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Determining Barriers and Recommendations for Strategies to Improve Enrollments in Health Insurance Applications for the Family Benefits Program

TABLE OF CONTENTS                                                                                                                    Page

I.   Major Project Report

a. Introduction to Problem………………………………………	3
b. Literature Review…………………………………………	8
c. Methods………………………………………………	19
d. Discussion of Results……………………………………………	27
e. Project Recommendations……………………………………………	33
f. Conclusions………………………………………………………	35
g. Major Project Meets the Mission of the Agency……………………	37
h. References……………………….	40
II.   Professional Practice Activities and Competency Attainment Report ALE II	42
III.   Poster Presentation and Handout……………………	14

Appendices

1. Applied Learning Experience II Application
2. Completed Student Logs
3. Mid Term Progress Reports (ALE II – Faculty Supervisor and Site Supervisor)
4. Final Evaluations (ALE II – Faculty Supervisor and Site Supervisor)
5. Final Evaluation- ALE Site Supervisor Assessment of Student Competency Attainment in

ALE II

6. ALE II – Site Supervisor Major Project Review Form
7. Student Evaluation of Applied Learning Experience II
8. Student Work Samples

 I. Introduction to the Problem/Issue

In the United States, health insurance is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a social welfare program funded by the government (DADS, 2017). In Chester county, residents between the age group of 65-74 years are the largest age group with public health insurance in Pennsylvania (" Chester County, PA" 2015). The population of the Chester county is estimated as 516,312 by the United States Census Bureau as of July1, 2016 and the people without insurance under the age of 65 years is 6.4% which equals to approximately 33,043 people without insurance in Chester county. The needs assessment, planning and evaluation will help this population to achieve a healthy life in future ("U.S. Census Bureau Quick Facts selected: Chester County, Pennsylvania & quot ;, 2016). Family benefits program strategized by Maternal and Child Health Consortium of Chester County aids thousands of disadvantaged Chester county families to gain access to health care since 1995 through their Health Insurance Enrollment Initiative (Us et al., 2017).

Family Benefits Program has a bilingual staff for participants to provide proper resources and act as a key towards their family’s health and success (Us et al., 2017). This program comprises facilities such as expertise in benefit eligibility determination, dedicated follow-up to ensure coverage is approved and maintained, training to social service agencies, enrollment assistance in 15 locations throughout the county (Us et al., 2017). Moreover, Maternal and Child Health Consortium have received a special Children’s Health Insurance Program enrollment grant from the U.S. Department of Health and Human Services (Us et al., 2017). This project will appraise the data profited by Maternal and Child Health Consortium of Chester County by applying the concepts of biostatistics in collecting, analyzing and interpretation of the data. Furthermore, the data will provide a hand to scrutinize the justification for the denial of an application. Top five reasons will be introduced through the data and a research will be supervised to figure out the techniques that can alleviate to overcome the hindrance. Based on information and knowledge, recommendations will be given to Maternal and Child Health Consortium to improve or remove those hurdles. Through available resources and data an analysis will be also be concluded to determine the public needs in a community setting. A lower percentage of Chester County residents between the age of 18 and 64 do not have health insurance, compared to Pennsylvania residents. The percentage of Chester County residents without insurance has slightly increased compared to 2005-2007; however, it has remained relatively constant since 2007-2009. In Chester county person with no insurance are diabetes (42%), substance abuse (37%), cancer (29%) and with insurance are substance abuse (49%), mental health problems (37%), aging (34%). The number of people living in poverty in Chester County has grown, particularly in Coatesville and Kennett Square. According to the 2009-2013 American Community Survey, five-year estimate, the median household incomes in Coatesville and Kennett Square were $35,115 and $63,328 respectively, as compared to the county’s median household income of $86,050. Likewise, 33.4% of individuals in Coatesville and 9.6% of individuals in Kennett Square are below the poverty line, as compared to the 6.9% in Chester County overall. This rising poverty leaves too many Hispanic and African American women in the county without access to basic resources such as health insurance, medical care, and health education due to language and cultural barriers, lack of transportation, and financial roadblocks. MCHC’s Healthy Start bilingual and multicultural Family Health Advocates meet the needs of the highest at-risk pregnant women and new mothers in the community with high-quality home visiting prenatal services. Their focus is on eliminating the disparities in birth outcomes that exist in Chester County. Members of the Hispanic community experience communication challenges with too few Spanish-speaking healthcare providers and therefore; a lack of understanding about health care issues and treatment. Members of the African American community reported, among other concerns, prejudice and insensitivity in the delivery of health services. MCHC continue providing emotional strengthening and support through depression screenings, health and early childhood developmental education as well as hands-on parental involvement and learning. Our new Community Health Worker Model on Chronic Diseases (Diabetes and Heart Disease) for the Healthy Start and Family Center programs, addresses diabetes and its link to poor birth outcomes, two public health issues disproportionally affecting minority populations, along with prevention. Through the Family Benefits Program, they were able to secure Medicaid or CHIP coverage for 98% of our uninsured participants during the fiscal year 2016-2017.

