Navigating systems of care 1

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Navigating systems of care 1

  1. 1. Navigating Systems of Care: Finding the RIGHT Care for Your Child or Teen Developed by the LA Family to Family Health Information CenterA statewide program of Bayou Land Families Helping Families
  2. 2. Who Can Help My Family?Feelings families can experience when they don’t know where to go for help. ANXIETY ANGER FRUSTRATION ADVOIDANCE “HELP!” CONFUSION SADNESS
  3. 3. Families Helping Families Network of Regional Resource Centers serving individuals with disabilities and special needs and their families and the professionals who serve them. Staffed by families who, through their own experiences, are committed to reaching out to other families who have members with disabilities or special needs. 3 Core Services information & referral education & training peer support
  4. 4. Families Helping FamiliesEach regional center is an independentnon-profit;Each provides a lending library;Computer available for families andprofessionals for research;Education and Medical Advocacyinformation and services;1-800-922-DIAL (3425)info@lafhf.org
  5. 5. Families Helping Families Orleans, Plaquemines, St. Bernard Avoyelles, Concordia, Catahoula, Grant, LaSalle, 1-877-243-7352 Rapides, Vernon, Winn 1-800-259-7200 Ascension, East & West B.R., East & West Feliciana, Bienville, Bossier, Caddo, DeSoto, Natchitoches, Red Iberville, Pointe Coupee River, Claiborne, Lincoln, Sabine, Webster 1-866-216-7474 1-877-226-4541 Assumption, Lafourche, St. James, St. John, Caldwell, East & West Carroll, Franklin, jackson, Terrebonne, St. Charles, St. Mary Madison, Morehouse, Ouachita, Richland, Tensas, 1-800-331-5570 Union 1-888-300-1320 Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. St. Tammany, St. Helena, Livingston, Washington, Martin, Vermilion Tangipahoa 1-800-378-9854 1-800-383-8700Allen, Beauregard, Calcasieu, Jefferson Davis, Cameron Jefferson 1-800-894-6558 1-800-766-7736 These FHF Centers have statewide programs.
  6. 6. Bayou Land Families Helping FamiliesServing St. Charles, St. James, St. John, St. Mary, Assumption, Terrebonne and Lafourche 286 Hwy 3185 Thibodaux, LA 70301 1-800-331-5570 or 985-447-4461 Fax: 985-447-7988 Web Site: www.blfhf.org Email Address: Blfhf@bellsouth.net
  7. 7. Bayou LandFamilies Helping Families
  8. 8. LA Family to Family Health Information Center Or C hildren and YouthS tatewide who Have an E xtended Illnes s .C hildren and Provides Health and Youth Health C are FinancingA ges 0-26 InformationWith S pecial C onnects to Health C are Res ources Needs or, Provides Training toAt Ris k for Families and Youth S pecial Health
  9. 9. Louisiana Family VoicesLouisiana Chapter of Family Voices Advocating for family centered care for children with special health care needs http://www.familyvoices.org/
  10. 10. Additional Bayou Land FHF Programs earlySteps Community Outreach Specialists Children’s Special Health Services Parent Liaisons Education Advocates Transition Specialists Various other programs that support individuals with disabilities, their families and the professionalswho serve them.
  11. 11. State Programs
  12. 12. D e p a rtm e n t o f H e a lt h & H o s p it a ls O f f ic e o f C it iz e n s O f f ic e o f M e n t a l O f f ic e o f P u b lic O f f ic e o f H e a lth w / D e v e lo p m e n t a l H e a lth H e a lth S e r v ic e s D is a b ilit ie s F in a n c in gR e g io n a l R e s o u r c e C e n te rs C h ild /A d o le s c e n t R e s p o n s e T e a m C e n t e r fo r C o m m u n it y H e a l th M e d i c a id L a H IP P e a r ly S te p s L a -Y E S C e n te r fo r C o m m u n ity P r e p a r e d n e s s K i d M E D & C o m m u n it y C A R E LaM O M s M e d ic a id W a iv e r S e r v ic e s ECSS C e n t e r f o r P r e v e n t a t i v e H e a l th L a C H I P , L a C H I P A f f o r d a b le M e d ic a id P u r c h a s e P la n C a s h S u b s id y P r o g r a m F O A M e d i c a id T a k e C h a rge C o m m u n ity H e a lth : C o m m u n ity P r e p : P r e v e n ta tiv e H e a lth : R e g io n a l E m e rg e n c y P rep S c h o o l B a s e d H e a lt h C t r s O P H C li n i c s H e a lth L A 2 0 1 0 CSHS I n ju r y P r e v e n t i o n / F lu H e a r in g , S p e e c h , V is io n F a m ily P la n n in g H I V /A I D S Im m u n iz a tio n P r o g r a m s S A F E K ID S W IC C o u n c il o n O b e s ity P r e v .
  13. 13. Human Services Authorities or Districts Legislatively defined and approved. Consolidate funding from Office of Citizens with Developmental Disabilities, Office of Behavioral Health (Mental Health and Addictive Disorder Services) Local governance by a Board of Directors for funding allocations Same services provided with more flexibility.All OCDD services can be accessed through SCLaHSA except Resource Center services.
  14. 14. Office of Citizenswith Developmental Disabilities (Services provided through South Central Louisiana Human Service Authority)
  15. 15. Office for Citizens with Developmental DisabilitiesServes Individuals who have disabilities that result in substantial functional limitations in 3 or more of the following areas of major life activity: (a) Self-care; (b) Receptive and expressive language; (c) Learning; (d) Mobility; (e) Self-direction; (f) Capacity for independent living; (g) Economic self-sufficiency; and, is not attributed solely to mental illness; Reflects the persons need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services which are of lifelong or extended duration and are individually planned and coordinated, or A substantial developmental delay or specific congenital or acquired condition in a person from birth through age nine which, without services and support, has a high probability of resulting in those criteria listed above later in life that may be considered to be a developmental disability.
  16. 16. Office for Citizens with Developmental DisabilitiesOCDD within the Department of Health and Hospitals serves as the Single Point of Entry (SPOE) into the Developmental Disabilities (DD) Services System.Community services regional offices and human services authorities/districts serve as the points of entry for individuals to receive services from both the regional offices/human services authorities/districts and the supports and services centers.  
  17. 17. Office of Citizens with Developmental Disabilities – Programs and ServicesThe Individual and Family Support Program provides resources to people with developmental disabilities to allow them to live in their own homes or with their families in their own community. Services include, but are not limited to: respite care, personal assistance services, specialized clothing, dental and medical services not covered by other sources, equipments and supplies, communication services, crisis intervention, specialized nutrition, and family education.The Cash Subsidy Program provides a monthly stipend to families of eligible children with severe disabilities, until the age of 18. Funds are intended to help families meet the extraordinary cost associated with maintaining their child in the home. Stipends are awarded on a first come, first serve basis to eligible children with exceptionalities identified through the Department of Education’s Pupil Appraisal Evaluation.
  18. 18. Office of Citizens with Developmental Disabilities – Programs and Services Louisiana’s Early Intervention SystemFor Louisiana for families with children ages 0 to 3 years with a diagnosed physical or mental condition and/or developmental delay. Early Steps provides a coordinated, family focused system of support and services at no cost to families. earlySteps is designed to meet the developmental needs of each eligible child and to enhance the family’s ability to respond to their child’s developmental needs in a natural environment. Services may include: occupational therapy, physical therapy, speech therapy and other services.
  19. 19. Office of Citizens with DevelopmentalDisabilities – Programs and Services System Points of Entry for earlySteps Orleans, Plaquemines, St. Bernard Vernon, Rapides, Winn, Grant, LaSalle, Catahoula, (877) 595-3408 Concordia, Avoyelles 1-866-445-7672 East & West B.R., East & West Feliciana, Pointe Caddo, Bossier, Webster, Claiborne, Bienville, Coupee, Iberville, Ascension Natchitoches, Sabine, De Soto, Red River 1-866-925-2426 1-866-676-1695 Assumption, St. John, St. Charles, St. James, Ouachita, Union, Jackson, Lincoln, Caldwell, Terrebonne, Lafourche, St. Mary Morehouse, East & West Carroll, Richland, 1-866-891-9044 Franklin, Tensas, Madison 1-877-322-4788 Lafayette, Iberia, St. Martin, Vermillion, St. Landry, St. Tammany, Livingston, St. Helena, Tangipahoa, Evangeline, Acadia Washington 1-866-494-8900 1-866-640-0238 Beauregard, Jefferson Davis, Allen, Cameron, Jefferson Parish Calcasieu 1-866-296-0718 1-866-494-8900
  20. 20. Office of Citizens with Developmental Disabilities – Programs and ServicesHome and Community-Based Waiver Services Available to individuals with developmental disabilities. These waivers are actual waivers of the usual Medicaid income and other requirements. Through waivers, a variety of services and supports are available to allow individuals to reside in community settings other than ICFs/DDs (Intermediate Care Facilities). NOW, ROW, Children’s Choice, Supports
  21. 21. Office of Citizens with Developmental Disabilities – Programs and ServicesA word about Medicaid waivers... Medicaid has an entitlement to nursing home/institutional care. Institutional care is extremely costly. Waivers waive usual requirements for Medicaid allowing servicesto be provided in home and community based settings at lower cost withgreater outcomes for individuals with disabilities. Waivers are optional for states. States must file applications for waivers to Centers for MedicaidServices. Stakeholder input must be included. Waivers can have very long waiting lists if sufficient matchingstate funds are not provided for legislatively.
