Welcome

1. Welcome Health Care Reform Webinar January 21, 2011 We will begin promptly @ 1PM EST Event Host John Lozier Executive Director, National Health Care for the Homeless Council This presentation is supported through a Cooperative Agreement with the Health Resources and Services Administration.

2. Health Care & Housing Are Human Rights Health Care Reform: An Overview for HCH Grantees January 21, 2011

3. Presenters Barbara DiPietro, PhD Claire Goyer, M.Ed Tom Andrews, BS • Director of Policy, National Health Care for the Homeless Council • Director of Policy, HCH of Baltimore, MD • Technical Assistance Program Coordinator, National Health Care for the Homeless Council • Executive Director (Retired), Duffy Health Center • President, St. Joseph’s Mercy Care Services • President, Board of Directors, National Health Care for the Homeless Council

4. Overview of Today’s Presentation Current status of Health Reform law Medicaid expansion Remaining uninsured Advocacy opportunities Health Center funding opportunities A Grantee perspective Health Care & Housing Are Human Rights

5. Current Status at Federal Level PPACA has been in effect for 10 months, but confusion remains among general public and controversy continues Courts: Mixed federal court decisions regarding “individual mandate”; possible Supreme Court determination Congress: Incoming Congress has pledged to repeal or reduce law’s impact/implementation Administrations: HHS implementing current provisions and planning for future changes Health Care & Housing Are Human Rights

6. Current Status at State Level States vary widely in political/policy philosophy and stages of planning; 20 states are part of federal lawsuit Establishing State Exchange systems Applying for federal planning grants & demonstration projects Projecting impact of law on rate of uninsured, budget, and existing health care structure Evaluating changes needed Health Care & Housing Are Human Rights

7. Medicaid Expansion Expands Medicaid to 133% Federal Poverty Level* $14,400/year for individual (in 2010) $24,300/year for family of 3 Allows for 5% MAGI Expect 16 million to 23 million new enrollees Federal reimbursement to states for newly eligible 100%: 2014-2016 95%: 2017 94%: 2018 93%: 2019 90%: 2020 and thereafter Health Care & Housing Are Human Rights

8. Medicaid Expansion (cont’d) Maintenance of Effort: states cannot reduce Medicaid or CHIP eligibility, increase premiums or enrollment fees, or otherwise restrict enrollment Violations: Lose all federal matching funding for the entire Medicaid program until corrected Benefit Package: Unknown how benefits for newly eligible will compare to those available to currently eligible Option for Early Expansion (even at incremental levels) Early Implementers to Date Connecticut DC Health Care & Housing Are Human Rights

9. Medicaid Expansion (cont’d) Benefits of early expansion: Reduces administrative burden in 2014 (“ramp up”) Extends health care to those most in need Reduces use of emergency departments and other high-cost venues Early expansion factors for states to consider: Current eligibility/participation Balance cost of newly eligible with previously eligible “Expansion States” Different considerations for Arizona, Hawaii, Delaware, Maine, Massachusetts, Vermont, New York due to existing waiver for single adult coverage Health Care & Housing Are Human Rights

10. A Brief Mention of the State Exchanges Online marketplaces designed to help individuals and small employers obtain private-market coverage; Focused on individual and small group markets; does not apply to self-insured plans (typically those offered by large employers) Must be implemented by January 1, 2014 Subsidies and credits, based on income (which can fluctuate): 100%-400% FPL Must contain insurance with “Essential Health Benefits” (yet to be defined), which may be less than current state requirements Health Care & Housing Are Human Rights

11. Medicaid Expansion (cont’d) State challenges in planning for 2014 Handling large influx of enrollment Determining newly eligible from previously eligible Ensuring state Exchange and Medicaid are able to integrate and provide seamless transition Boosting provider availability Budgeting for rate increases Unknowns: Impact of Medicaid expansion on other mainstream funding programs (e.g., block grants); specifics behind enrollment procedures; breadth of required services Health Care & Housing Are Human Rights

