The document discusses developing a network of care for the nearly 4 million people still in the Medicaid coverage gap. It begins with an agenda for the discussion, which will include an overview of the number of uninsured people in the gap, where they are located, and services available in Florida. There will be small and large group discussions, as well as a debriefing and closing remarks from the speakers. The panelists will discuss how to conduct culturally sensitive outreach, the importance of financial access to services, and the need for collaborative partnerships to facilitate care.

1. © 2016 Enroll America | StateOfEnrollment.org
Valencia Bostic, Director, Chronic Disease Prevention, Palmetto Health; Russell Robinson, Manager, Patient Financial
Clearance, Palmetto Health & Christopher Irizarry, MPA, Vice President and Executive Director of Clinic Services,
Health Care District of Palm Beach County | 05.13.16
4 Million People Still In Medicaid Gap – Developing a
Network of Care

2. © 2016 Enroll America | StateOfEnrollment.org
2
• What you can expect and who are our panelists
• Number of people in the coverage gap, who & where they
are
• A brief look at the services in FL
• Small group discussions
• Larger group discussion
• Debrief & speaker closing
• Next Steps
AGENDA

3. © 2016 Enroll America | StateOfEnrollment.org
3
• Understand outreach that is inclusive and culturally
sensitive
• How financial components lead to access to services
• The importance of collaborative partnerships to
facilitate flow of services
WHAT YOU CAN EXPECT

4. © 2016 Enroll America | StateOfEnrollment.org
4
INTRODUCING OUR PANELISTS
Christopher F. Irizarry,
is an Officer with the Health Care District of
Palm Beach County
Valencia Bostic, Director, Chronic Disease
Prevention, Office of Community Health
Palmetto Health
Russell D. Robinson, Manager, Financial
Navigation, Palmetto Health

5. © 2016 Enroll America | StateOfEnrollment.org
5
• Nationally, nearly 4 million adults fall into the coverage gap
• Adults in the coverage gap are spread across the country in
states with the largest uninsured populations
OVERVIEW
FL GA NC Other States that Have Not Expanded Medicaid TX
FL
20%
NC
8%
GA
11%
Other States
that Have
Not
Expanded
Medicaid
35%
TX
26%
Midwest Northeast South West
Midwest
7%
South
89%
Northeast
1%
West
3%
Source Kaiser Family Foundation

6. © 2016 Enroll America | StateOfEnrollment.orgFair or Poor Good Excellent of Very Good
Excellent or Very
Good
50%
Fairor Poor
18%
Good
32%
Hispanic White Black Other
Black 28%
Hispanic 23%
White 45%
Other 4%
55-64 35-54 19-24 25-34
19-24 years
24%
55-64 years
17%
35-54 years
35%25-34 years
24%
6
• Racial/ethnic characteristics of those in the coverage gap
vary by state
• Adults of all ages fall into the coverage gap
• Uninsured are less likely than those with insurance to receive
preventive care
OVERVIEW (continued)
Source Kaiser Family Foundation

7. © 2016 Enroll America | StateOfEnrollment.org
Miami – Dade County
Jackson Memorial Hospital - Jackson Health System's financial assistance policy is
designed to ensure that all residents of Miami-Dade County receive a single high
standard of care regardless of their ability to pay. Anyone in need of critical or
emergency health care may receive such care regardless of financial status or ability
to pay.
Orlando (all counties)
The Primary Care Access Network, also known as PCAN, is a dynamic collaborative
among Orange County Government, primary health care centers, community agencies,
hospitals and other social services. PCAN’s mission is to improve the access, quality
and coordination of health care services to the underinsured and uninsured populations
of Orange County.
Broward County –
Memorial Healthcare System - Healthcare Plans for Uninsured Patients (HOPE)
Financial Assistance or Charity Care – Provided at reduced prices or for free to low-
income patients and families
A LOOK INTO PARTS OF FL

8. The C. L. Brumback Primary Care Clinics
Organizational Introduction and Overview
May 2016

9. Our Mission
To provide compassionate, comprehensive health
services to all Palm Beach County (Florida)
residents, through collaboration and partnerships, in
a culturally sensitive environment.
9