  22. 22. Office of Citizens with Developmental Disabilities – Programs and ServicesThe New Opportunities Waiver (NOW) is available for individuals to be able to live in the community. NOW is intended to provide specific, activity focused services rather than continuous custodial care.The following are the services provided under the NOW: Individual and Family Support (IFS) Service-Day-Night; Center-Based Respite; Community Integration and Development; Home adaptations; Specialized Medical Equipment and Supplies; Supported Living; Substitute Family Care; Day Habilitation and Transportation; Supported Employment and Transportation; Employment Related Training; Professional Services; Personal Emergency Response System; Skilled Nursing Services; and One-Time Transitional Services.
  23. 23. Office of Citizens with DevelopmentalDisabilities – Programs and Services The Residential Options Waiver (ROW) enables Money- Follows-the-Person strategies for people served in ICFs/DD (Intermediate Care Facilities for individuals with Developmental Disabilities) and nursing facilities to move to a comprehensive HCBS waiver option so that they can live in the community in a residential setting of their choice.
  24. 24. Office of Citizens with Developmental Disabilities – Programs and ServicesChildren’s Choice is an intermediate level waiver service, is for Children under age 19. Individuals on the waiting list for other long-term waivers may opt for Children’s Choice and receive capped services until a full waiver slot is available or they turn 19.Medicaid services are provided with Children’s Choice and including EPSDT screenings and extended services, and up to $15,000 per year in Children’s Choice services including required Support Coordination (case management).Children who age out (reach their 19th birthday) Transfer with their waiver to the most appropriate waiver option for them, as long as they remain eligible for waiver services.
  25. 25. Office of Citizens with Developmental Disabilities – Programs and ServicesChildren’s ChoiceEPSDT services MAY include respite assistance if the child is medically involved and needs assistance with daily living tasks or has other health needs.
  26. 26. Office of Citizens with Developmental Disabilities – Programs and Services Cash SubsidyCash Subsidy provides a monthly stipend to familiesof eligible children with severe or profounddevelopmental disabilities from birth to age 18.Funds are intended to help families meet theextraordinary costs associated with maintaining theirchild in the home.
  27. 27. Office of Citizens with Developmental Disabilities – Programs and Services Community Support TeamsIntensive treatment intervention allowing individuals withdevelopmental disabilities to remain in their community livingsetting.These supports and services include: initial and ongoingassessment, psychiatric services, family support andeducation, support coordination and any other services criticalto an individualt s ability to live successfully in the community. CST teams, consisting of psychologists, social workers,nurses, and psychiatrists, provide supports and services on a24-hour, 7 day a week basis. CST Team supports and services are provided in thecommunity rather than in an office-based practice andcombine skill teaching with clinical management. There are nine (9) CST Teams located in various regionsthroughout the state; they are managed through localdevelopmental centers and accessed through RegionalOffices.
  28. 28. Office of Citizens with Developmental Disabilities – Programs and Services Extended Family Living (EFL)Extended Family Living provides supports and servicesto people with developmental disabilities, regardless oftheir age, in the home of non-related persons. Thesehome settings are approved and routinely monitored bypublic and private providers. EFL supports and services are provided for the purposeof meeting the physical, emotional, educational,habilitative, and social needs of the individual in a familysetting.
  29. 29. Office of Citizens with Developmental Disabilities – Programs and ServicesFive Resource Centers provideleadership, enhance communication andcollaboration, and increase the availabilityand capacity of support and services topeople with developmental disabilities.Services provided include trainingopportunities, training curriculumdevelopment, provision of resourcematerials, resource guides, peer reviews,and program reviews.
  30. 30. Office of Citizens with Developmental Disabilities – Programs and Services Medical, Dental and Allied Health SupportsEstablish training programs that educate medical and dentalstudents.(Operation House Call in New Orleans- exposes pediatric andfamily medicine residents to the daily routine of parents who have achild with a disability living at home. In an effort to educateprofessionals, the family has a chance to demonstrate not only theextraordinary challenges they face as a family caring for a child witha disability, but also the natural acceptance and dignity the familyhas in recognizing the child as a vital, important part of the family.)Identifying, publishing and disseminating available dentaland medical resources.Providing limited medical and dental services to people withdevelopmental disabilities living in the community through trainingmodules.
  31. 31. Office of Citizens with Developmental Disabilities – Programs and Services Nutritional, Physical & Nursing SupportsGeneral health and specialized care for people with developmentaldisabilities through community-based partnerships and collaborativerelationships with individuals, families, providers, educational institutions,and community professionals. Supports and services include, but are notlimited to educational/training events and materials, consultations, andtechnical assistance.Fills service gaps and improves service delivery efforts through partnershipsand collaborations connecting the person with systems and individualsupports.Training Topics May include: Nutritional/Physical Support; WheelchairSeating; Transfer/Handling Techniques; Fall Prevention; TherapeuticPositioning; Fracture Reduction; Gastroesophageal Reflux Issue; AspirationIssues; Health Risk Screening; ; Seizure Management; DiabetesManagement; Infection Control Practices; Basic Health Care Concepts;Emergency First Aid; Dysphagia (difficulty swallowing); Preventive HealthCare Strategies; and more.
  32. 32. Office of Citizens with Developmental Disabilities – Programs and Services Psychiatric and Behavior SupportsCommitted to increasing community capacity to support and include people with developmental disabilities. The Resource Centers serve individuals with developmental disabilities experiencing psychiatric and/or behavioral challenges and their families, community practitioners and private and non- profit providers who serve individuals with developmental disabilities and university students.They may provide workshops on Psychiatric topics such as AAIDD Positive Behavior Support Training; In-Service Training for Community Providers/Supports and Services Centers; Program Review of Psychiatric and Behavioral Services; Individual Consultations; Library Consortium.
  33. 33. Office of Citizens with Developmental Disabilities – Programs and Services Community InclusionThe Resource Centers explore and develop exemplary models ofservice delivery and promising practices which support communityinclusion, accessibility, personal choice and independence of peoplewith developmental disabilities. Initiatives and trainingopportunities focus on the following areas as they apply to CommunityInclusion: Personal Outcomes; Relationship/Friendship Building;Health and Wellness; Employment; Housing; and, Transportation.
  34. 34. Office of Citizens with Developmental Disabilities – Programs and Services Aging with Developmental DisabilitiesProvide community resources and training on such topics as relationship building; care giving; housing; transportation; health and wellness; age- related diseases; long term planning, and; end of life care.Activities may include:Developing and providing community capacity building in the areas of aging with developmental disabilities through training events/educational materials, consultations, technical assistance, and limited direct services;Building partnerships and collaborative relationships with providers, community professionals, other state agencies, educational institutions, professional organizations, and other stakeholders to efficiently target gaps and improve multiple efforts;Recruiting and retaining highly qualified and capable professionals to maintain and increase the pool of expertise in Louisiana, andAccomplishing and promoting research and publication.