12. Remaining Uninsured In 2016: 21 million non-elderly left uninsured Medicaid eligible, but un-enrolled: 10-11 million Undocumented: 7 million Non-participating: 4 million Penalty: Individual penalty payments are based on the income of the tax return. Those below filing threshold are exempt from penalty. Sources: Congressional Budget Office (CBO), March 20, 2010. Letter to Speaker Pelosi. CBO, Payments of Penalties for Being Uninsured Under the PPACA, April 22, 2010. Health Care & Housing Are Human Rights

13. Advocacy Opportunities Encourage your state to consider advance implementation of the Medicaid expansion (even at the lowest FPL levels), greater benefits & ongoing services for those remaining uninsured Implement assertive outreach and enrollment, reach as many as possible to minimize the uninsured population; establish best practices for teams Participate in State Implementation Task Forces/ Councils/Committees: attend meetings, provide comments, educate policymakers about needs of individuals experiencing homelessness  Conduct site visits!!  Health Care & Housing Are Human Rights

14. Health Center Funding Allocates $11 billion in health center funding over 5 years (in addition to annual appropriations) Operations Funding: $9.5 billion total FY2011: $1 billion FY2012: $1.2 billion FY2013: $1.5 billion FY2014: $2.2 billion FY2015: $3.6 billion Capital Funding: $1.5 billion National Goal: Increase number of health center patients from 20 million in 2010 to 40 million in 2015 Health Care & Housing Are Human Rights

15. Anticipated Funding Opportunities New Access Points New service delivery site for the provision of comprehensive primary and preventive health care New Starts Satellite Applicant Expanded Services Medical Behavioral Health Enabling Health Care & Housing Are Human Rights

16. Maximizing Funding Opportunities:Be Ready! Have a clear organization-wide plan What’s your long range vision? How have you identified your priorities? What are your strategic objectives? What will your outcome measures be? How will you evaluate your programs? What’s the process for continuous improvement? What constitutes success? Health Care & Housing Are Human Rights

17. Readiness: Target Population and Community Landscape Who is homeless in your local area? What are the most prevalent health care needs? Who is un-served or underserved? What makes up your health & safety net? What are the gaps? Health Care & Housing Are Human Rights

18. Readiness: Key Relationships Examine your current partnerships Local hospital Discharge planning sources Referral sources Emergency responders – police & fire Political leaders Business community Continuum of Care Don’t be afraid to “step out of the box”! Health Care & Housing Are Human Rights

19. Readiness: Patient Centered Medical Home Current Status of: Team functioning Consumer voice Comprehensive services Certification processes Health Care & Housing Are Human Rights

20. Readiness: Meaningful Use EMR Status Outcomes Development and Management Clinical Measures Health Care & Housing Are Human Rights

21. Readiness: Stating Your Case Document your ideal service delivery model and identify what you need to get to that goal Integrated care model status Implementation of Evidence Based Practices Staffing Needs Facility Utilization Trends Finances Health Care & Housing Are Human Rights

22. Readiness: Quality Improvement/ Quality Assurance How are you collecting data? How are you using data to improve? How are you doing in terms of HRSA’s Clinical and Financial Performance Measures? How are you measuring consumer satisfaction? Health Care & Housing Are Human Rights

23. Readiness: Governance 330 compliance Board membership Board functioning Consumer input Health Care & Housing Are Human Rights

24. Readiness: Finances Financial Management Policies and procedures Billing and collection systems Systems for collecting, organizing and tracking key financial performance data Payment Reform Global payments ACOs Health Care & Housing Are Human Rights

25. Grantee Response:Anticipating Funding Opportunities Updated Needs Assessment – Local School of Public Health Student Project Safety-Net Initiative (4 FQHC’s & Public Hospital) – Supported by Local Foundations Access to primary care – formal assessment – School of Public Policy Creation of new open access clinic to divert emergency room visits and refer patients to patient centered medical home Possible Accountable Care Organization (ACO) Health Care & Housing Are Human Rights