 II.  Literature Review

 

The United States is about to embark on a great challenge: how to modify the current system of providing health care coverage for its citizens (Bauchner, 2017).However, the fundamental underlying question remains unanswered and was rarely mentioned during the past 8 years—Is health care coverage a basic right or a privilege (regardless of how that coverage is provided or who provides it)? Until that question is debated and answered, it may not be possible to reach consensus on the ultimate goal of further health care reform (Bauchner, 2017). Without agreeing to the goal, measuring success will be nearly impossible. The reforms resulting from the Affordable Care Act (ACA) over the past 6 years have led to increases in health care coverage (Bauchner, 2017). There is broad consensus that an estimated 20 million to 22 million individuals have obtained health care insurance since 2010primarily through the expansion of Medicaid, coverage through parents’ policies for young adults until age 26 years, and the health care exchanges (Bauchner, 2017). But that leaves more than 25 million US residents without health insurance. Is the United States a just and fair society if so many individuals lack health care coverage? The United States guarantees all citizens an education, access to fire and police services, a national postal service, protection by the military, a national park system, and many other federal- and state-funded services. But the country has not yet committed to ensuring that all of its citizens have health care coverage (Bauchner, 2017). The months and years ahead are filled with uncertainty regarding how the US health care system will evolve (Bauchner, 2017). For example, will block granting Medicaid lead to a 2-tiered health care system and reduced access, or will it improve quality and reduce the increase in health care costs? If health savings accounts and tax credits replace the individual mandate, will individuals purchase health insurance? Will selling health insurance across state lines truly increase competition and reduce cost, or will it adversely affect the right of states to decide what represents adequate care for their citizens, lead to fewer health care networks with less competition rather than more, and create confusion for individuals who will not understand how such an insurance plan works in their state? Will a pool of dollars to ensure coverage of those with preexisting medical conditions be sufficient, or will these individuals once again be “uninsurable”? Will the various changes being discussed destabilize the commercial insurance market, leading to higher costs and less coverage particularly for those with preexisting health care conditions? Will these reforms solve the problem of increasingly oppressive cost of care for the working and middle classes and small businesses? The ACA needs to be modified, even though it has accomplished a great deal, principally by expanding the number of newly insured individuals (Bauchner, 2017). However, much remains to be accomplished, including how to ensure high-quality, affordable health insurance for all residents and how to control the continual increases in annual health care spending, now exceeding $3 trillion (Bauchner, 2017). Whether the proposals currently being discussed will help the United States reach these goals is uncertain, and as with the ACA, measuring outcomes will be important (Bauchner, 2017). Sorting out the most effective way to provide health care coverage in the United States is a work in progress and will require careful assessment and likely repeated changes (Bauchner, 2017). If the goals of further health care reform are clear and are measured but are not reached, then it will be necessary to return to previous discussions that have included a public option, a single-payer system, lowering the eligibility for Medicare, or further privatization of the health care system (Bauchner, 2017). I hope that all physicians, including those who are members of Congress, other health care professionals, and professional societies would speak with a single voice and say that health care is a basic right for every person, and not a privilege to be available and affordable only for a majority (Bauchner, 2017). The solution for how to achieve health care coverage for all may be uniquely American, but it is an exceedingly important and worthy goal, emblematic of a fair and just society. Public insurance cover increased from 2000–2010 in part because of an aging population and an economic downturn in the latter part of the decade. Funding for Medicaid and CHIP expanded significantly under the 2010 health reform bill  (Bauchner, 2017). The proportion of individuals covered by Medicaid increased from 10.5% in 2000 to 14.5% in 2010 and 20% in 2015. The proportion covered by Medicare increased from 13.5% in 2000 to 15.9% in 2010, then decreased to 14% in 2015. The uninsured proportion was stable at 14–15% from 1990 to 2008, then rose to a peak of 18% in Q3 2013 and rapidly fell to 11% in 2015 (Bauchner, 2017). The proportion without insurance has stabilized at 9%. A 2011 study found that there were 2.1 million hospital stays for uninsured patients, accounting for 4.4% ($17.1 billion) of total aggregate inpatient hospital costs in the United States (Bauchner, 2017). The costs of treating the uninsured must often be absorbed by providers as charity care, passed on to the insured via cost-shifting and higher health insurance premiums, or paid by taxpayers through higher taxes. Public programs provide the primary source of coverage for most seniors and also low-income children and families who meet certain eligibility requirements (Bauchner, 2017). The primary public programs are Medicare, a federal social insurance program for seniors (generally persons aged 65 and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families; and CHIP, also a federal-state partnership that serves certain children and families who do not qualify for Medicaid but who cannot afford private coverage  (Bauchner, 2017). Other public programs include military health benefits provided through TRICARE and the Veterans Health Administration and benefits provided through the Indian Health Service. Some states have additional programs for low-income individuals. In 2011, approximately 60 percent of stays were billed to Medicare and Medicaid up from 52 percent in 1997 (Bauchner, 2017). Pregnant women in Chester County are more likely to receive prenatal care in the first trimester compared to pregnant women in Pennsylvania overall. Age: Less than half of pregnant women age 15-17 (40.1%) and age 18-19 (44.4%) receive prenatal care during the first trimester. About half of pregnant women age 20-24 receive prenatal care during the first trimester (51.6%). Pregnant women age 25 and older have higher percentages of prenatal care during the first trimester, ranging from 72.4% to 83.1%. Race/Ethnicity: Black and Hispanic pregnant women have similar rates of prenatal care during the first trimester and are lower than the rates for White pregnant women (Bauchner, 2017). Chester County’s percentage of pregnant women receiving no prenatal care during pregnancy is half of Pennsylvania’s rate. Age: Pregnant women age 18-19 have the highest percentage of no prenatal care (2.3%). Race/Ethnicity: A higher percentage of Black and Hispanic pregnant women receive no prenatal care during pregnancy compared to White pregnant women (Bauchner, 2017).

