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Angela T. Burden, RN, MA, Director Quality Improvement & Infant Loss Initiatives PowerPoint Presentation
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Angela T. Burden, RN, MA, Director Quality Improvement & Infant Loss Initiatives

Angela T. Burden, RN, MA, Director Quality Improvement & Infant Loss Initiatives

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Angela T. Burden, RN, MA, Director Quality Improvement & Infant Loss Initiatives

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  1. Overview of Baltimore Health Care Access Programs & Servicesand theMaryland Primary Adult Care Program (PAC) Angela T. Burden, RN, MA, Director Quality Improvement & Infant Loss Initiatives (410) 649-0521 ext. 3039

  2. A Word About BHCA • Baltimore Health Care Access, Inc. (BHCA) is a quasi-public/non-profit agency of the Baltimore City Health Department created in 1997 in response to State legislation governing the roles of local health departments in the Medicaid Managed Care Program known as HealthChoice. DHMH provides ACCU/Ombudsman and MCHP Eligibility grant funding to perform these functions. • Since 1997, BHCA has expanded its mission to include services to special populations such as those in need of Addiction Support, the Homeless, Immigrants, and the uninsured and underinsured.

  3. BHCA Programs and Services Eligibility Services • We provide eligibility services for the Maryland Children’s Health Insurance (MCHP) Program for Baltimore City residents. MCHP provides Medicaid health insurance coverage for pregnant women of any age and children age 18 or younger who meet certain income requirements. • We also provide eligibility services for the Primary Adult Care (PAC) Program. PAC provides FREE primary care to low-income adults age 19 and older. • Through Kaiser Permanente, BHCA processes Bridge Program applications for Baltimore City residents.

  4. Maternal & Child Health Programs Maternal and Infant Health Improvement Program - Serves as the single point of entry for Prenatal Risk Assessments and Infant Identification Forms to identify high-risk pregnant women and infants. Eligible women are referred for intensive case management through the BCHD’s Maternal & Infant Nursing Program. Initial outreach services are provided by Family Advocates who refer lower risk women to supportive services including community-based home visiting programs. School Health Program The School Health Program is a collaboration with the BCHD-School Health Program. It is designed to assure that eligible school-age children have access to health insurance through MCHP education, outreach, and linkage to services once enrolled. The Crib Project The Crib Project is a collaboration between First Candle/SIDS Alliance and various Baltimore City home visiting programs. The project provides safe bedding to infants as well as providing education to parents on safe sleep practices and promoting the Back to Sleep message.

  5. Immigrant Services Program • Our Advocates assist Baltimore City’s immigrant population by providing interpretation services, MCHP, Medicaid, Emergency Medical Assistance outreach and application assistance as well as assistance in navigating the HealthChoice system. Assistance in linking with resources is also provided. • Advocates are strategically location at sites around the City that serve the Immigrant population. They include: • 1.Hispanic Apostolate • 2.Care-A-Van – SECO and Patterson Park • 3.The Resettlement Center • 4.La Carolina – Immunization & Family Planning Clinics • 5.CASA de Maryland • 6.Centro de la Comunidad • 7.BCHD WIC Program • 8.Bayview – Children’s Medical Practice • Latino Kiosks Project: The Kiosks provide Spanish-language health-related information and resources placed in strategic locations around the City to assist the Latino community in accessing and utilizing available health resources.

  6. C.A.R.E. Program(Coordination, Assistance, Referral, and Education) • Provides community based outreach, education and health care coordination services for non-compliant special populations within HealthChoice, MCHP, and those potentially eligible for Medical Care programs (MA, MCHP, and PAC). • Assists in removing barriers that may be keeping enrollees from accessing health care. • Assists enrollees through education, assistance, advocacy, and conflict resolution in understanding the managed care system and using their MCO’s internal grievance process • Investigates and resolves complaints that are referred to us through the DHMH’s HealthChoice Enrollee Action Line/complaint resolution unit. • Existing collaborations with BCDSS, CICL, and the BCHD MCH division to provide outreach services to special populations identified by these groups.

  7. Other BHCA Programs/Services Resources for Families, Communities and Providers • At visitors will find a large selection of resources to assist in understanding and navigating the HealthChoice system, services for Children with Special Health Care Needs, Resources for the Uninsured and Underinsured, and linkages to key websites to obtain further information – such as to the DHMH PAC Program website. • BHCA participates in many community health fairs, conferences and forums to educate the Baltimore community about its services, HealthChoice, PAC, Bridge, and accessing healthcare services when you are uninsured or underinsured. • Direct Provider and Community education and training are offered on topics such as BHCA Programs and Services, HealthChoice/Medicaid, MCHP, PAC, MD Family Planning Waiver Program, Bridge Program, accessing low-cost/no-cost services, and other available services programs for special populations. Project H.E.A.L.T.H • Utilizes college student volunteers to assist providers with assessment and referral of patients to local resources. Project HEALTH Help-desks are located at select Baltimore City clinical sites.