  35. 35. Office of Citizens with Developmental Disabilities – Programs and Services Resource CentersOCDD Resource Center OCDD Resource Center OCDD Resource45439 Live Oak Drive 3501 5th Avenue, Suite C2 CenterHammond, LA 70401 Lake Charles, LA 70607 5401 Shed RoadPhone: (225)567-7391 Phone: (337) 475-8084 Bossier City, LA 71111 Phone: (318) 741-5327OCDD Resource Center OCDD Resource Center4460 General Meyer Avenue P.O. Box 5191New Orleans, LA 70131 Pineville, La 71360Phone: (504) 364-6600 Phone: (800) 584-8511
  36. 36. Office for Citizens with Developmental DisabilitiesHow Do I Apply for Services?Contact your regional OCDD or Human Service Authority. http://new.dhh.louisiana.gov/index.cfm/subhome/11/n/8 1.866.783.5553
  37. 37. Office for Citizens with Developmental Disabilities Metropolitan Human Service Capitol Area Human Service South Central Louisiana Human District District Services Authority1010 Common Street, 5th Floor 4615 Government St., 2nd Floor 690 East First Street New Orleans, LA 70113 Baton Rouge, LA 70806 Thibodaux, LA 70301 1-800-889-2975 1-800-768-8824 1-800-861-0241 Community Services Office Community Services Office Community Services Office214 Jefferson Street, Ste. 301 3501 Fifth Avenue, Ste. C2 429 Murray Street - Suite B Lafayette, LA 70501 Lake Charles, LA 70605 Alexandria, La 71301 1-800-648-1484 1-800-631-8810 1-800-640-7494 Community Services Office Community Services Office Florida Parishes Human Service 3018 Old Minden Road - 122 St. John Street Authority Suite 1211 Rm. 343 21454 Koop Drive - Suite 2H Bossier, LA 71112 Monroe, LA 71201 Mandeville, La 70471 1-800-862-1409 1-800-637-3113 1-800-866-0806 Jefferson Parish Human Service Authority 3300 W. Esplanade, Ste 213 Metairie, LA 70002 (504) 838-5357
  38. 38. Office of Mental Health (OMH) Services provided throughSouth Central Louisiana Human Service Authority
  39. 39. Office of Mental Health Programs & ServicesOMH family support services assure that families have the necessary personal support, information and skill to cope, to maintain family integrity, and to enhance the likelihood that children with serious emotional disturbance can successfully remain at home. Service elements include respite care, care and education, telephone trees, parent support groups, parent case manager training, home aide services, transportation, and advocacy services.
  40. 40. Office of Mental Health Programs & Services Supported living services, either through specialized residential programs or through case management and other services which support persons living in their own homes, are available throughout the State. Individuals with serious psychiatric disabilities are provided with services necessary to address both their housing and mental health/rehabilitative needs. The types of housing resources available for adults include group homes, supervised apartments, respite apartments, board and care homes, foster care, and individual residences with support. For adolescents, housing is limited to group homes and foster care.
  41. 41. Office of Mental Health Programs & Services Day Programs & Psychosocial Rehabilitation Programs Provide opportunities for teaching new rehabilitative skills related to community living and work activities; build networks of peer support; teach self-help community activities; and provide a place where individuals can learn how to relate to persons and communicate their needs and desires successfully. In addition, day programs provide secure, structured environments where individuals experiencing disruption in routine behaviors brought on by their illness can receive treatment and support. Day programs also provide structured activities which allow children and adolescents with severe emotional disturbances to remain in school. Each of the nine mental health planning regions has at least one psychosocial program which provides for the development of both social and vocational rehabilitative needs of each person who utilizes the programs resources. The number of hospital days experienced annually by persons before and after coming to these programs typically drops from a pre-program average of 60 days to six to ten days post-program enrollment.
  42. 42. Office of Mental Health Programs & Services Day Programs & Psychosocial Rehabilitation Programs Magnolia Family Services, LLC For Medicaid Patients Only Psychiatric evaluations medication management, family and individual therapy, parenting skills development, child skills development, psychosocial skills training, behavior modification, educational interventions. Services are available to children and adolescents with a recenthistory of behavior and/or emotional problems, adults with a recenthistory of emotional/psychological conflicts, those receiving or whohave received help with little or no success and individuals needing long-term treatment to make positive changes in their lives.
  43. 43. Office of Mental Health Programs & Services Day Programs & Psychosocial Rehabilitation Programs Magnolia Family Services, LLC 106 Hickory Street Thibodaux, LA 70301 Phone: 985-449-4055 Fax: 985-449-4178 Emergency: 985-447-1319 magnoliafamiliyservices.com
  44. 44. Office of Mental Health Programs & Services Crisis Management Services Crisis services are provided on a 24-hour basis. These services are designed to provide a quick and appropriate response to individuals who are experiencing acute distress. Care services include telephone counseling and referrals, face-to-face screening and assessment, community housing for stabilization and crisis respite.REGION 3 CRISIS LINE CHILDREN OR ADULTS1-800-535-3694 AFTER 4:30PM OR WEEKENDS
  45. 45. Office of Mental Health Programs & Services Child/Adolescent Response TeamThe Child and Adolescent Response Team is a response to your request for support services during times when a child or adolescent appears to be in crisis. Any child below the age of 18 may receive services. Any child or child’s guardian may call CART to request services, regardless of income level or insurance.The Child and Adolescent Response Team was designed to assist children and their parents during times of crisis by providing support for the family in their own resolution of the crisis. A variety of services are available, and are personally tailored to suit your needs. CART services are available 24 hours a day, 7 days a week.
  46. 46. Office of Mental Health Programs & ServicesEarly Childhood Supports and Services Program (ECSS)ECSS is a group of parents, advocates, interested community members as well as public and private agencies. These agencies provide services to children ages 0-5 and their families.This group meets, at least monthly to discuss children and their families who have been referred for service coordination. If you can answer “yes” to any one of the following questions, then you may want to ask about participating in the ECSS program: • Are you worried about the effects of arguing on your young child? • Are family needs getting in the way of you working, returning to school, or achieving your life goals? • Are you worried about other family members because of a serious problem that has not been corrected? • Do you have problems getting help for your child or family? • Does your young child (age 0-5) and family need assistance due to a developmental delay, diagnosed medical condition, family history of mental illness or substance abuse?
  47. 47. Office of Mental Health Programs & Services Early Childhood Supports and Services Include: • Referral to appropriate supports and services • Case Management • Clinical Case Management • Behavior Modifications • Counseling • Parent Support Groups • Training and Technical Assistance • Consultation to other providers and/or agencies • Infant Mental Health Screening • Infant Mental Health Assessment • Emergency Intervention Funds to purchase supports and services • Other services specified in service plan such as domestic violence; child abuse; advocacy on behalf of the parent and child; referral to address medical needs; referral to public assistance; medication referral; referral for parent/family/peer support; and educational opportunity referral for parents.
  48. 48. Office of Mental Health Programs & Services Early Childhood Supports and ServicesEligibility: Families of children who are 0-5 and who are at- risk of removal from home or school due to behavioral problems. Families of children who have multiple risk factors such as abuse, neglect, exposure to violence, poverty, developmental disability, etc which have been documented by one of the participating agencies.
  49. 49. Office of Mental Health Programs & ServicesPARTICIPATING AGENCIES: • Early Childhood Programs: Head Start, HIPPY, Early Steps, Child Care Assistance • Educational Needs: Speech, Occupational or Physical Therapy, Special Instruction • Mental Health: Counseling, Medicine Management, Community Support • Public Health Programs: WIC, Family Planning, Immunizations • Family Support: Financial Needs • Parenting Center: Parenting Classes • Other Community ServicesContact any one of the participating agencies or call (800) 342-2629
  50. 50. Office of Mental Health Programs & Services Metropolitan Human Service Office of Mental Health South Central Louisiana Human District Monroe Area Services Authority New Orleans Area 1-318-362-3339 1-985-857-3615 After Hours: 800-256-2522 After Hours: 1-504-556-9730 1-800-535-3694Jefferson Parish Human Service Office of Mental Health Office of Mental Health Authority Shreveport Area Alexandria Area East Bank: 504-838-5257 1-318-676-5111 1-318-487-5611 West Bank: 504-349-8833 Adult Crisis: 1-866-416-5370 After Hours:1-800-654-1373 After Hrs.: 504-832-5123 Child Crisis: 1-800-820-6143 Office of Mental Health Office of Mental Health Capitol Area Human Service Lake Charles Area Lafayette Area District 1-337-475-8022 1-337-262-4100 Baton Rouge Area 1-225-922-2700 Florida Parishes Human Service Mandeville Area 1-985-748-222-0
  51. 51. Office of Public Health
  52. 52. Office of Public Health Programs & ServicesCommunityCARE is a comprehensive health delivery system or MedicalHome for linking Medicaid recipients to a Primary Care Physician (PCP). ThePCP manages the care of each CommunityCARE enrollee by providing healtheducation, preventive care, and acute care and refers the enrollee tospecialists when needed. The PCP also admits enrollees to the hospital. ThePCP shares medical information with the emergency room and otherauthorized health care providers. The CommunityCARE PCP arranges formedical care coverage 24-hours a day, seven days a week.This Medical Home is the first place enrollees turn to for their health careneeds. The PCP establishes an on-going relationship with eachCommunityCARE enrollee.