Age: In Chester County, the infant mortality rate is highest among infants less than 28 days of age (3.1 per 1,000 live births). The infant mortality rate for infants age 28-364 days of age is 1.3 per 1,000 live births.

Race/Ethnicity: The infant mortality rate for babies born to Black mothers has been decreasing, but a large disparity still exists. The infant mortality rate for babies born to Black mothers is nearly three times that for Hispanic or White mothers (Bauchner, 2017). Women, Infants, and Children (WIC) is a supplemental nutrition program that provides supplemental foods, health care referrals, and nutrition education for low-income pregnant women, postpartum women, and infants and children up to age five. The percentage of mothers on WIC has slightly increased between 2005 and 2010. Chester County has a lower percentage of mothers on WIC compared to Pennsylvania (Bauchner, 2017). Age: The percentage of Chester County mothers on WIC decreases with age. The age groups with the highest percentage of mothers on WIC include: 15-17 (80.0%), 18-19 (71.7%), 20-24 (55.0%), and 25-29 (22.9%). The age groups with mothers age 30 and older have less than 10% of mothers on WIC. The Hispanic population has the highest percentage of mothers on WIC.

3. Completed Project Methods

1. Project Goal and Objectives

 

Maternal and Child Health Consortium of Chester County (MCHC) goal is “to improve maternal and child health through the collaborative efforts of individuals, providers, and policy makers”. Through a growing body of research and our own experiences, the mission was accomplished by focusing on a child’s earliest years, including the prenatal period. Working with both mothers and children in these critical early years sets up the entire family for good health and establishes a strong foundation for learning. Yet, many Chester County families who were struggling merely to make ends meet and to provide the essentials that were not able to focus on their child’s health and development. Our core programs reached families who are facing such hardships at a critical time in their children’s lives, removing the barriers that stand in the way of their child’s health and success” (“Mission & Vision | Maternal and Child Health Consortium of Chester County”, 2017).Maternal and Child Health Consortium of Chester County (MCHC) envision  of empowering families to build a healthier and brighter future for their children by addressing the social and environmental issues that perpetuate and exacerbate poor health conditions in our communities ” (“Mission & Vision | Maternal and Child Health Consortium of Chester County”, 2017).Maternal and Child Health Consortium of Chester County’s goals is to ensure that all pregnant and parenting women in Chester County have access to high-quality health care regardless of race, language, insurance status, or immigration status.