  8. Newest Programs ! Addiction Outreach Services The Methadone Project • Provides public benefit assistance at select Methadone treatment centers in Baltimore City. Buprenorphine Access Project • Provides technical assistance, outreach and tracking of clients on long-term Buprenorphine therapy. The goal is to transfer clients to Primary Care Providers that are Bup.-certified in order to continue their therapywhile also receiving FREE primary health care covered through PAC benefits. Homeless Services Program • Provides “street” and on-site assistance at local shelters and drop-in centers for individuals experiencing homelessness. • Individuals are assessed and linked as needed to necessary health care services and medical benefits such as PAC.

  9. The Kaiser Bridge Plan • Kaiser Permanente works with local government and nonprofit organizations to provide health coverage for families in need. • The purpose of the Bridge Plan is to assist individuals who, due to a recent change in job status or income, are uninsured. • To be eligible –individuals must be employed! • The benefits are for a 2 year period. At the end of the 2 years, members are no longer eligible for Bridge, but have the option of purchasing the Kaiser Plan at full price. • Applications, income and asset information, and eligibility determination is completed by community partners on behalf of Kaiser. • BHCA serves as the Kaiser Community Outreach Partner in Baltimore City and submits all eligible applicants to Kaiser for processing. • Kaiser will notify applicants within 45 days of receiving their application.

  10. Bridge Plan Contact Information Baltimore HealthCare Access, Inc. 201 E. Baltimore Street, Suite 1000 Baltimore, MD 21202 (410) 649-0521 • Urah Blackwell, Bridge Plan Coordinator ext. 3090 • Therese McIntyre, Communications/Legislative Affairs Director Ext. 3007

  11. For More Information Contact Us At: Baltimore HealthCare Access, Inc. 201 E. Baltimore Street, Suite 1000 (10th Fl.) Baltimore, MD 21202 (410) 649-0500 Kathleen Westcoat, MPH, President Traci Kodeck, MPH, Chief Program Officer Angela Burden, MA, RN, Director QI (training)

  12. The Maryland Primary Adult Care Program (PAC)

  13. What is PAC? • PACis the newest Maryland Medical Care Program that offers basic health care to low income adults age 19 and over. • PAC is income and asset based - Enrollees do not need to have a medical condition to qualify. • PAC stresses the role of Primary Care in the prevention and/or complication of medical conditions. DHMH states, “PAC helps stop little problems before they become BIG health problems.” • PACstands for Primary Adult Care. Primary care is health care that is provided by a general medicine doctor, or nurse clinician who take primary responsibility for managing the health care of patients.

  14. What is PAC? • PAC is administered by the Department of Health and Mental Hygiene (DHMH), clients do not have to go to the Department of Social Services (DSS) to apply. The application process is handled through the mail – no face-to-face interview is required. • PAC follows a managed care model of care. Meaning – members must pick a Managed Care Organization (MCO) – similar to a HMO. The PCP must be a member of the MCO that the member selects. The MCO is responsible for assuring that the PAC member receives all covered benefits from the PCP necessary for the member to remain healthy. • The four (4) PAC MCOs are – Jai Medical Systems, Maryland Physicians Care, Priority Partners, and United Health Care.

  15. What is the Eligibility Criteria? IndividualMaryland residents age 19 or over who are not on Medicare are eligible if: • their income does not exceed $1,005 a month (new income guidelines effective March 1st of each year), and • they have less than $4,000 in assets. (Two or more person households have higher income scales and are allowed up to $6,000 in assets). • They are not being claimed on their parents’ tax return • You must be a U.S. citizen to qualify for PAC. Proof of citizenship and identity will be required to be mailed in with the application. Other forms may also be required to be submitted along with the application, such as “Proof of No Income.”

  16. Quick Facts • The PAC membership ID card is yellow and white. (This is used to obtain services outside of the MCO network; called fee-for-service - FFS). The MCO will also issue a membership card to identify their members. • PAC benefits for primary care do not start until enrollment in a MCO – no retroactive paymentwill be made for primary care received prior to MCO enrollment. Outpatient mental health and pharmacy benefits are Fee-For-Service (paid by DHMH) until MCO enrollment. • After MCO enrollment, the yellow & white PAC card is used to pay for certain benefits not covered by the MCO – such as HIV/AIDS drugs, mental health drugs, and specialty mental health care.