  53. 53. Office of Public Health Programs & ServicesWho is eligible for CommunityCARE? Most low-income families with children, disabled adults and children who are Medicaid recipients are required to participate in CommunityCARE with some exceptions.· Certain medically high risk patients may warrant the direct care and supervision of a non-primary care specialist. Requests for medical exemptions are reviewed for approval on a case by case basis. Requests must be submitted in writing, along with supporting medical documentation of the recipients medical condition(s). Requests for medical exemption should be mailed to: DHH- CommunityCARE Program, P.O. Box 91030, Baton Rouge, LA 70821, Attention: Angela Mastainich, Program Coordinator. A preprinted request form is available on the CommunityCARE web site, www.la-communitycare.com . ·
  54. 54. Office of Public Health Programs & Services Children’s Special Health ServicesCSHS is a program of services provided through the Louisiana Office of Public Health for children in Louisiana who have special health care needs.The CSHS program provides services for children with certain chronic physical illnesses or serious disabilities which cause significant limitations in major life activities.Children Who Are Eligible: Live in Louisiana and are under 21 years of age; Have a condition which can benefit from rehabilitation services, is covered by CSHS and requires long term treatment by specialists, physicians and multi-disciplinary staff. Meet financial guidelines established by CSHS.
  55. 55. Office of Public Health Programs & Services Children’s Special Health ServicesServices include: Doctors and other health care workers Medical tests and procedures Hospital care Therapies Home health services Medical equipment and supplies Parent/family support services Medications and special diets Nursing, nutrition and social services follow-up Care coordination, case management, and resource development
  56. 56. Office of Public Health Programs & Services Children’s Special Health ServicesHow Does a Family Apply For CSHS? The application process starts at your local parish health unit. A parent can contact the parish health unit or the CSHS Regional Office where the child lives for further information. A referral from a physician or audiologist is needed.
  57. 57. Children’s Special Health Services REGIONAL OFFICESREGION Resource Center 504-896-1340 REGION II 225-242-4890 (No Direct Services) 353 N. 12th St., Room 95200 Henry Clay Ave., Suite 2016 Baton Rouge, LA 70802New Orleans, LA 70118 Ascension, E. Baton Rouge, E. Feliciana, Iberville, PointeJefferson, Orleans, Plaquemines, St. Bernard Coupee, W. Baton Rouge, W. FelicianaREGION III 985-447-0896 REGION IV 337-262-5616, Ext 1062535 Veterans Blvd. 220 West Willow St., Building AThibodaux, LA 70301 Lafayette, LA 70508Assumption, Lafourche, St. Charles, St. James, St. John, Acadia, Evangeline, Iberia, Lafayette, St. Landry, St.St. Mary, Terrebonne Martin, VermilionREGION V 337-480-2552 REGION VI 318-487-52823236 Kirkman Street (P.O. Box 3170), 5604 “A” Coliseum Blvd.Lake Charles, LA 70602 Alexandria, LA 71303Allen, Beauregard, Calcasieu, Cameron, Jefferson Davis Avoyelles, Catahoula, Concordia, Grant, LaSalle, Rapides, Vernon, WinnREGION VII 318-676-74881035 Creswell Avenue REGION VIII 318-361-7282 1650 Desiard StreetShreveport, LA 71101Bienville, Bossier, Caddo, Claiborne, DeSoto, Monroe, LA 71201Natchitoches, Red River, Sabine, Webster Caldwell, E. Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union, W. Carroll REGION IX 15481 W. Club Deluxe Rd. Hammond, LA 70403 985-543-4165 Livingston, St. Helena, St. Tammany, Tangipahoa, Washington
  58. 58. Office of Public Health Programs & Services Shots for TotsIn 1992, Shots for Tots was created in response to the low levels of immunizations among preschool children and the epidemic outbreaks of measles in Louisiana. Children are required to be fully immunized when entering school, however, by waiting until they enter school, we leave our children susceptible to vaccine preventable diseases for two or three years. The vision of Louisianas Infant Immunization Initiative is to see 90% of all children immunized with their primary series by age two. Unfortunately, the National Immunization Survey 2007 reflects that among Louisiana children 19-35 months of age only 77.0% (+6.1) are fully immunized. Clearly, our goal has not been met. Shots for Tots is a network of public and private entities working cooperatively to update and educate both parents and providers alike in order to ensure the highest level of immunizations possible because Louisianas most valuable assets are its children.
  59. 59. Office of Public Health Programs & Services Shots for TotsPolio VaricellaMumps HepatitisMeasles InfluenzaChickenpox RubellaWhooping Cough RotovirusBacterial MeningitisPneumococcal It is very important for yourDiphtheria baby to get theseLock Jaw shots on time.
  60. 60. Office of Public Health Programs & Services Shots for TotsCheck with your baby’s Doctor or Health Unit to see that your child is up-to-date.Write Shots for Tots 1450 L & A Road Metairie , LA 70001Call 1-800-251-BABY
  61. 61. Office of Public Health Programs & ServicesKIDMED is the screening component of one ofLouisiana’s Early Periodic Screening,Diagnosis and Treatment (EPSDT) Programs.EPSDT provides preventive health screening,diagnosis, and treatment services for suspectedvision, hearing, dental and medical problems.Louisiana has been nationally recognized ashaving one of the top five EPSDT programs in thenation, exceeding goals for EPSDT participationset by the Center for Medicare and MedicaidServices (CMS). EPSDT services are available toMedicaid-eligible children under the age of 21.EPSDT benefits end on the child’s 21st birthday.
  62. 62. Office of Public Health Programs & Services AIDS Drug Assistance Program (ADAP)ADAP provides assistance to individuals living with HIV/AIDS to purchase HIV-related prescription medications. ADAP provides this assistance for persons who do not have private health insurance, do not qualify for Medicaid or are awaiting Medicaid coverage and cannot afford to pay for medications.Current Eligibility Criteria * Documented HIV infection; * Documented Louisiana residence; * Documented household income at or below 200% of the Federal Poverty Level; * No third party provider for protease inhibitors or antiretroviral outpatient medications (including private insurance and Medicaid. See below for information regarding Medicare Part D); * Current prescription for medication(s) covered by the Louisiana ADAP formulary, written by a licensed physician; and * No financial assets exceeding $4,000 (excluding a house and a car)Enrolled in the program at all regional LSU Medical Centers which are the charity hospitals in Louisiana. Potential program candidates can be screened for eligibility status and enrolled on the same day. The medical and financial eligibility screening process takes approximately two weeks. For more information contact; Heather Weaver LCSW Louisiana ADAP Coordinator, HIV/AIDS Program 1010 Common St, 11th Floor, New Orleans, LA 70112 Direct Phone 504-568-5489, Direct Fax 504-568-7042 Main Office Phone 504-568-7474 hweaver@dhh.la.gov http://www.dhh.louisiana.gov/offices/page.asp?ID=264&Detail=7901
  63. 63. Office of Public Health Programs & Services School-Based Health CentersWHY ON A SCHOOL CAMPUS?Students spend a significant portion of their day on school grounds. SBHCs are accessible, convenient, encourage family and community involvement, reduce student absenteeism, reduce parental leave from work for doctor visits, and work with school personnel to meet the needs of the students and their families.Parental consent must be obtained prior to seeing a student as a patient.ADOLESCENT SCHOOL HEALTH INITIATIVE ACT (R.S. 40:31.3)This law authorizes the Office of Public Health to facilitate and encourage the development of comprehensive health centers in Louisiana public schools. It specifically prohibits counseling or advocating for abortion and the distribution of contraception.