Maternal and Child Health Consortium of Chester County have different programs to achieve different objectives likewise

• The Kennett Square Family Center program has been an excellent resource for the parents of young children.  The public health nurse observes the need for families to have guidance in parenting at young ages, and to receive the support in enrolling their children in kindergarten. The public health nurse makes many referrals to the Family Center and consider themselves a strong partner. The program leverages each other’s interventions to provide a continuum of care, which has the greatest hope of breaking the chain of poor child care.
• MCHC works with county agencies in the Coatesville area in order to assist clients in obtaining services with minimal delay.  The Program is informed about the various services that are available to local residents.  The Information and Referral Specialist assists individuals and families in the Coatesville area with referral assistance to access services such as: health insurance and CHIP, transportation information, housing information, domestic violence information, utility and rental assistance.
• No family should have to sacrifice food on the table to be able to bring their child to a doctor. The Family Benefits Program helps families provide the basics – food and health coverage – to become healthier and stronger.
• Studies are clear about what obstacles stand in the way of a healthy baby. The Healthy Start services (in Spanish and English) target these risk factors during a woman’s pregnancy and in her child’s earliest years to ensure a healthy family.
• Below is the program expense presented by MCHC in the annual report of 2016-2017.

Family benefits program strategized by Maternal and Child Health Consortium of Chester County aids thousands of disadvantaged Chester county families to gain access to health care since 1995 through their Health Insurance Enrollment Initiative (Us et al., 2017). Family Benefits Program have a bilingual staff for participants to provide proper resources and act as a key towards their family’s health and success (Us et al., 2017). This program comprised facilities such as expertise in benefit eligibility determination, dedicated follow-up to ensure coverage is approved and maintained, training to social service agencies, enrollment assistance in 15 locations throughout the county (Us et al., 2017). Moreover, Maternal and Child Health Consortium have received a special Children’s Health Insurance Program enrollment grant from the U.S. Department of Health and Human Services (Us et al., 2017). This project appraised the data profited by Maternal and Child Health Consortium of Chester County by applying the concepts of biostatistics in collecting, analyzing and interpretation of the data. Furthermore, the data provided a hand to scrutinize the justification for the denial of an application. Top five reasons got introduced through the data and a research was supervised which helped to figure out the techniques that can alleviate to overcome the hindrance. Based on information and knowledge, recommendations were given to Maternal and Child Health Consortium to improve or remove those hurdles. Through available resources and data, an analysis was concluded to determine the public needs in a community setting. In Chester county, residents between the age group of 65-74 years are the largest age group with public health insurance in Pennsylvania ("Chester County, PA", 2015). The population of the Chester county is estimated as 516,312 by the United States Census Bureau as of July1,2016 and the people without insurance under the age of 65 years is 6.4% which equals to approximately

33,043 people without insurance in Chester county. The needs assessment, planning and evaluation helped this population to achieve a healthy life in future ("U.S. Census Bureau Quick Facts selected: Chester County, Pennsylvania", 2016).

2.  Target Population Analysis

Maternal and child health Consortium (MCHC) serves entire Chester county and holds four different location . Its mission is “Empowering families to build a healthier and brighter future for their children by overcoming the social and environmental barriers that lead to poor health in our communities” (“Mission & Vision | Maternal and Child Health Consortium of Chester County”, 2017). The location of the MCHC targets the population which needs the most. The county’s Hispanic population is concentrated in southern Chester County. According to the 2010 Census, nearly 60% of Avondale’s and 50% of Kennett Square’s residents are Hispanic (“Health Statistics | Chester County, PA – Official Website”, 2017). In 2010, there were more Hispanic residents (32,503) in Chester County than Black residents (29,388). More than one in ten residents (11.4%) in Chester County speaks a language other than English at home.

Prenatal care in first Trimester: Pregnant women in Chester County are more likely to receive prenatal care in the first trimester compared to pregnant women in Pennsylvania overall. Age: Less than half of pregnant women age 15-17 (40.1%) and age 18-19 (44.4%) receive prenatal care during the first trimester. About half of pregnant women age 20-24 receive prenatal care during the first trimester (51.6%). Pregnant women age 25 and older have higher percentages of prenatal care during the first trimester, ranging from 72.4% to 83.1%. Race/Ethnicity: Black and Hispanic pregnant women have similar rates of prenatal care during the first trimester and are lower than the rates for White pregnant women.

No prenatal care: Chester County’s percentage of pregnant women receiving no prenatal care during pregnancy is half of Pennsylvania’s rate. Age: Pregnant women age 18-19 have the highest percentage of no prenatal care (2.3%). Race/Ethnicity: A higher percentage of Black and Hispanic pregnant women receive no prenatal care during pregnancy compared to White pregnant women.

