October 1st.

Health Fair sponsored by Illinois Senator Miguel de Valle
In April, CKF-IL hosted "Partners for Healthy Kids" Statewide KidCare Conference in Oak Brook. This conference brought together over 200 people, including KidCare advocates, state officials, state and national policy makers, public relations professionals, and social service workers to discuss the status of the State Children's Health Insurance Program's policies and applications.

Additionally, CKF-IL has been successful in advocating a simpler enrollment process for families by shortening the KidCare application from 5 pages to a 2 ½ page form. The signing of a federal waiver to allow federal SCHIP funds to be used for FamilyCare was another success achieved by CKF-IL in October 2002. Currently, we are negotiating with the Illinois Department of Public Aid to allow for self-declaration of income on KidCare and FamilyCare applications and to develop an electronic point of entry to provide greater access and ease to the application process.

The coalition is supported by funds from the Robert Wood Johnson Foundation; one-half of this money must be received in matching dollars. The grant period began in January 2002 and runs through December 2005. In order to sustain the coalition's efforts past the grant period, CKF-IL seeks to institutionalize KidCare and FamilyCare outreach and enrollment into the faith community, schools, businesses, and health care settings.

On behalf of Covering Kids and Families Illinois, I am writing to request $50,000 from the VNA Foundation in matching funds for the Hospital-based KidCare Enrollment Project. The objective of the project is to increase the number of eligible children, pregnant women, and families enrolled in Medicaid, KidCare, and FamilyCare by institutionalizing outreach, enrollment, and referral in nine community hospitals and one federally qualified health center (FQHC) within the communities they serve. The funds would be used from January 1st, 2003 through December 31st, 2003.

---

B. PURPOSE OF FUNDING REQUEST

Need
The plight of America's uninsured has become an increasingly urgent issue as a result of the rising cost of health insurance and the economic downturn that has forced employers to cut back on health care subsidies to their employees. According to the U.S. Census Bureau, there were nearly 1.7 million Illinois residents without health insurance in 2001. A report released by The Urban Institute in August 2002 revealed that there were 192,960 children in Illinois who qualified for KidCare, but were not yet enrolled. The majority of these children and families reside in the Cook and collar Counties.

Studies have found that 7 out of 10 families eligible for KidCare do not know that they qualify. This presents a significant communications challenge to raise community awareness of the program, galvanize enrollment, publicize successes, and monitor the media to ensure that accurate information is reaching the public.

The uninsured are not a stagnant population, but a repeatedly changing one. Wage earners in low paying positions face unstable employment, frequent job changes, and the constant threat of losing employer based insurance if they are offered insurance at all. In fact, the New York Times recently reported that one of the fastest growing populations of uninsured is the middle class as a result of large number of layoffs in the technology and communications fields. It is for this reason that enrollment and outreach efforts for the KidCare program must continue to reach the growing uninsured population.

Program Description
Project Goal: To increase access to health care for underserved families in the Chicago area.

With the knowledge and experience from a similar project launched by Metropolitan Chicago Healthcare Council (MCHC), a committee of CKF-IL coalition members were brought together to discuss the institutionalization of KidCare and FamilyCare into the health providers setting. Through the support of the Michael Reese Health Trust, MCHC worked with five hospitals over the course of a year and enrolled 3,200 children and pregnant women into KidCare. Each hospital was given $35,000 to help cover staffing costs. Each KidCare application that was submitted and approved through the project generated on average $1,200 in revenue to the participating hospital in one year; this is payment for health care that would have otherwise gone uncompensated.

MCHC's project shows how the health care setting provides an opportunity to refer uninsured clients seeking health services to KidCare or FamilyCare and enroll them on-site. Families without health insurance often use emergency rooms for their source of primary care, which can lead to higher insurance rates for those with private or employer-based insurance, as well as increasing the financial burden on families already struggling financially. By identifying these self-pay clients, the Hospital-based KidCare Enrollment Project would be able to enroll eligible families on-site and promote preventive health services with an initial health screening by a nurse. As a result, clients would gain greater access to affordable options for comprehensive medical coverage. The VNA Foundation grant would allow CKF-IL to work with nine community hospitals and one FQHC to institutionalize KidCare into the hospital setting and provide access to preventative as well as emergency care.