  64. 64. Office of Public Health Programs & Services School-Based Health Centers(Minimum) STAFF Primary Care Provider (Physician, Physician Assistant, or Nurse Practitioner) Physician Medical Director Registered Nurse Masters Level Mental Health Provider Administrator Office AssistantSERVICES Primary and preventive health care including, comprehensive exams and sports physicals, immunizations, health screenings, acute care for minor illness and injury, and management of chronic diseases such as asthma Mental health services Health education and prevention programs Case management Dental services Referral to specialty care Louisiana Childrens Health Insurance Program (LaCHIP) application centers
  65. 65. Office of Public Health Programs & Services School-Based Health Centers2008-2009 SCHOOL-BASED HEALTH CENTER SITESLouisiana is in the forefront in the SBHC movement, with 62 SBHCs in 26 Louisiana Parishes serving 95 public schools and providing access to nearly 60,000 students in the 2008-09 school year. http://www.dhh.louisiana.gov/offices/reports.asp?ID=255&Detail+808 All information on School Based Health Centers http://www.dhh.louisiana.gov/offices/?ID=255
  66. 66. Office of Public Health Programs & Services Sound Start Louisiana’s Hearing, Speech and Vision ProgramThe Sound Start Program began in 1994 with a handful of volunteers who successfully sponsored legislation mandating newborn hearing screening on all infants at-risk for hearing loss. Further legislation passed in 1999 and signed into law in 2000 mandated hearing screening on all infants born in or transferred to a facility in Louisiana. No state funding was appropriated for this effort.The mission of this program is to assure that all infants who are deaf or hard of hearing can achieve their maximum potential in life. That is accomplished by assuring that early intervention services are secured as soon as possible. Early intervention may include the fitting of hearing aids and early developmental services before the child reaches six months of age.The Advisory Council will be developing guidelines for screening pass/ refer criteria, appropriate hospital supervision guidelines, protocols and procedures for pediatric diagnostic audiology assessment.Regional directories for the eight other regions of the state will be completed.Continuing education in pediatric testing and hearing aid fitting will be provided statewide.
  67. 67. Office of Public Health Programs & ServicesLouisiana’s Hearing, Speech and Vision ProgramThe Sound Start Program is working towards helping each hospital in the statereach 100% compliance law. The professionals involved with this project include:The Advisory Council made up of representatives from many disciplines wasappointed by the Governor to serve three-year terms. This council advises theOffice of Public Health on the rules and regulations, quality assurance, and programplanning and evaluation.Two State Coordinators and nine Regional Task Force Coordinators areavailable to help each hospital create and manage the highest quality hearing-screening program.An Epidemiologist is involved in collecting, analyzing, and managing the data fromthe birthing and screening programs, tracking the follow-up data from diagnosticsources and early intervention programs, and developing reports.
  68. 68. Office of Public Health Programs & Services Louisiana Childhood Lead Poisoning Prevention Programhttp://www.dhh.louisiana.gov/offices/?ID=360
  69. 69. Office of Public Health Programs & Services Louisiana Comprehensive Hemophilia Care CenterThe Louisiana Comprehensive Hemophilia Care Center diagnoses, evaluates and treats patients with congenital and acquired conditions of bleeding such as hemophilia, von Willebrand disease and other rare factor deficiencies. Located at the Tulane University School of Medicine in New Orleans, La. with an outreach clinic in Lafayette, La. This multi-disciplinary clinic is open to all ages. Patients from Louisiana and the gulf coast region may be referred by their physician or may self-refer. The Center is the only federally-funded hemophilia treatment center (HTC) in Louisiana and offers a comprehensive model of care which includes evaluation and treatment recommendations from hematology, nursing, physical therapy, social work, dental and orthopedic services. This approach has been proven to address health and emotional issues of patients with this chronic disease.
  70. 70. Office of Public Health Programs & ServicesLouisiana Comprehensive Hemophilia Care CenterThe HTC also offers a home infusion program that allows for prompt therapy to reduce bleeding complications, as well as access to new therapies through numerous clinical research trials. In addition, the HTC operates a 340B program by which patients can obtain their clotting factor concentrates at reduced costs to help maintain insurance coverageThrombosis clinic The HTC thrombosis clinic serves patients who are genetically predisposed to clotting, as well as those patients with acquired thrombophilia. They offer genetic testing, counseling, the most recent advances in anticoagulation management, patient education, and patient advocacy to those who are affected by thrombosis. Thrombosis patients are seen by Dr. Cindy Leissinger and Dr. Rebecca Kruse- Jarres. Both are hematologists that specialized in hemostasis, thrombosis and platelet dysfunctions.
  71. 71. Office of Public Health Programs & ServicesLouisiana Comprehensive Hemophilia Care CenterReferrals can be made by contacting Alicia Cole RN, BSN at 504 988-5433 or acole@tulane.edu.The Louisiana Center for Bleeding and Clotting Disorders Tulane University Health Sciences Center 1430 Tulane Avenue New Orleans, LA 70112-2699 504-988-5433 h http://www1.omi.tulane.edu
  72. 72. Office of Public Health Programs & Services WIC (Women, Infants and Children)Special Supplemental Nutrition Program for pregnant, breastfeeding, and postpartum women, infants, and children (under 5 years old). WIC provides nutritious foods, nutrition information, and referrals to other health and social services. The foods provided may include: infant formula and cereal, adult cereals low in sugar and high in iron, milk (and lactose-reduced milk), cheese, juice, eggs, peanut butter or dried beans/peas carrots, and canned tuna.
  73. 73. Office of Public Health Programs & Services WIC Income Eligibility Levels 2011-2012Your gross income cannot exceed: For more than 10 householdHousehold Gross Annual Gross Monthly members, or for income questions, call 1-800-251-BABY 1 $20,147 $1,679 or your WIC Clinic. Individuals 2 $22,214 $2,268 with proof of Medicaid, Food Stamps, or TANF automatically 3 $34,281 $2,857 meet income requirements. 4 $41,348 $3,446 **O ne pregnant woman 5 $48,415 $4,035 counts as 2 household 6 $55,482 $4,624 members. 7 $62,549 $5,213 8 $69,616 $5,802 9 $76,683 $6,391 10 $83,750 $6,980
  74. 74. Office of Public Health Programs & Services WIC Locationshttp://www.dhh.louisiana.gov/offices/page.as p?id=320&detail=7658
  75. 75. LA Bureau of Protective ServicesReport neglect, abuse, extortion orexploitation of adults with disabilities, ages18-59. 1-800-898-4910 1-225-342-9057 P.O. Box 3518, BIN#11 Baton Rouge, LA 70821
  76. 76. Office of HealthServices Financing
  77. 77. Health Services Financing Programs F a mil y Op p o r t u n it yLaMOMS LaHIPP Ac t M e d ic a id B u y - I n
  78. 78. Health Services Financing Programs & ServicesInpatient Hospital Services.Outpatient Hospital Services.Prenatal Care.Vaccines for Children.Physician Services.Nursing Facility Services for persons aged 21 or older.Family Planning Services and Supplies.Rural Health Clinic Services.Home Health Care for persons eligible for Skilled-NursingServices.Laboratory and X-ray Services.Pediatric and Family Nurse Practitioner Services.Federally qualified Health-Center (FQHC) Services, andAmbulatory Services of an FQHC that would be available inother settings.
  79. 79. Health Services Financing Programs & ServicesEarly Periodic Screening, Diagnostic, and Treatment(EPSDT) Services for children under age 21.Diagnostic Services.Clinic Services.Intermediate Care Facilities for individuals withcognitive disabilities (ICFs/MR).Prescription Drugs and Prosthetic Devices.Optometrist Services and eyeglasses.Nursing Facility Services for children under age 21.Transportation Services.Rehabilitation Services.Home and Community-Based care tocertain persons with chronicimpairments. Continued…
  80. 80. Health Services Financing Programs & Services LA Medicaid’s Friends & Family Transportation ProgramPays your friend or family member to take you to the doctor.To qualify, you must already receive Medicaid benefits ANDYour friend/family member must:Have a current LA Driver’s LicenseHave a current LA State Inspection StickerHave minimum liability care insurance as required by the State of LAFill out an application and receive an approval letter from the Friends & Family Transportation Program.
  81. 81. Health Services Financing Programs & ServicesLA Medicaid’s Friends & Family Transportation Program YOU NO LONGER NEED TO HAVE THE APPLICATION NOTARIZED!All that’s needed is 2 witnesses to the signature.
  82. 82. Health Services Financing Programs & Services LA Medicaid’s Friends & Family Transportation Program To get an application, call the transportation contractor in your area or visit the web at www.Medicaid.DHH.Louisiana.govBaton Rouge 1-800-259-1944New Orleans 1-800-836-9587AFTER Qualifying:Call the Transportation Contractor at least 24 hrs. before each appointment to let them know the date and time of your appointment. Call ASAP after emergency visits.