Infant Deaths: Age: In Chester County, the infant mortality rate is highest among infants less than 28 days of age (3.1 per 1,000 live births). The infant mortality rate for infants age 28-364 days of age is 1.3 per 1,000 live births. Race/Ethnicity: The infant mortality rate for babies born to Black mothers has been decreasing, but a large disparity still exists. The infant mortality rate for babies born to Black mothers is nearly three times that for Hispanic or White mothers.

Woman, infants and children (WIC) (also served by MCHC): Women, Infants, and Children (WIC) is a supplemental nutrition program that provides supplemental foods, health care referrals, and nutrition education for low-income pregnant women, postpartum women, and infants and children up to age five. The percentage of mothers on WIC has slightly increased between 2005 and 2010. Chester County has a lower percentage of mothers on WIC compared to Pennsylvania. Age: The percentage of Chester County mothers on WIC decreases with age. The age groups with the highest percentage of mothers on WIC include: 15-17 (80.0%), 18-19 (71.7%), 20-24 (55.0%), and 25-29 (22.9%). The age groups with mothers age 30 and older have less than 10% of mothers on WIC. Race/Ethnicity: The Hispanic population has the highest percentage of mothers on WIC.

Health Care and Access: Age: Younger people, age 18-44, more commonly do not have a personal healthcare provider (16%) compared to those age 45-64 (4%) and age 65 and older (5%). Similarly, younger people, age 18-44, were more commonly unable to see a doctor due to cost (11%) compared to those age 45-64(6%) and age 65 and older (4%). Gender: Males more commonly do not have a personal healthcare provider (11%) compared to females (9%). However, females (9%) more commonly could not see a doctor when they needed to because of the cost compared to males (7%).

Pregnant Women on Medicaid: Age: Younger mothers are more commonly on Medicaid. Mothers age 15 or less (67.8%), age 18-19 (64.3%), and age 15-17 (59.2%) have the highest percentages on Medicaid. Mothers age 45 and older have the lowest percentage of mothers on Medicaid (12.2%). At age 25, the percentage of mothers on Medicaid drops from 55.9% (Age 20-24) to 28.5% (Age 25-29). Mothers over the age of 30 have percentages of 12.2-15.6. Race/Ethnicity: Black mothers have the highest percentage of mothers on Medicaid. White mothers have the lowest percentage.

No Health Insurance: A lower percentage of Chester County residents between the age of 18 and 64 do not have health insurance, compared to Pennsylvania residents. The percentage of Chester County residents without insurance has slightly increased compared to 2005-2007; however, it has remained relatively constant since 2007-2009. Age: Younger people, age 18-44, more commonly did not have health insurance (12%) compared to those age 45-64 (5%). Gender: Females living in Chester County more commonly did not have health insurance (10%) compared to males (8%).

3. Completed Project Activities

To determine and minimize the barriers in enrollment in Health insurance application, family benefit program had to be evaluated. Hence, a framework was prepared to evaluate the family benefit program.

The aim of the framework was

1. To identify the barriers causing hindrance in enrollment in health insurance.

2. Strategy to minimize those barriers further leading to increase in enrollment.

Framework (“Framework for Program Evaluation – CDC”, 1999)

Effective program evaluation proves to be a systematic way to improve and report for public health actions by involving procedures that are useful, feasible, ethical, and accurate. The Framework for Evaluation in Public Health guided as a public health professional in the use of program evaluation. Moreover, it is also practical, non-prescriptive tool, designed to summarize and organize essential elements of program evaluation.

In accordance with the framework, steps were followed to evaluate the program

1. Engage stakeholder

Stakeholder was the medium of contact that helped to build a bridge of trust toward the vision of the project. Kelly Lynch, site supervisor enabled the bridge by providing knowledge. Through a health insurance gathering organized by Maternal and Child Health Consortium of Chester County held at Government service center located at West Chester, assisted to gain knowledge and know the current situation of health insurance in Pennsylvania State. At the end of the sessions questions were asked by the audience and answered by the panelists regarding health insurance based on the current clause and laws for legal immigrants as well as citizens of United States. The session provided a lift in the project. There were a number of panelists likewise PA Health Access Network (PHAN), Pennsylvania Health Law project, Public Health Management Corporation (PHMC) and local Federally Qualified Health Centers. Topics included updates on Affordable Care Act, Medicaid, Children’s health Insurance program(CHIP) and the impact of recent changes in health care within health centers.