  17. Benefits • Benefits include FREE primary health care and a nominal pharmacy co-pay (Jai Medical Systems and Maryland Physicians Care have waived their co-pay). • FREE in-office mental health services to a counselor, or psychiatrist. • FREE limited Dental benefits are available from all four the MCOs. • All MCOs except Priority Partners offers FREE limited Vision Coverage to all members. • Other specialty services are only available for Diabetics.

  18. Benefits (Cont’d) • Specialty services for Diabetics: Such as 1) Vision care – one (1)ophthalmologic exam and one pair of glasses per year. 2) Foot care - assistive devices such as blood glucose meters, compression stockings, canes, and crutches (wheelchairs are not included). • PACdoes not cover in-patient hospital care, emergency room services, specialty services (including substance abuse), or EPSDT services.

  19. Benefits (Cont’d) • Some free lab and diagnostic services. • Pharmacy benefits with minimal co-pay – up to $2.50 for generic drugs, and $7.50 for brand name drugs. Except for contraceptives which are FREE. **(Be sure to check the MCO Comparison Chart)

  20. What About Substance Abuse Services? • With the exception of Buprenorphine; substance abuse services are not covered by PAC. • Buprenorphine can be prescribed by Primary Care Physicians. • After initial treatment for SA, PAC members may continue Buprenorphine treatment through their PCP along with receiving other PAC-covered primary care.

  21. Buprenorphine/PAC Outreach Sites(for clients attending these sites only) • Universal Counseling Services - 122 Weber Street, 21230 (410) 752-5525 Mon. 5:30 -6:30 p.m. & Tues. 11 a.m. – 3 p.m. Tammy Braswell • Total Health Care, Inc. - 1501 W. Saratoga Street, 21223 (410) 383-7197 Tues. 9-10 a.m. & Wed. 9 a.m. – 12 noon Tammy Braswell • Univ. of MD – ADAP – 630 W Fayette St, 21201 (410) 328-0126 Tuesday 12 noon – 3 p.m. Raquele Brimmage • Park West HC – 4120 Patterson Av., 21215 (410) 764-2266 Friday 1 p.m. – 3:30 p.m. Tammy Braswell • Powell Recovery Center – 14 S. Broadway, 21213 (410) 276-1773 Friday 11 a.m. – 4 p.m. Tomika Press

  22. Buprenorphine/PAC Outreach Sites(for clients attending these sites only) • Harambee Treatment Center - 3939 Reisterstown Rd., Suite 105 (410) 542-2145 Thursday 8-11:30 a.m. Raquele Brimmage • Next Passage - 2901 Druid Park Drive, Suite A – 103 (410) 728-8901 Tuesday 8-11:30 a.m. Raquele Brimmage • Partners in Recovery - 2225 N. Charles Street 21218 (443) 573-8672 Monday 8-11:30 a.m. Sadie Matarazzo • FHC of Baltimore - 631 Cherry Hill Road Brooklyn, 21225 (410) 354-2000 ext. 249 Monday 9-11:30 a.m. Raquele Brimmage • Sinai Hospital – 2401 W Belvedere Av, 21215 (410) 601-5461 Monday 10 a.m. – 1p.m. Tammy Braswell

  23. How to Apply for PAC • To receive a PAC application or for more information call 1-800-226-2142 or go online at • New TDAP (Temporary Disability)recipients will receive PACbenefits automatically until a decision is made regarding their disability (SSI benefits). (no application required) • The DHMH/BHCA Dedicated Baltimore City Eligibility Unit has 45 days to make a decision regarding eligibility.

  24. What Happens After Eligibility is Determined? The member will receive what is known as an “Enrollment Packet” from the DHMH-appointed Enrollment Broker -PSI. It will contain: • Their yellow and white PAC membership card. • Information about PAC – including their rights & responsibilities, and important telephone numbers. • Information about the four (4) PAC MCOs. The information will help the member select which MCO and PCP is right for them. (Clients have 21 days to select a MCO or one will be chosen for them). • A “Health Questionnaire” to obtain current health status and past medical history. • Instructions on timelines associated with selecting a MCO, completing the questionnaire, and getting the information back to DHMH. • Annual renewal is required. DHMH will send out notices in advance so keep your contact information current with DHMH and your MCO/PCP.

  25. Resources to Assist • Mail Completed Applications To: PAC Program Application P.O. Box 386 Baltimore, Maryland 21203-0386 • PAC Call Center 1-800-226-2142. Questions regarding status of applications, etc. ***** • Enrollees may call the PAC Enrollee Action Line at 1-888-754-0095 for assistance with accessing service, complaints/grievances. • To enroll, clients may call the PACEnrollment Line at 1-866-676-5880.