  83. 83. Health Services Financing Programs & Services F a mil y Op p o r t u n it y Ac t M e d ic a id B u y - I n For families with children with disabilities including mental health and behavioral disabilities as well as developmental; Parents may “buy-in” to the Medicaid program at low rate premiums ($15-$35 per month); Premium covers all children in family who have disabilities; Gives more children with disabilities access to the full range of Medicaid services
  84. 84. Health Services Financing Programs & ServicesMonthly Income Levels… Income Limits through# of Family Monthly Income March 2012 Members ------------ 1 $2,708 Add $935 for each 2 $3,643 additional family member 3 $4,578 over 9 4 $5,513 F a mil y Op p o r t u n it y 5 $6,448 Ac t 6 $7,383 M e d ic a id B u y - I n
  85. 85. Health Services Financing Programs & Services
  86. 86. Health Services Financing Programs & ServicesLouisiana provides health benefits for eligible children from birth up to age 19 using special income amounts and fewer requirements than other Medicaid programs. Even if your income is more, your children may still qualify. You can receive deductions from your total income for: Earned Income, Childcare Payments, Child Support Received, Child Support Payments to someone outside the home.Services Provided By LaCHIP: Doctor Visits Hospital, Dental, Hearing and Vision Care Lab Work & Tests Immunizations (shots) Prescription Medicines Medical Equipment & Supplies Medically Necessary Transportation Speech & Language Therapy Physical Therapy Occupational Therapy Mental Health Clinic Services Psychological Tests & Therapy Appointment Scheduling Assistance
  87. 87. Health Services Financing Programs & Services•Must be under age 19•Eligibility must first be explored for “more generous” benefits –Medicaid if income is below 100% or 133% FPL – Regular LaCHIP if too high for Medicaid up to 200% FPL –Eligible for LaCHIP Affordable Plan up to 250% FPL•12 month waiting period for households who drop insurance withoutgood cause**Call #1-877-252-2447 for information on good cause reasons
  88. 88. Health Services Financing Programs & ServicesGood Cause Reasons• Divorce or death of parent• Lifetime maximum reached• COBRA coverage ends• Lay-off or business closure• Changed jobs & new employer does not offer dependent coverage• Employer stops providing dependent coverage• Monthly premium > 10% of gross income
  89. 89. Health Services Financing Programs & Services$50 monthly premium per familyNo deductible except a $200 mental health deductibleCo-pay levels like State Group Benefits PPO• $150 Emergency Room co-pay (if not admitted) • Prescription co-pays • A percent of charges (e.g. 10% or 20% or between $8 to $16 for most visits)Annual “cap” on out-of-pocket cost is 5% of family grossincome.
  90. 90. Health Services Financing Programs & ServicesCoverage begins the month following approval after firstpremium payment has been receivedOnce a family pays out-of-pocket costs equaling 5% ofannual income, no additional co-pays or premiums forremainder of plan yearNo cost sharing for Native Americans who are members of afederally recognized tribeNo Dental or Vision Benefits.
  91. 91. Health Services Financing Programs & Services► Same services as Medicaid ►Same services and Providers as► Operated under the State Workers Benefits Medicaid Program ► Operated under the Louisiana► Income eligibility up to Office of Group Benefits 200% FPL ► Income eligibility up to 250% FPL
  92. 92. Health Services Financing Programs & Services# in Household LaCHIP LaCHIP Affordable 1 $1,805 $2,257 2 $2,429 $3,036 3 $3,052 $3,815 4 $3,675 $4,594 5 $4,299 $5,373 6 $4,922 $6,153 Add $624 for each Add $780 for each additional family additional family member member in household in household
  93. 93. Health Services Financing Programs & Services Common Questions regarding LaCHIP and LaCHIP Affordablehttp://www.dhh.state.la.us/offices/faq.asp?ID=119
  94. 94. Health Services Financing Programs & ServicesAny pregnant woman, married or single, may apply for health coverage. Income limits are higher so working couples can make more money and still be eligible. Resources like bank accounts, cash on hand, cars or property are not counted. You can have other insurance coverage in addition to this coverage. Your other insurance will pay first; then LaMoms will cover the amount that is left, up to the Medicaid allowed amount.Covered Services: Pregnancy-Related Services Delivery and care up to 60 days after your LaMOMS pregnancy ends Doctor Visits Lab Work/ Tests Prescription Medicines Hospital Care
  95. 95. Health Services Financing Programs & ServicesTo Apply You Will Need: Social Security Number Proof of the total family income Proof of expected date of delivery Health Insurance cards if you have other health insurance Proof of child support payments made to someone outside of your home Receipts for the care of a child or an adult with a disability LaMOMS You may be eligible to be paid back for medical services received up to 3 months before you applied if you are eligible on the date the services was received and you used a Medicaid provider and the service is covered by the Medicaid Program. You may use any doctor who is enrolled as a Medicaid Provider.For more information about the LaMoms Program contact 1-888-342-6207
  96. 96. Health Services Financing Programs & ServicesFamily Size Monthly Income Amount 2 $2,429 3 $3,052 4 $3,675 5 $4,299 6 $4,922 7 $5,545 8 $6,169 LaMOMS
  97. 97. Health Services Financing Programs & ServicesLouisiana Health Insurance Premium Payment Program (LaHIPP)May provide assistance for the cost of private health insurance through LaHIPP your employer.Call 1-866-362-5253www.LaHIPP.DHH.Louisiana.gov
  98. 98. Health Services Financing Programs & ServicesLaHIPP may pay some or all of the health insurance premiums foran employee and their family if they have insurance availablethrough their jobs and someone in the family has Medicaid. Thosegetting Medicaid will also be able to have health insurance.People who get Medicaid and have group health insurance availablefrom a job, and working parents or guardians and their children ordependents who get Medicaid may be eligible.Even if employment ends, the continuing health insurance that maybe available from your employer (also known as COBRA) may alsobe paid. LaHIPP
  99. 99. Health Services Financing Programs & ServicesHow LaHIPP works:People who have Medicaid and can get health insurance from a job may qualify for LaHIPP. Other people in the home who can join the health plan could also qualify.LaHIPP will send the family a letter, an application for LaHIPP, and a copy of the Employer Health Insurance Information Form that must be filled out LaHIPP by a human resource representative where the adult in the family works.After getting this information, the LaHIPP program looks Send the at how much it would cost to join the health plan. If completed this is less than what Medicaid would pay for medical services for the person on Medicaid, then forms to LaHIPP will pay some or all of the cost of the LaHIPP within insurance from the job. 30 days.
  100. 100. Health Services Financing Programs & ServicesThe TAKE CHARGE/ Family Planning program covers services such as: 4 Yearly physical examinations or necessary re- visits Laboratory tests for the purpose of Family Planning Approved medications and supplies (example: birth control pills, patches, IUDs diaphragms, etc.)There is a limit of FOUR visits per calendar year (includinginitial visit and revisits). Primary care services are NOTcovered by the TAKE CHARGE program. When a need forprimary care treatment is identified during a family planningwaiver visit, the waiver participant will be given informationabout primary care providers.
  101. 101. Health Services Financing Programs & ServicesFamily Size Monthly Income Limit 1 $1,669 2 $2,246 3 $2,823 4 $3,399 5 $3,976 6 $4,553 7 $5,129 8 $5,706
  102. 102. Health Services Financing Programs & ServicesTo get health coverage through Medicaid Purchase Plan, you must have a severe disability work be at least age 16 but not yet age 65 have COUNTABLE monthly income that is less than $2,257 have COUNTABLE assets that are less than $25,000 take other health insurance coverage, if you can get it at no cost to you pay a premium when your COUNTABLE monthly income is more than $1,354.MPP COUNTS less than half of the money you earn (work for) and all but $20 of any other money you get.NOT COUNTED: Home, one vehicle,life insurance policy, medical savings,retirement accounts, spouse’s share ofany community property.