Work Plan Objectives:
By January 31st, choose the nine community hospitals and one federally qualified health center for the project.
By March 31st, 2003, identify a KidCare Nurse Coordinator at each of the ten sites.
By June 30th, 2003, train staff in ER, OB, Finance, and Pediatric Departments on the process for referral and enrollment for KidCare and FamilyCare eligible patients at the ten selected sites.
By September 30th, 2003, send letters to all self-pay clients at the ten sites describing KidCare and providing a telephone number for enrollment and referral assistance.
By December 31st, 2003, contact 60,000 families in person, by mail, or phone to ask them to enroll in KidCare and/or FamilyCare.
By December 31st, 2003, distribute a list of KidCare and FamilyCare providers to the 6,500 new enrollees.
By December 31st, 2003, enroll a total of 6,500 new clients into Medicaid, KidCare, or FamilyCare through the KidCare Nurse Coordinators at the 10 sites included in the project. Scott Ziomek, Hospitals and Health Care Providers Committee Chair would co-lead the project along with Kathy Chan. Scott is also the Director for MCHC Government Relations and led the pilot project on which this taskforce created its model. His experience will provide insight and direction for planning and implementation, helping us to achieve our project goals. Laura Leon, KidCare Project Director and Kathy Chan, KidCare Project Associate from Covering Kids and Families Illinois would conduct the staffing and organizational duties, including collecting and organizing data, recording minutes, coordinating training sessions, and facilitating the participation of all committee members.

A taskforce of CKF-IL coalition members has been assembled to serve as a steering committee and provide resources and assistance to this project. Members include Laura Derks, Director of the Program Development Office of Community Affairs, University of Chicago Hospitals; James Kolstad, Manager of KidCare and Consortium Initiatives, Children's Memorial Hospital; Jamie Gilmore, Project Manager of Community Health Services Outreach and Enrollment, Illinois Primary Health Care Association; Jim Gregory, Senior Financial Analyst, Illinois Hospital Association; Rosemary Kaminski, Pediatric Case Manger, St. Joseph Hospital; Lindsay Calcatera, Manger of Development and Communications, Access Community Health Network; Marcia Rosenblum, KidCare Outreach Coordinator, American Academy of Pediatrics-Illinois Chapter; and Scott Allen, Executive Director, American Academy of Pediatrics-Illinois Chapter.

The first step in this project would involve selecting the nine community hospitals and one federally qualified health center that currently do not have KidCare outreach or on-site enrollment. Currently, hospitals under consideration for this project include: Swedish Covenant, St. Mary's, St. Elizabeth's, Ingalls, West Suburban, St. James, St. Francis, Mercy, Christ, Holy Cross, and Little Company of Mary. The taskforce would select hospitals located in areas with underserved populations and those with a high rate of obstetrics and pediatric services. Once the hospitals are approached and agree to be part of this project, the next step would be to identify and train an existing staff member at each site to be a KidCare Nurse Coordinator and run an outreach, enrollment, and referral program.

The KidCare Nurse Coordinator would be responsible for assisting with the KidCare application process and providing an initial health assessment to determine necessary medical services for the uninsured patient(s). The latter responsibility would educate patients about how, when, and where to access health services and encourage them to seek care in a non-ER medical home. Thus, the KidCare Nurse Coordinator not only shows the patient the path to health services, but also serves as a guide on this path.

Additionally, the KidCare Nurse Coordinator would be responsible for connecting existing services in the intake and financial departments to automatically refer uninsured patients to a KidCare Application Agent. Throughout the year, outreach would include distributing KidCare information throughout the hospital and any satellite sites. Coordinators would also organize presentations with human resource mangers to assist eligible hospital employees with the application process.

At the end of the project, it is expected that hospitals would see the public health and financial benefits and continue the responsibilities of the KidCare Nurse Coordinator position.

EVALUATION
In order to measure the effectiveness of this project, CKF-IL intends to look at several outcome measures, which are listed below:
By December 2003, 6,500 children and adults will be enrolled in KidCare or FamilyCare through the efforts of nine local hospitals and one federally qualified health center.

By December 2003, 60,000 contacts will have been made with families who are likely to be eligible for KidCare or FamilyCare.

Through a random sampling of at least 650 KidCare applicants from this project, 75% will have accessed health services from the assessment by the KidCare Nurse Coordinator. Project staff will work closely with the ten sites to create tracking forms and a self-reporting system that will record the number of families that request information on state funded health insurance programs, new enrollees, and the success rate of these applications. Enrollment data from the Illinois Department of Public Aid will be collected monthly and included in the final report.

From October through December 2003, a consultant will be hired to conduct a random sampling of 10% of all KidCare applicants from this project. Clients will be surveyed to find out whether health services have been accessed since their enrollment in Medicaid, KidCare, or FamilyCare. A breakdown of the services will be recorded and once analyzed, we expect that 75% of those surveyed will have accessed services recommended by the KidCare Nurse Coordinator.

The ultimate measure of the success of this project will occur when the nine hospitals and one federally qualified health center sustain the position of the KidCare Nurse Coordinator through the grant period and in the future.

---

Budget - Grant Proposal to VNA Foundation

Illinois Maternal and Child Health Coalition Hospital Based KidCare Enrollment Project Budget 2003

VNA Facts

VNA awards grants quarterly.

Enter your email address in the field below:

20 N. Wacker Dr., Suite 3118
Chicago, IL 60606
Phone: 312/214-1521
Fax: 312/214-1529