10. Why are we here?
In our patient’s own words:
“They have a wonderful staff. They
always meet my needs. When I’m
feeling bad they make me smile. They
not only treat me physically but they
also treat me mentally and I’m grateful
for that.”
– Anthony Smith, Patient
Anthony Smith, Patient at
West Palm Beach Clinic
10

11. Why are we here? (con’t)
In our patient’s own words:
“I think the dental services are great! It’s
very convenient for people who can’t afford
to go to a regular dentist. I was kind of
nervous since it was my first visit to get my
teeth examined but they made me feel very
comfortable. I would recommend the C. L.
Brumback Primary Care Clinics’ dental
clinics to my friends and family members.”
– Chantelsha Frazer, Dental Patient
11
Robert Rotella, DDS and
Chantelsha Frazer,
Dental Patient at
West Palm Beach Clinic

12. We are the Front Door of Palm Beach
County’s Health Care Safety Net
• The C. L. Brumback Primary Care Clinics
• Pharmacy Program
• Health Coverage – Coordinated Care and Maternity Care
Programs
• School Nurses staffing health rooms in nearly 170 public schools
• Skilled nursing at the Edward J. Healey Rehabilitation and Nursing
Center
• Lakeside Medical Center in Belle Glade, the county’s only public
hospital serving the rural, agricultural communities bordering Lake
Okeechobee
• Oversight and funding of the county’s lifesaving Trauma System,
including the Trauma Hawk Aeromedical Program
12
Palm Beach County voters had the vision in 1988 to approve the
creation of the Health Care District and fund this safety net
system with ad valorem, or property taxes.

13. Nine Clinic Locations
13
• Majority of sites along the more populated east coast, I-95 corridor
• Large unpopulated agricultural area in western part of the county
• Two sites near hospital in underserved, rural area of need known as the Glades

14. C. L. Brumback Primary Care Clinics’
Timeline
• In 2012, Florida Department of Health
Palm Beach County migrated the
oversight of the primary care clinics
to the Health Care District
• The Health Care District was awarded
a grant from the U. S. Department of
Health and Human Services Health
Resources and Services
Administration (HRSA) beginning in
January 2013
14

15. Timeline (con’t)
• In 2013, the Health Care District began operating four clinic sites:
West Palm Beach, Lantana, Delray Beach and Belle Glade
• In 2014 the Clinics:
– Expanded to include evening and Saturday hours
– Implemented a Certified Application Counselor Program
– Began integration of Behavioral Health Services
– Opened a school-based clinic at Palm Beach Lakes Community
High School, called the Rams Clinic
– Received a $50,000 American Cancer Society grant for colorectal
cancer screenings
15

16. • Opened a Primary Care Clinic at Jerome Golden Center
for Behavioral Health (March)
• Opened a Primary Care Clinic at the Lewis Homeless
Resource Center (May)
• Opened Four Dental Clinics: Lantana, Delray Beach,
West Palm Beach and Belle Glade (July)
• Received $50,000 American Cancer Society grant for
breast cancer screenings (April)
• Awarded federal “New Access Point” grant of $650,000
annually and opened a new clinic in western Lake
Worth (August)
• Received a Health Center Quality Improvement Grant of
$171,160, the fourth highest award in Florida (August)
In 2015
16

17. In 2016
• Lake Worth Clinic expanded hours Thursday nights until 7 pm and
Saturdays from 9 am to 1 pm (January)
• Recognized by the American Cancer Society for the Brumback Clinics’
contributions toward the fight against cancer
17

18. Clinic Governance and Operations
• District Clinic Holdings, Inc., doing business as C. L. Brumback
Primary Care Clinics
• Board of Directors
– Ten members, majority are clinic users
– Many served on Board when grant was under the Health
Department
• 165 full-time employees
• Providers and staff speak English, Spanish and Creole
• Four Clinic sites are co-located in Health Department centers
which further strengthens partnership
18

19. Adult and Pediatric Clinic Services
• Medical evaluations
• Yearly physicals
• Well visits and sick visits
• Pharmacy services
• Laboratory services
• Diabetes/hypertension
screenings
• Mammogram and specialty care
referrals
• Immunizations
• Financial counseling
• General and preventive dentistry
for adults and children
• Mental health counseling
• Treat Chronic Conditions
• Employment, school, Department
of Transportation and sports
physicals
• Health care for the homeless and
agricultural workers
• Hearing and vision testing
• School forms DH 680 and DH
3040
19

20. Pharmacy Services
• The Health Care District operates
pharmacies at five clinic sites: West Palm
Beach, Lantana, Delray Beach, Belle Glade,
and Lake Worth
• A broad formulary of medications are
available
• District pharmacies do not charge a co-pay
20

21. Homeless and Migrant Support Services
• Primary Care Services at the Lewis Homeless Resource Center
• Clinics provide medical outreach workers to provide primary care
and other services to the homeless in the field
• Team includes
– Clinical Staff
– Eligibility Staff
– Behavioral Health Care Staff
– Pharmacy Services
• Outreach teams assist migrant populations
21

22. Clinic Statistics – Calendar Year 2015
• 28,680 unduplicated patients
– 18,615 Adults (18-64 years)
– 8,650 Children (18 years and younger)
– 1,415 Older Adults (age 65 and over)
• 24,452 unique medical patients
• 6,294 unique dental patients
• 73,418 total encounters
− 10,278 encounters for Migrants
− 17,277 encounters for Homeless
− More than 20,000 dental encounters
22

23. Medical and Dental Plans Accepted
• HCD Option 1
• HCD Option 2
• Medicare
• Medicaid
• Medicaid Share of
Cost
• Vita Health
17
In 2013
Now
Now: Medical
• CMS (So. Fla. Community
Care Network)
• Cigna (HMO, PPO, Open
Access Plus)
• Cigna GWH (HMO, PPO,
Open Access Plus)
• Coventry Commercial
Plans (PPO, HMO, POS)
• Florida Blue Cross Blue
Shield Medicare Advantage
PPO
• Florida BCBS Exchange
(My Blue)
• Florida BCBS Health
Options
• Florida BCBS Preferred
Patient Care
• HCD Options 1 & 2
• Humana (MMA)
• Humana Exchange (HumX)
• Magellan Complete Care
(MMA)
Medical (con’t)
• Medicaid
• Medicare
• Molina (MMA)
• Molina Medicare
• Molina Marketplace
• Molina KidCare
• Prestige Health
Choice (MMA)
• Simply Healthcare
(MMA)
• Sunshine Health
(MMA)
• Sunshine Exchange -
Ambetter
• Sunshine Medicare
Advantage
• United Healthcare
Commercial Plans
• Veterans Choice
(Healthnet)
• Wellcare/Staywell -
Florida Healthy Kids
Dental
• Argus Dental & Vision
• Assurant
• Children’s Medical
Services (CMS)
• Dentaquest - Florida
Medicaid
• Dentaquest Florida
Medicare
• Dental Health &
Wellness
• DHA PPO-Aetna Life
Insurance Company
• DHA PPO-United
Concordia
• Florida Blue - Dental
• Health Care District of
Palm Beach County
(HCD)
• MCNA
• Medicaid

24. ACA Impact on Enrollment
• The Health Care District’s managed care plans serve
county residents who are not eligible for other health
coverage programs.
• These plans do not duplicate state or federal health plans.
• When Florida decided not to expand Medicaid under the
Affordable Care Act, the District’s Coordinated Care
Program became an option for many of the uninsured
county residents left without coverage.
24
• Since 1993, this program has been providing health care benefits to
qualifying low-income residents (100% FPL or below) who cannot obtain
or cannot afford coverage anywhere else.

