Medicaid Managed Care - U.S. Senate Special Committee on Aging

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Communicating With Vulnerable Populations: <strong>Medicaid</strong> 171
Many health plans, of course, welcome new members. But Medica Health Plans' outreach
program to Medica Choice <strong>Care</strong> members offers much more than a friendly hello and
an explanation of benefits. Medica Health Plans views the welcoming call as an opportunity
to immediately connect members to needed medical and social services. The representatives
begin by telling the members about Medica Health Plans' free <strong>Medicaid</strong> services, such
as Provide-a-Ride and Interpreter Services. Then they ask several basic health-related questions,
such as 'Are you pregnant?" or 'Do you or one of your children have asthma?' If
the member answers "yes" or 'maybe" to one of these questions, the representative inquires
further to make sure the person with the condition or illness is currently under the care of
a health care provider
The representative also asks members with children under the age of five if they participate
in the WIC (Women with Infant Children) program, the federally-funded program that
provides nutrition education and nutritious-food advice to low-income pregnant women
and mothers with young children. If a member says "no," the representative sends a fax to
the WIC program, which then makes sure one of its workers contacts the family to schedule
an appointment.
During welcoming calls, Medica Health Plans' access representatives also inquire as to
whether members have any clothing, housing, or other urgent social service needs. If a member
indicates that he or she would like help with a particular problem, the representative
passes that information on to one of Medica Health Plans' social workers. It's not unusual
for a new member to have an urgent need for assistance. One young mother, for example,
told the access representative who first contacted her that she and her two young children
had been forced to move in with her sister after their house had burned down and now the
sister was about to be evicted. The representative passed this information on to one of
Medica Health Plans' staff social service coordinators, who immediately started helping the
young mother get in touch with county agencies that could help her find emergency housing.
During another call, a representative noticed that the new member answered "yes" very
quietly when asked if she needed any resources about family violence. Realizing that the
woman might be afraid to speak up because her abuser was in the room with her, the representative
asked if she was safe at that moment. When he felt confident that the woman
was not in immediate danger, he gave her the phone number of an Medica Health Plans
social worker and told her to call the number when she felt free to talk about her options
for getting help. The woman did call later and received the assistance she needed.
These welcome calls have been very well-received by members. Not only do they help
educate new members about the health resources available to them, they also go a long way
toward establishing a friendly partnership relationship between members and the Medica
Choice <strong>Care</strong> staff. As one member said to an access representative when she realized what
the phone call was about: "What! My health insurance company is actually calling me?" As
a result of these personal contacts, members are less hesitant to call later with questions or
concerns-and, as a result, more likely to get timely, appropriate health care.
OVERCOMING OTHER BARRIERS
Not being able to afford phone service can be a serious impediment to getting and following
through on medical care. In the 1992 survey of <strong>Medicaid</strong> recipients, 30 percent of
Native American respondents, 15 percent of African-American respondents, and 12 percent
of Hispanic respondents said they were not able to make phone calls at home.
Medica Health Plans cannot, of course, afford the cost of supplying all its <strong>Medicaid</strong>
members with phone service. But in very unusual situations, such as when a <strong>Medicaid</strong> recipient
is experiencing a very high-risk pregnancy and her phone has been disconnected for lack
of payment, Medica Health Plans arranges, usually through local social services agencies, to