In addition, shadowing one of the members of Family Benefit Program named Maribel Castro helped me to understand the barriers in a more appropriate way. The stories spoken by the client itself helped me to analyze the data in a more meaningful way.

2. Description of the program

Family benefits program strategized by Maternal and Child Health Consortium of Chester County aids thousands of disadvantaged Chester county families to gain access to health care since 1995 through their Health Insurance Enrollment Initiative (Us et al., 2017). Family Benefits Program has a bilingual staff for participants to provide proper resources and act as a key towards their family’s health and success (Us et al., 2017). This program comprises facilities such as expertise in benefit eligibility determination, dedicated follow-up to ensure coverage is approved and maintained, training to social service agencies, enrollment assistance in 15 locations throughout the county (Us et al., 2017). Moreover, Maternal and Child Health Consortium have received a special Children’s Health Insurance Program enrollment grant from the U.S. Department of Health and Human Services (Us et al., 2017).

3. Focused evaluation design

The design provides investment in quality and increases the chances that the evaluation will succeed by identifying procedures that are practical, politically viable, and cost effective. Failure to plan thoroughly can be self-defeating, leading to an evaluation that might become impractical or useless. Stakeholders agree on a design focus, it is used throughout the evaluation process to keep the project on track. Activities as shown in the flowchart aided in focusing the design.

4. Gather credible evidence

Data was provided by Cecilia Arce, Director of Programs and Fran Lisowski, Data coordinator. Data includes the updated status of health insurance application from July 2017 to September 2017.The outcomes of the health insurance application was also reported in the data which enabled me the current status of the application likewise accepted, denied or voluntary withdrawal. The reason for the denial of the health insurance application was also mentioned in the data system.

5. Justify conclusions

Based on the qualitative and quantitative analysis, interpretations and judgment were made. However, conclusions were justified based on evidence using five elements like recommendations, analysis, interpretation and judgment.

6. Ensure use and share lessons

The results and recommendations done at the end of the evaluation were shared with the site supervisor Kelly Lynch. The main role behind sharing lessons was to make sure that the primary purpose of the project is achieved.

4. Completed plans for Data Collection.

Prospective observation study method was applied to collect data.

1. Learned objectives

• The worksite health insurance application process.
• Reasons to collect data.
• The types of data used in worksite.
• Understanding types of insurance provided in the Family Benefit Program and types of assistance provided for the same.

2. Measures

• Bilingual application assistance by Maternal and Child Health Consortium (MCHC)
• Excel spreadsheets used to keep track on the applications with information such as office locations, name of the applicant, birth date, case number or any additional comments.
• Color coded system on the spreadsheet to signify approvals, disapprovals, pending application, and any other relevant information.
• Respondents Privacy and Data Security: To maintain the privacy and data security (to protect confidentiality of the participants) Institutional Review Board(IRB) Protocol were followed throughout the program.

3. Data collection methods

• Outreach and meeting summary form completed by MCHC staff.
• Compass-PA’s online enrollment portal for public benefit data.
• Family benefit Coversheet form used to collect applicant’s personal data.
• Challenger soft-tracks applicant data, type of health coverage applied for and applicant outcome on a continual basis.
• Excel spreadsheets updated by MCHC with personal tracking sheet number of applicants completed each month.
• Below is the bar graph presented by MCHC in their annual report of 2016-2017 highlighting the household income.

5. Completed Plans for Data Analysis

Through Excel spreadsheets data was collected from July 1, 2017 to September 30, 2017. Demographic details like age at the time of registration, age group, status of visa, country of origin race, language spoken, and type of health aid applied for, all the details were entered in the excel sheets. Status of applicant was the prime focus for analyzing data. Date of denial, reapplication and transfer were noted in the data system to record the status of application. Cases where emergency medical assistance was required were also noted.

Statistical analysis was performed using SAS software (SAS
Institute Inc. 2011. Base SAS® 9.4 Procedures Guide. Cary, NC: SAS Institute
Inc.)

6. Completed Project Timeline

 

Activity			Month
	October	November	December	February	March
Identified the internship site & conduct interview	X
Select Major Project plan	X	X
Attended MCHC meetings	X	X		X	X
Gathered material		X	X	X	X
Research	X	X		X	X
Attended Health Insurance Gathering					X
Shadowed Family Benefit specialist					X
Collected Data				X	X
Collected data into SAS					X
Analyzed Data					X
Evaluation of results					X

IV. Project Results               

 

The project results for Determining Barriers and Recommendations for Strategies to Improve Enrollments in Health Insurance Applications for the Family Benefits Program in Chester County from July 1, 2017 to September 30, 2017 is discussed in this section of the paper.