  103. 103. Health Services Financing Programs & ServicesAccessing State Health Services Assistance LaMOMS F a mil y Op p o r t u n it y LaHIPP Ac t M e d ic a id B u y - I n
  104. 104. Health Services Financing Programs & Services Louisiana Online Application Centerhttps://bhsf2eb.dhh.louisiana.gov/o nlineapppublic/secure/
  105. 105. Health Services Financing Programs & Services Accessing LaCHIP & LaCHIP AffordableInformation you will need: Social Security number for anyone applying for coverage, proof of family income, proof of child support payments, receipts for the care of a child or disabled adult, proof of expected date of delivery for anyone who is pregnant.Download instructions and paper application at:http://www.dhh.louisiana.gov/offices/publications.asp?ID=119&Detail=607
  106. 106. Health Services Financing Programs & Services Accessing Family Opportunity Act Medicaid Application available at:http://bhsfweb.dhh.la.gov/onlinemanualspublic/mfmpublicnonfill able/1-foa.pdf F a mil y Op p o r t u n it y Ac t M e d ic a id B u y - I n
  107. 107. Health Services Financing Programs & Services Accessing Other Medicaid ProgramsApplication Web Links:LaMomshttp://www.dhh.louisiana.gov/offices/publications.asp?ID=137&Detail=99Medicaid Purchase Planhttp://www.dhh.louisiana.gov/offices/publications.asp?ID=136&Detail=486Take chargehttp://www.dhh.louisiana.gov/offices/publications.asp?ID=291&Detail=1385
  108. 108. Community and Provider Specific Programsand Additional Resources
  109. 109. Provider Specific Programs Children’s Healthcare Assistance Plan (CHAP) assists families with income too high to qualify for Medicaid, but whose lack of resources limit their access to quality healthcare. •Includes children whose family income is between 200% (Medicaid limit) and 350% of the Poverty Income Guidelines •Covered services include Inpatient, Short Stay Services, Outpatient Clinics, Emergency Room, Therapies provided by Children’s Hospital and The Toothbus visits. •Limited to participating physician services performed at Children’s Hospital
  110. 110. Provider Specific ProgramsACCESSING CHAPS:Applications can be completed upon registration or admission to Children’s Hospital or can be received via mail by calling (504) 894-5166 or by visiting:http://www.chnola.org/PageDisplay.asp?p1=4294Eligibility RequirementsProof of Income must be submittedReview of Medicaid Eligibility*Appropriate proof of income must be submitted with your application. Copies of pay stubs, forms approving or denying unemployment compensation or workmen’s compensation, written verification of wage from agencies (e.g. SSI, AFDC, Private Employer) are examples of income.
  111. 111. Provider Specific Programs # in A BHousehold 1 $21,780 $38,115 2 $29,420 $51,485 3 $37,060 $64,855 4 $44,700 $78,255 5 $52,340 $91,595 6 $59,980 $104,965 7 $67,620 $118,335 8 $75,260 $131,705
  112. 112. Provider Specific Programs Dental care at substantially reduced fees at Student ClinicsPayment plans are not available because of the reduced fees; therefore, patients are expected to pay for services at the time of the appointment. Any treatment that involves laboratory costs must be paid in advance of the procedure. Private dental insurance is not accepted in lieu of payment; however, the students can assist in completing claim forms for the reimbursement of out-of-pocket expenses. For questions regarding private insurance please call (504) 941-8116. Medicaid, which covers most dental care for children under 21 and dentures for adults, is accepted and the patient will incur no out-of-pocket expenses if the care is pre- authorized.
  113. 113. Provider Specific Programs Patient Information / Appointments New Orleans Campus Clinic Telephone (504) 619-8700 or 619-8770 * (Dental appointments are not given through email.) Appointments for Children Telephone 941-8201 (age 0-6) 941-8196 (age 7-13) or 896-1337 (clinic at Childrens Hospital) Endodontics AppointmentsTelephone 941-8402 (referral by a dentist required) Fax 941-8400 Orthodontics Appointments Telephone Numbers (504) 619-8572 Faculty Dental Practice (504)619-8721 Baton Rouge South Campus Clinic Telephone (225) 334-4934
  114. 114. Provider Specific Programs Sickle Cell Anemia ClinicsSickle Cell Center of Southern LA Children’s Hospital1415 Tulane Avenue 200 Henry Clay AvenueNew Orleans, LA 70112 New Orleans, LA 70118504-988-5413 504-896-9740Adult Sickle Cell Day Hospital:504-988-1250Ochsner Foundation Hospital Earl K. Long Sickle Cell Clinic1516 Jefferson Hwy (LSU Pediatric Medical Home)Jefferson, LA 70121 1401 North Foster DrivePediatrics: 504-842-3900 Ext. 63037 Baton Rouge, LA 70806Adult: 504-842-3910 225-987-9061 St. Jude Affiliated Clinic 7777 Hennessy Blvd., Suite 312 Baton Rouge, LA 70808 225-763-6337
  115. 115. Federally Funded Health CentersFederally-funded health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income. Health centers provide2. checkups when youre well3. treatment when youre sick4. complete care when youre pregnant5. immunizations and checkups for your children6. dental care and prescription drugs for your family7. mental health and substance abuse care if you need itHealth centers are in most cities and many rural areas. http://findahealthcenter.hrsa.gov/
  116. 116. Federally Funded Health Centers Bayou CountryTECHE ACTION CLINIC TECHE ACTION CLINIC TECHE ACTION CLINIC809 W. Tunnel Boulevard 189 Mozart Drive (DULAC) PIERRE PARTHouma, LA 70360-5555 Houma, LA 70363-7990 3617 Hwy 70 S.985-851-1717 337-282-2550 x 104 Pierre Part, LA 70339-4455 985-252-6211TECHE ACTION CLINIC TECHE ACTION CLINIC TECHE ACTION CLINIC1115 Weber Street 159 E. 3rd Street 471 Central AvenueFranklin, L a 70538-4124 Edgard, LA 70049-2450 Reserve, LA70084-5509337-828-2550x 104 337-828-2550 x 104 337-828-2550 x 104 TECHE ACTION CLINIC 471 Central Avenue Reserve, LA70084-5509 337-828-2550 x 104
  117. 117. Federally Funded Health Centers River ParishesST. CHARLES COMMUNITY ST. CHARLES COMMUNITY JEFFERSON COMMUNITYHEALTH CENTER HEALTH CENTER HEALTH CARE CENTERKENNER PEDIATRICS MOBILE UNIT 11312 Jefferson Hwy200 W. Esplanade Ave., Ste. 310 4105 David Drive River Ridge, L A 70123-1709Kenner, LA 70065-2474 Kenner, LA 70065 504-463-3002985-785-5800x 5803 985-785-5800ST. CHARLES COMMUNITY ST. CHARLES COMMUNITY JEFFERSON COMMUNITYHEALTH CENTER HEALTH CENTER HEALTH CARE CENTER843 Milling Avenue 15464 River Road 4028 US Hwy 90Luling, LA 70070-4442 Norco, LA 70079-2530 Avondale, LA 70094985-785-5800 x 5803 985-785-5800 504-463-3002
  118. 118. LATANLA Assistive Technology Access NetworkLow-interest, long-term assistive technologyloans for items like computers with adaptiveinput/output devices, closed circuit TV for sightimpaired, Brailling machines, new and usedvehicle loans for modified vehicles, vehiclemodifications, augmentative or alternativecommunication devices, telecommunicationdevices, adaptive home modifications likeramps, prosthetics and/or orthotics,environmental control units, wheelchairs bothpowered and manual, and more.
  119. 119. LATANLA Assistive Technology Access Network 3042 Old Forge Road Baton Rouge, LA 70808 1-800-270-6185/ 225-925-9500 Fax 225-925-9560 www.latan.org
  120. 120. CEREBRAL PALSY OF LAGrants up to $2,000 per individual per year to be used for: Equipment purchases Therapies 2380 Barataria Blvd., Suite 5 Marrero, LA 70072 (504)341-0676 1-800-375-8275 Email: cerebralpalsy@bellsouth.com www.cpofla.com
  121. 121. Prescription Drug AssistanceCenla Medication Access Program helps with free prescriptions forLouisiana residents.Must be a resident of Louisiana with income at or below 200% of Federal Poverty Level and no prescription coverage, Insurance or Medicaid and 18 years old or older. 1-888-443-7494 or visit www.cmaprx.org
  122. 122. Prescription Drug AssistanceThe Partnership for Prescription Assistance brings together America’spharmaceutical companies, doctors, other health care providers, patient advocacyorganizations and community groups to help qualifying patients who lackprescription coverage get the medicines they need through the public or privateprogram that’s right for them. Many will get them free or nearly free. Its mission isto increase awareness of patient assistance programs and boost enrollment ofthose who are eligible. Through this site, the Partnership for PrescriptionAssistance offers a single point of access to more than 475 public and privatepatient assistance programs, including more than 180 programs offered bypharmaceutical companies. To access the Partnership for Prescription Assistanceby phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669). https://www.pparx.org/Intro.php
  123. 123. Prescription Drug Assistance Prescription Drug Assistance Listings— Extensive list of medications and the contact information for the companies that make them.http://www.nami.org/Content/ContentGroups/Helpline1/Prescription_Drug_Patient_Assistance_Programs.htm “Free or low-cost medications provided by pharmaceutical companies Some pharmaceutical companies offer medication assistance programs to low-income individuals and families. These programs typically require a doctor’s consent and proof of financial status. They may also require that you have either no health insurance, or no prescription drug benefit through your health insurance. Please contact the pharmaceutical company directly for specific eligibility requirements and application information.”
