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HCHD Resource Guide

HCHD Resource Guide. Anoop Agrawal, M.D. Baylor College of Medicine. Objectives. Understand Harris County’s Gold card system Know which patients can come to MLK Learn how to recruit patients from BTGH Learn how to recruit Medicaid patients Know how to make clinic appointments.

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HCHD Resource Guide

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  1. HCHD Resource Guide • Anoop Agrawal, M.D. • Baylor College of Medicine

  2. Objectives • Understand Harris County’s Gold card system • Know which patients can come to MLK • Learn how to recruit patients from BTGH • Learn how to recruit Medicaid patients • Know how to make clinic appointments

  3. Who can come to MLK Clinic? • ONLY Harris County residents are eligible • Medicare or Medicaid • Gold card • Blue Cross/Blue Shield PPO • If a pt does not meet the above criteria, then they will asked to pay $70 up front - they will also receive a bill for the balance for additional services (lab, xray) in the mail.

  4. What is a Gold Card? • It is a financial assistance program provided by Harris County. • Depending on an individual’s income, he/she may qualify for county medical services at significantly reduced rates. • Example: Family of 4 with gross monthly income of $3,000: $5 for doctors visits and each prescription; $25 for ER visit; $100 for admission

  5. How to get a Gold Card? • An individual needs to complete an application and provide proof of six items: • 1. Your identity - driver’s license, marriage license, birth certificate, wage stub, job badge with picture • 2. Where you live - there is no durational requirement • 3. Household income for the past 30 days

  6. Eligibility continued... • 4. Household composition (who lives with you) - birth certificate, baptismal record, baby’s Popras form • 5. Immigration status - do not have to be U.S. citizen to qualify; persons who claim to be undocumented are eligible; persons with certain types of visas ARE NOT(ie H1, J1, visitors)! • 6. Documentation of other health care coverage

  7. Online Resources • Application and information available on online at www.hchdonline.com under the ‘Patient information’ tabl • There is an online payment calculator that will you an idea of how much assistance the individual qualifies for. • Gold card is not permanent - usually expires after 6 months, and the individual must reapply.

  8. I saw a patient in the BT ER, can they come to see me? • Patients are assigned to a HCHD clinic according to their zip code. This is termed their PTL (primary treatment location) • If you intend to keep this patient as part of your permanent panel, then this needs to be changed. • You can provide 1-2 visits for f/u care of the ER or inpatient encounter, then back to PTL.

  9. I cared for a patient in the BT ER or wards and they don’t have any coverage. • Can this patient see me or another provider in the HCHD system? • YES. They are permitted to F/U in the HCHD system for the next 30-60 days. • They get 1 or 2 f/u visits for free, right? • NO - they will have to pay $70 for any clinic visit - even ER F/U or Hospital F/U.

  10. Following Hospital Stay or ER visit • Patient’s without any type of coverage, i.e. Gold card, Medicaid or Medicare, is allowed 1-2 follow-up visits over the next 30-60 days • This is to allow the patient time to obtain a Gold card. • PEARL: Patient can obtain a Gold card DURING their inpatient stay if they qualify. Have your support staff help you.

  11. I’m seeing a patient at the VA. Can I bring them to MLK for f/u? • NO! Veterans have health care benefits through the Veteran’s Affairs Medical Program. • Bringing them to the county system would not benefit them.

  12. My patient has Medicaid... • In order for a Medicaid patient to be seen at MLK, they must have an attending in the HCHD system listed as their Provider or PCP. • The patient needs to call the number on their Medicaid paper and ask to change. Please note that this change will not go into effect until the first of the next month. If it is after the 15th of the month, then the change will occur in ~1 1/2 months.

  13. I’m seeing a patient at TCH. Can I bring them to MLK for f/u? • If the patient has Medicaid and they do not have a provider (or they are looking for a new provider) - then YES! • If they have private insurance, then the answer is likely NO. • The county services are for the underserved.

  14. Making appointments... • If you are seeing a patient at a non-HCHD site, then they will need to call the desk for an appointment (713-873-4752). • If they have a Gold card, then instruct them to NOT call the number on the back! • Keep in mind who can and cannot come to MLK!

  15. Formularies • HCHD negotiates for competitive drug prices from the pharmaceutical companies • Certain drugs require approval. This is a way to cost contain and/or to prevent overuse/inappropriate use of a medication. • If you are seeing a Medicare or Medicaid patient you must use their formularies, not HCHD’s! • online resources: www.epocratesonline.com

  16. Referrals • Gold card patients must be referred to specialty clinics within the HCHD system. • Medicare or Medicaid patients can be referred to any provider that accepts their plan. • Example: • TCH accepts only a few Medicaid plans (Texas Children’s Health Plan, Community Health Choice, Molina) • TCH only takes their own CHIP plan

  17. How are my appointments made? • The clerk needs to know the appt is to be made at the MLK pavilion (M) • Next you need to know the ‘Resource’ code - it is named based on your year: i.e. MDP1, MDP2, MDP3, MDP4 • There the clerk will find your name and appointment availability. • There is an additional resource - MDPD for overflow pediatric patients.

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