 

 

Figure 1

Above figure 1 outlines the data collection and analysis process. The result of the analysis states from July 1, 2017 to September 30, 2017, there were 1220 applicants who enrolled in Family Benefit program and applied for Medicaid health Insurance. Out of 1220 applicants, 55 applications (4.5%) were denied due to various reasons which will be stated at end of summary. However, 20 applicants (1.7%) out of 1220 applicants were denied for insurance and the reason was unknown. Hence, 1145 applicants were approved which counts for 93.8% as acceptance rate. Also, out of total applicants 263 applicants (21.5%) were adult and 957 applicants (78.4 % ) were children( figure 2 ) . So, it can be concluded that Maternal and Child Health Consortium is achieving its mission at a higher rate which is “Empowering families to build a healthier and brighter future for their children by overcoming the social and environmental barriers that lead to poor health conditions in our communities”.                                                                                                                                             

Figure 2

Below Figure 3 entitles the demographic data based on applicant’s country of origin an immigration status. In total of 1220 applicants of Medicaid there were 983 applicants (80.5%) who were USA based origin and remaining 237 applicants (19.4%) belonged to different countries of origin and were legal immigrants of USA. Different countries include Mexico, Nigeria, Liberia, Columbia, Ecuador, Pakistan, Peru, India, Cambodia, Bangladesh, Morocco, Vietnam, Korea, Guatemala, China, Venezuela, Africa and Syria.

 

Figure 3

 

 

 

 

 

 

 

Below figure 4 outlines the data collected of the applicants who applied for CHIP (Children Health Insurance Program) between July1,2017 and September 30,2017 through Family Benefit Program. There were total 283 applicants, out of which 245 applicants (86.5%) were accepted and 30 applicants (10.6%) applications were rejected and 8 applications (2.8%) were denied after the approval due to lack of evidence of self-employment.

Figure 4

Based on the data results, one can conclude that the acceptance rate of the Family Benefit Program is high and fulfilling the mission of the agency. However, denial rate cannot be neglected as everyone needs a healthier life for better and long living. Subsequently, the reasons for the denial of the health insurance can help to overcome the barriers that lead to road of health care. Hence, top reasons for denial of the application were noted after the data analyst in order to avoid the rejection and more families are benefited with the Family Benefit Program.

Top reasons for the denial of health insurance application of Medicaid and CHIP were:

However, below is the list of required documents required to fulfill the eligibility criteria for Medicaid and CHIP:

V. Project Recommendations and Conclusions

Family benefits program strategized by Maternal and Child Health Consortium of Chester County aids thousands of disadvantaged Chester county families to gain access to health care since 1995 through their Health Insurance Enrollment Initiative (Us et al., 2017). Family Benefits Program has a bilingual staff for participants to provide proper resources and act as a key towards their family’s health and success (Us et al., 2017). This program comprises facilities such as expertise in benefit eligibility determination, dedicated follow-up to ensure coverage is approved and maintained, training to social service agencies, enrollment assistance in 15 locations throughout the county (Us et al., 2017). Moreover, Maternal and Child Health Consortium have received a special Children’s Health Insurance Program enrollment grant from the U.S. Department of Health and Human Services (Us et al., 2017). Through the Family Benefits Program, Family Benefits Specialists were able to secure Medicaid or CHIP coverage for 98% of our uninsured participants during the fiscal year 2016-2017.

Based on the reasons of denial, recommendation was made as a result of project implementation which were

1. Counseling by a Family Benefit specialist can help to educate the applicants regarding the benefits and procedure for Health insurance application. Also, appointment preparations and complete assistance at the time of application filling can be given (Us et al., 2017).

2. Timely update on application to the applicants can help applicants to provide the required documents and avoid rejection of the application (Us et al., 2017).

3. Follow up with the applicants after the approval of the insurance can remind the applicants to make initial premium payment and decrease the rate of termination of insurance (Us et al., 2017).

4. Advocacy support can help the applicants to gather proper verified documents.

5. Increase eligibility awareness can help the applicants to understand the criteria and can help to fasten the process of application procedures.