25. ACA Impact on Enrollment (con’t)
• Over 14,000 members of the District’s Vita Health
shared-cost plan became eligible to purchase
coverage through the federal health exchanges and
were notified the plan would sunset in January 2016.
• Members were assisted in enrolling in the health
insurance Marketplace, Medicaid, Florida KidCare or
the Health Care District’s Coordinated Care Program.
25
• The Brumback Clinics’ Certified Application Counselors (CAC’s) help
patients apply for health coverage on-site and through community
outreach.
• Our CAC’s partner with the Health Council of Southeast Florida and
Enroll America county-wide.

26. What You Can Do
• Partner with public health departments and FQHC’s
• Collaborate with community, state and national
health organizations
• Participate in community outreach
– Schools, religious institutions, local not-for-profit health
care organizations, agencies for women’s health,
families and children, municipalities, libraries, county
government, etc.
26
• Establish relationships with migrant and homeless organizations
• Train and staff CAC’s to help consumers navigate through
application and enrollment processes

27. Questions
27
Christopher F. Irizarry, MPA
VP & Executive Director of Clinic Services
Cirizarr@hcdpbc.org
561-642-1005

28. Palmetto
Health Columbia,
South Carolina
Thursday, May 12, 2016

29. To be remembered by each patient as providing
the care and compassion we want for our
families and ourselves.
Our Vision

30. Who We Are
Largest most comprehensive integrated health care provider in the Midlands with 7
hospitals and 1,835 beds
Locally owned, nonprofit system
Foster G. McGaw National Prize Winner

31. Palmetto Health
Our Strategy

32. Today’s Message
•Engaging Stakeholders and Leadership
•Assessing Resources
•Developing programs

33. Connect to Purpose
https://www.youtube.com/watc
h?v=qIxN2qkNrRI

34. Stakeholders and Leadership
Palmetto
Health
Community
Health
Board
Advisory/
Task Force
Consultants
Community
Annual Town
Hall
Meetings
Community
Health
Needs
Assessment
Community
Boards/
Committees
Engaging Stakeholders and Leadership

35. Canvas
Community
Resource
Analysis
Set
Priorities
Assessment

36. Program Development
Target
Population
Outcomes/
Measures
Service
Lines

37. Continuum of Care
Infant
Teen
Young Adult
Senior
Healthy Start
Maternal & Child Health
Screenings
Chronic Disease Management
Diabetes Prevention
Richland Care
Palmetto Cares
TeleHealth
Women at Heart
Paramedic Program

38. More About Our Palmetto Health
Strategy

39. ACA Implementation
Focus Population
Focus shift to 3 major customer populations
o 0-100 % of Federal Poverty Guidelines (FPG)
o 101-200% of FPG
o 201% & above FPG
Medicaid
Gap
Unfunded/ Uninsured Customers

40. Contracting
o Our Finance Staff made the decision to sign
contracts with all of the ACA Health Plans in our
region.
o This was an effective strategy as we could refer
customers to a variety of plans, and they could make
the best selection for their situation.
o By contracting with all of the plans, we were able to
offer a medical home for more customers.

41. Palmetto Cares
o Although South Carolina did not expand the
Medicaid program, the state did create the Health
Outcomes Program(HOP).
o Our system created the Palmetto Cares program as a
response to this.
o This program assisted customer s by gaining them
access to a primary care physician .
o Several options, both within the hospital system &
within the community, were utilized.

42. Insurance Premium Assistance
Program
o A community partner, The Cooperative Ministry,
received funds to assist customers with Insurance
premium payments.
o Assistance is available for individuals with incomes
between the 101-200% FPG level who have selected
a Silver Plan.
o Our Financial Counselors work closely with the
partner and refer potentially eligible individuals for
assistance.

43. Insurance Premium Assistance Program

44. Annual Self Assessments
o Debriefing sessions at the end of each Enrollment
Period
o Strategic Planning for Future Years
o Investigate Partnership Expansion
o Review of our Communication Strategy

45. Communication Samples

48. Ongoing Challenges
o South Carolina still has not expanded Medicaid.
o Some ACA covered Patients have ended their
coverage due to inability to maintain monthly
coverage.
o Most ACA covered patients have high deductibles
and are challenged paying these amounts.
o Customers continue to utilize the ER for primary
health needs.

49. Thank You