26. Grantee Response:Anticipating Funding Opportunities (cont’d) Capital Campaign & Expansion Project Purchase of new mobile coach – ARRA funding Addition of diagnostic services (radiology/ultrasound) – ARRA funding Addition of vision services – private funding EMR in all clinics and EDR recently installed Health Care & Housing Are Human Rights

27. Grantee Response:Maximizing Funding Opportunities New Access Point Application – December, 2010 After-hours/weekend clinic - partnership with local public hospital and homeless women’s service provider Diversion from ED, walk-in and outreach Patient navigator – Referral to medical home (private funding) Expanded Services Application – January, 2011 Behavioral health (integrated model) – two clinics Add 4 new mobile clinic locations with new coach New Ryan White Funding – Expand Early Intervention Clinic Health Care & Housing Are Human Rights

28. Grantee Response: Readiness: Community Landscape, Target Population & Key Relationships Launching strategic planning process – 1st Quarter, 2011 Build on needs assessment - new five year plan Expanded relationships with public hospital (NAP), other FQHC’s and Morehouse School of Medicine (behavioral health services) New relationships for mobile clinics sites Transitional and supportive housing Evening clinics at shelters Health Care & Housing Are Human Rights

29. Grantee Response:Readiness: Patient Centered Medical Home, Meaningful Use & Quality Improvement Initiated medical home education program Clinics sites Outreach activities Collaboration with other homeless service providers Service Area Competition Application (November, 2010) Clinical Performance Measures focused on criteria related to Patient Centered Medical Home Financial Performance Measures focused on Meaningful Use Health Care & Housing Are Human Rights

30. Grantee Response:Readiness: Patient Centered Medical Home, Meaningful Use & Quality Improvement (cont’d) Patient navigators – Two-Three Clinics (Americorp) Linkage to partner agencies for referrals (public hospital, other service providers) SSI and patient assistance programs Referrals for other services Enabling services Discussion with PCA to move into IT network Support all EHR applications/Meaningful Use requirements Lower cost Health Information Exchange with public hospital & other FQHC’s Health Care & Housing Are Human Rights

31. Grantee Response:Readiness: Governance & Finance Bylaw changes – December, 2010 New 330 governance requirements Term limits and some change in leadership Expanded activities for Client Advisory Committee Focus groups Expanded volunteer and staffing opportunities New Market Tax Credit Participation in all managed care programs & proactively communicating with patients on medical home Health Care & Housing Are Human Rights

32. Grantee Response:Medicaid Expansion Status of Georgia – NOT GOOD Current eligibility does not include most homeless Participating in federal lawsuit/new Governor on record as opposing expansion Other opportunities SSI benefits – Patient navigators Expanded FQHC access/collaboration - ACO Other advocacy efforts: mental health funding & incarceration discharge planning Future programs: Readiness activities in “Blue” states Health Care & Housing Are Human Rights

33. More Information The National Health Care for the Homeless Council is a membership organization for those who work to improve the health of homeless people and who seek housing, health care, and adequate incomes for everyone. Additional health reform materials at:http://www.nhchc.org/healthcarereform.html NHCHC offers free individual memberships at:http://www.nhchc.org/council.html#membership Sign up for advocacy-related Mobilizers at:http://www.nhchc.org/mobilizer.html Next webinar: Meaningful Use on January 26 at 2:00 EST. To register:http://www.nhchc.org/Webinars/DMUwebinar.html Health Care & Housing Are Human Rights

34. Questions & Answers Claire Goyer, M.Ed Tom Andrews, BS Barbara DiPietro, PhD • Director of Policy, National Health Care for the Homeless Council • Director of Policy, HCH of Baltimore, MD • Technical Assistance Program Coordinator, National Health Care for the Homeless Council • Executive Director (Retired), Duffy Health Center • President, St. Joseph’s Mercy Care Services • President, Board of Directors, National Health Care for the Homeless Council