  124. 124. Prescription Drug AssistanceNeedyMeds, Inc.Web site: www.needymeds.com Phone: 1-215-625-9609Provides info on drug assistance programs, including requirements andapplication forms.If You Are Not Eligible for Medicare, Do Not Have Drug Coverage, and Have Limited Income Together Rx Access Card Web site: www.together-rxaccess.com Phone: 1-800-444-4106 Created to help people who do not have prescription drug coverage save on brand-name prescription drugs, other prescription products, and a wide range of generic drugs. To get a card, you must meet all of the following criteria: not eligible for Medicare; have no prescription drug coverage (public or private); household income equal to or less than $30,000 for a single person, $40,000 for a family of two, $50,000 for a family of three, $60,000 for a family of four, and $70,000 for a family of five (income limits may be higher in Alaska and Hawaii); legal United States resident. Information in English and Spanish.
  125. 125. Prescription Drug Assistance If You Have Health InsuranceHealthWell Foundation Web site: www.healthwellfoundation.org Phone: 1-800-675-8416 HealthWell Foundation is a non-profit, charitable group that helps certain people who cannot pay for their prescription drug costs, insurance premiums, and co-payments of private insurance, employer-sponsored insurance plans, Medicare, or Medicaid. It also can help with some other out-of-pocket health care costs. The program serves only those with certain health conditions, which are posted on the Web site. Only certain cancers are included in their coverage.Patient Advocate Foundation Co-Pay Relief Assistance Program Web site: www.copays.org Phone: 1-866-512-3861 The Patient Advocate Foundations Co-Pay Relief Assistance Program helps patients who meet certain requirements pay for the prescriptions and treatments they need. This program is available only to people with certain medical conditions who also have insurance (including Medicare or Medicaid). Only certain cancers are included in their program. (Spanish and English.)
  126. 126. Prescription Drug Assistance If You Have Health InsurancePatient Services Incorporated (PSI) Web site: www.uneedpsi.org Phone: 1-800-366-7741 A national, non-profit helping patients with certain chronic illnesses and their families with health insurance premiums and medicine co-payments. Assistance is based on severity of the medical and financial need. PSI also helps locate and purchase health insurance coverage. Only a few cancers are included in this program.Patient Access Network Foundation Web site: www.patientaccessnetwork.org Phone: 1-866-316-7263 A non-profit helping under-insured patients who can’t afford out-of-pocket costs for their treatment. The program helps patients with certain medical conditions who meet their financial, insurance, and medical requirements. (Only certain cancers are included in their program.
  127. 127. Prescription Drug AssistanceContact the Louisiana Family to FamilyHealth Information Center for acomprehensive Prescription Drug Assistance Packet 1-800-331-5570
  128. 128. Federal Pre-Existing Condition Insurance Apply at www.pcip.govCovers range of health benefits including primary and specialty care,hospital care and prescription drugs.Premiums are not higher because of your medical condition.Does not base eligibility on income.Must be a citizen or national of the US or lawfully present.You must have been uninsured for at least 6 months.You must have had a problem getting insurance due to a pre-existingcondition.
  129. 129. La Health Plan Insurance High Risk PoolResident of LA for at least 6 monthsIneligible for other major health insurance2 written denials of coverage within last yearIneligible for Medicaid, Medicare, COBRACannot be terminated due to non-payment6 month waiting period for pre-existing conditionsincluding prescription drugs.
  130. 130. La Health Plan Insurance HIPAAResident of LA for at least 6 monthsIneligible for other major health insuranceMust apply before or within 63 days of last day of coverageMust have 18 months creditable coverageMust elect and exhaust COBRARecent coverage must have been groupIneligible for Medicaid, Medicare, COBRACannot be terminated due to non-paymentNo pre-existing condition for children who are special enrollees thatenroll within 63 days of birth, adoption or placement for adoption12 month pre-existing condition for other special enrollees (ex.Spouse)NO WAITING PERIOD FOR PRE-EXISTING CONDITIONS FORELIGIBLE ENROLLEES UNDER HIPAA.
  131. 131. La Health Plan InsuranceLouisiana Health Plan 1-800-736-0947www.lahealthplan.org
  132. 132. Pre-Existing Condition InsuranceContact the Louisiana Family to Family Health Information Center for a comprehensivePre-Existing Condition Insurance Packet 1-800-331-5570
  133. 133. Anger Management Groups Bayou Council on Alcoholism 446-0643
  134. 134. Grants for Medical ServicesUnited Health Care Children’s Foundation  Assistance grants for medical services not fully covered by private insurance. (Ex. Speech therapy, physical therapy, psychotherapy, wheelchairs, braces, hearing aids and eye glasses www.uhccf.orgDisabled Children’s Relief Fund  Provides children with disabilities with assistance for wheelchairs, orthopedic braces, walkers, lifts, hearing aids, eye glasses, medical equipment, therapy and surgery. www.dcrf.com
  135. 135. Other Mental Health ServicesCenter for Child and Family Development 873-7221 Takes children as young as 3 years old.
  136. 136. Support GroupsCHADD  TGMC Outreach Center (Houma Mall) 858-7020La Federation of Families for Children’s Mental Health  THIBODAUX REGIONAL MEDICAL CENTER, 602 N. Acadia Rd. Support groups are confidential. Always held 5-6pm.  Reservations are required: CHRISTINE HYMEL @ 985-870-8811B.R.I.D.G.E.S.  For individuals recovering from mental illness 1-877-274-3446FathersNetwork  www.fathersnetwork.org For fathers raising children with special healthcare needs or developmental disabilities.
  137. 137. Eye Glasses$25 Eye Glasses www.25dollareyeglasses.netVision USA Eye health/vision services free of charge to families who do not qualify for government aid or private insurance due to income. 1-800-766-4466Kellum Eye Center Provides free eye exams, glasses, medications and eye surgeries. (Assists only 4 people per week. 872-5577
  138. 138. Eye GlassesNew Eyes for the Needy Must meet poverty guidelines of program-provides vouchers for eyeglasses. 1-973-376-4903 or www.neweyesfortheneedy.orgSight for Students Eye Exams and glasses to children 18 or younger whose parents meet the poverty guidelines and have no insurance. 1-888-290-4964Knights Templar Eye Foundation Assistance for eye surgery for those with no insurance and unable to pay. 1-847-490-3838
  139. 139. Eye GlassesLions Clubs Lions Club Phone: Bayou Blue—Coteau Lions Club 856-0448 Bourg Lions Club 594-2054 Chauvin Lions Club 594-8276 East Houma Lions Club 851-1810 Evergreen Lions Club 876-6935 Evergreen sunset Lions Club 851-3141 or 868-2901 Golden Meadow Lions Club 693-3308 Houma Lions Club 879-4663 Lockport Lions Club 532-2554 Montegut Lions Club 594-5454 or 594-5960 or 594-7789 Raceland Lions Club 537-76332 Terrebonne Lions Club 876-3047 Thibodaux Lions Club 446-6329 or 447-3017 West Houma Lions Club 868-3152
  140. 140. Hearing AidsAudient Hearing aid assistance for all ages with hosehold income up to 250% of federal poverty level. 1-866-956-5400 or www.audientalliance.orgStarkey Hear Now Program Assistance for low income families with hearing aids at reduced costs. 1-800-328-8602 or www.starkeyhearingfoundation.orgUnited Health Care Children’s FoundationAssistance grants for medical services not fully covered by private insurance. (Ex. Speech therapy, physical therapy, psychotherapy, wheelchairs, braces, hearing aids and eye glasses 1-800-3289-5979 ext. 24459 (11a-3p, M-F) www.uhccf.orgwww.betterhearing.orgAdditional financial resources.
  141. 141. Any Questions?
  142. 142. F2FHIC Website http://www.blfhf.org/f2fhic/index.phpHIC Home Page Medical DiaryAdvocacy Medical HomeFact Sheets PagePage Paying forFamily Voices Medical CostsLink TransitioningHC Providersand Info Youth.
  143. 143. Reminder… Bring your child’s IEP, last evaluation and medical information. Call the local FHF center. (www.fhfla.org) McKinney-Vento Homeless Act – your child is entitled to attend any school anywhere if you are homeless.
  144. 144. PLEASEComplete your evaluations!
  145. 145. Karen ScallanProgram DirectorLouisiana Family to Family Health Information CenterA Statewide Program of Bayou Land Families Helping Familiesf2fhic@bellsouth.net286 Hwy 3185Thibodaux, LA 70302985-447-4467 or 800-331-5570

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