Conclusion:

Summing up the data results and recommendations one can conclude that Maternal and Child Health Consortium is reaching thousands of families and providing health care assistance to achieve a healthy life. The results were estimated from three months of data as every individual deserves a healthy life even the slightest percentage of people who fails to receive healthcare needs an urgent attention. Maternal and child health Consortium is providing technical assistance to overcome the challenges by providing training to staff member conducted by County Administrative officer (CAO) of Chester county. Training includes education regarding CHIP/Medicaid eligibility criteria, annual recertification requirements and electronic insurance application procedures. The Family Benefit Program manager serves as a Benefits Enrollment specialist through bi-weekly staff meetings, case reviews and assistance related to complex cases (Us et al., 2017). Moreover, the project manager also provides technical assistance to other staff members from partnering organization to ensure their ability to submit enrollment applications and solve complex issues that arises (Us et al., 2017).

However, there were many lessons learned while shadowing the staff members of Family Benefit Program as stated below-

• It is important to follow -up after 4-6 weeks the application or renewal is submitted.
• Maintain communication with the applicants and their case workers at County Assistance Office.
• Submission of excel spreadsheet on a weekly and monthly basis to the data coordinator and data manager for renew and updates on enrollment status.
• Providing bilingual assistance to the applicants for better communication.
• Set up a reminder to the applicants through Care message.

Maternal and Child health Consortium also established memorandum of understanding to enable data sharing. The reason to setup a memorandum was to ensure health insurance enrollment activities were properly documented based on MCHC standards (Us et al., 2017).

Lastly, the data collection, analysis, and interpretation helped Maternal and Child Health Consortium to review the application more accurately and helped them to analyze the loop holes related to denial of the application status applied for Medicaid and Chip (Us et al., 2017).

It can be said that Maternal and Child health Consortium is achieving it mission and fulfilling its vision based on the objectives in a very effective way.

VI. MAJOR PROJECT MEETS THE MISSION OF THE AGENCY

Maternal and Child Health Consortium mission is “to empower families to build a healthier and brighter future for their children by overcoming the social and environmental barriers that lead to poor health conditions in our communities” (Us et al., 2017).

In Chester County one in eight individuals go to bed hungry and nearly one in ten adults have no insurance. Children who are living without basics  like nutritious food or health care face a tough childhood (Us et al., 2017). It is not easy for them to learn and grow when they may be hungry or suffering from an unaddressed medical need. Research shows that children who lack the essentials during their early years may face long-term effects, including the need for special education (Us et al., 2017). MCHC has helped thousands of disadvantaged Chester County families gain access to healthcare since 1995 through their Health Insurance Enrollment Initiative(Us et al., 2017). Bilingual staff of Family Benefits Program enrolls participants in resources that are key to their families’ health and success.

The Family Benefits Program offers:

• expertise in benefit eligibility determination
• dedicated follow-up to ensure coverage is approved and maintained
• training to social service agencies
• enrollment assistance in 15 locations throughout the county

MCHC was selected as one of only 39 grantees nationwide to receive a special Children’s Health Insurance Program enrollment grant from the U.S (Us et al., 2017). Department of Health and Human Services. The award proves the success of their work and enables them to be part of a national initiative to expand their work to link uninsured children to health coverage in Chester County and share their best practices regionally (Us et al., 2017).

The Family Benefits Program helps families provide the basics – food and health coverage in order to become healthier and stronger (Us et al., 2017). By joining them, one can make sure that families in Chester have the resources they need to do the world’s most important job: raise a healthy family. Hence, through project implementation and meeting the needs of the families one can achieve the mission of the agency.

 

VII. References

Framework for Program Evaluation – CDC. (1999). Cdc.gov. Retrieved 15 March 2018, from https://www.cdc.gov/eval/framework/index.htm

Us, A., Board, S., Start, H., Benefits, F., Center, F., & Services, I. et al. (2018). Chester County Maternal and Child Health Consortium – MCHC. MCHC. Retrieved 19 March 2018, from http://www.ccmchc.org

Chester County Births by Birthweight 2005-2009. (2010). Webapps.chesco.org. Retrieved 17 November 2017, from http://webapps.chesco.org/webapps/health/sorting/births/lbw.html

Chester County Trimester of 1st Prenatal Visit 2005-2009. (2012). Webapps.chesco.org. Retrieved 17 November 2017, from http://webapps.chesco.org/webapps/health/sorting/births/TrimesterofCare.html

Health Statistics | Chester County, PA – Official Website. (2017). Chesco.org. Retrieved 17 November 2017, from http://www.chesco.org/366/Statistics

Us, A., Board, S., Start, H., Benefits, F., Center, F., & Services, I. et al. (2017). Chester County Maternal and Child Health Consortium – MCHC. MCHC. Retrieved 17 November 2017, from http://www.ccmchc.org/

(DADS), D. (2017). American Fact Finder – Community Facts. Factfinder.census.gov. Retrieved 7 December 2017, from https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml