Newsletter (March 2020)

In This Issue:

All Things Medicaid: Is the Safety-Net Stable?
Be Counted – Census 2020
MHHA invited to join MLP Safe and Healthy Housing Cohort
Medicaid and the Coronavirus
“Long-awaited interoperability rules finalized by Trump admin”
(Almost) Welcome Our New VISTA – Tim Morton
ReFUND Colorado – An Easy Way to Support MHHA

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All Things Medicaid: Is the Safety-Net Stable?

COVID-19 Update: At the PIAC call on March 18, HCPF Director Kim Bimestefer and Medicaid Director Tracy Johnson spoke about actions the Department is taking to respond to COVID-19. A section 1115 waiver was submitted on Friday, March 13^th to CMS including approval for a variety of temporary measures. The 14-page waiver application included 11 amendments to Appendix K, Home and Community Based Services. Changes include:

• Paying telehealth/telemedicine (computer, phone, text, eConsult) at the same rate as for a regular encounter.
• Getting people enrolled in Medicaid quickly; as people lose their jobs they are first filing for unemployment and then Medicaid enrollment.
• Getting providers credentialed including those waiting, graduating, and retired.

CMS has approved a 6.2% FMAP bump over the current 50% rate; HCPF had requested 100% and is still working on it.

With the economic impact of COVID-19, the state revenue forecast will be significantly affected. There is the concern that if we get approval from CMS to make changes, will the state be able to afford it.

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There are so many pieces in motion with Medicaid right now that it’s hard to keep up with everything. The issues most on my mind these days are declining enrollment, Payment Error Rate Measurement, the proposed Medicaid Fiscal Accountability Rule, and uncertainty about the Community Health Center Fund.

Through the Medicaid expansion under the Affordable Care Act, along with the “welcome mat” effect, over 100,000 new Medicaid holders were enrolled in Denver, which helped cut our uninsured rate by half. These newly-enrolled have had the opportunity to access regular healthcare, as well as the additional care coordination services provided through Colorado Access, Denver’s Regional Accountable Entity.

As a result of ACA implementation and Medicaid expansion, safety-net providers in Colorado made substantial improvements, increasing services, programs, and even locations to better serve residents who face some of the greatest barriers to gaining coverage and accessing care. However, changes to policy and regulation at the federal level now threaten to undermine Medicaid and destabilize the safety-net in Colorado.  

Below is a very brief summary of each of the above topics and, for those of you who want to go deeper, some additional links to further reading. The most important take-away: if we fail to act, the healthcare safety-net could experience a significant contraction, jeopardizing operations at critical facilities and leaving many Coloradans without coverage or care.

• Decline in Medicaid Enrollment: MHHA has been focused on understanding in more detail the factors contributing to the decline in Medicaid enrollment and rising uninsured rate among our members, with the goal of developing strategies to mitigate the erosion of the payer mix. As the ratio of uninsured to insured patients increases, these facilities have fewer resources to meet the needs of the people they provide care for.

The Colorado Center on Law and Policy released a report in December about the Medicaid decline, outlining several potential factors for decreased enrollment, including a stronger economy, the “chilling effect” of Public Charge, and operational changes made by HCPF in response to pressure from CMS.

MMHA contributed to helping Colorado Health Institute develop a research agenda on declining Medicaid enrollment, and CHI has received funding to proceed with the development of two related reports. The first is due out in April.

What you can do: Let MHHA know if you have experienced declining Medicaid enrollment and how it has affected operations and the people you serve.

• Medicaid Payment Error Rate Measurement: “PERM” measures “improper” payments in Medicaid based on audits of whether a state is implementing its program in accordance with federal and state policies. The Center for Medicaid/Medicare Services has interpreted PERM differently, equating the errors with fraud, and indicating that they may claw back funding from states whose audits reveal an error rate greater than 3%.

At the February meeting of the Program Improvement Advisory Committee for the RAEs, Medicaid Director Tracy Johnson shared that Colorado’s PERM is 28%, putting $30-$60 million or more of Medicaid funding at risk. As a result, HCPF is “implementing several work streams in partnership with county partners to improve eligibility practices.” For now, the claw back remains theoretical, but clearly is driving a number of HCPF’s operational decisions.

What you can do: Work with the counties to ensure people keep their information with HCPF up to date and complete the income verification requirements promptly.

• Medicaid Fiscal Accountability Rule (MFAR): While intensely wonky, this proposed rule by CMS could have a significant impact on financing mechanisms for Medicaid, such as the Hospital Provider Fee. We don’t know what the exact impact of MFAR would be in Colorado, but the Colorado Hospital Association in their comment letter estimated a $3 billion loss in Medicaid funding as a result. To learn more, read Cindy Mann’s excellent blog post.

What you can do: The comment period has closed, so the best course is to contact CMS and ask the rule be withdrawn.

• Community Health Center Fund: Funding for Federally-Qualified Health Centers has been caught up in the federal budget chaos since last summer. Support for the CHCF has been maintained through a series of “Continuing Resolutions,” which is what happens when Congress doesn’t reach an agreement on a new budget by the October 1^st start date. CHCF support was extended for 60 days, then 30 days, and then until May 22, 2020. But there is still uncertainty about when and if the federal budget will be passed, and how much will be earmarked for the CHCF.

What you can do: Contact members of Congress to urge full funding of the CHCF.

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Be Counted – Census 2020

COVID-19 Update: Mandatory and requested restrictions on gatherings and close contact will have a significant impact on our Census outreach, education, and enrollment efforts. MHHA is developing new strategies, such as phone and direct mail, to substitute for our original outreach plans. If you have ideas about how we can effectively reach hard-to-count populations in these challenging times – or how we could partner with your organization – please email Census2020@milehighhealthalliance.org.

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The Mile High Alliance (MHHA) has received three time-limited Census 2020 grants to provided education and outreach for “hard to count” populations in Denver.  The funding is designed to offer staff and community education presentations and provide collateral material for MHHA members and community organizations, as requested.  The collateral materials are available in English/Spanish and various other languages.  Additionally, MHHA will collaborate with various community partners to coordinate five community Census/health events in Southwest Denver and Montbello.

MHHA’s model for Census outreach and education includes the following activities:

• Providing collateral materials for partner organizations that can reach hard-to-count communities in Denver
• Providing Census training for your staff
• Post-training technical assistance if your staff have questions
• Help with the development of a work or action plan for Census plans for your organization

To date, we have facilitated two community presentations/training and have additional presentations scheduled in the upcoming months. We welcome the opportunity to provide additional information and assistance to your organization.  Please feel free to contact us at census2020@milehighhealthalliance.org

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MHHA invited to join MLP Safe and Healthy Housing Cohort

MHHA was invited to participate in the MLP Safe and Healthy Housing Cohort. By convening this cohort, the Network for Public Health Law (NPHL) and the National Center for Medical-Legal Partnership (NCMLP) aim to support MLPs working at the intersection of individual patient/client needs and population health. The conveners will facilitate opportunities for peer discussion and will provide legal technical assistance to support MLP efforts to improve health through housing. 

The NPHL and NCMLP commit to working with the cohort on developing a legal strategy to improve access to safe and healthy housing. The conveners will partner on legal strategy implementation by providing up to 20 hours of legal technical assistance, connecting MLP leadership with state and local health departments, and facilitating three virtual meetings of the cohort. Cohort members will periodically check in with point persons. These meetings will serve as an opportunity to adjust the legal strategy, brainstorm solutions to obstacles, identify new contacts, and celebrate accomplishments to date.

In addition to participating in the cohort, members will attend and engage in three virtual meetings and participate in the 2020 Public Health Law Conference in Baltimore, MD, where the cohort will convene in person. 

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Medicaid and the Coronavirus

Here is an important discussion of the connection between the current COVID-19 pandemic and Medicaid by Sara Rosenbaum from George Washington University: 

“In their recent editorial on the burgeoning public health crisis brought on by the fast-spreading coronavirus, David Blumenthal, M.D., and Sara Collins point out Medicaid’s long-standing role as the nation’s single largest health care first responder. ” [Read more] 

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“Long-awaited interoperability rules finalized by Trump admin”

“Trump administration healthcare officials on Monday (March 9th) finalized two highly anticipated rules prohibiting the practice of information blocking and giving patients more agency over their medical data. The rules had been held up amid controversy and a fierce industry discussion about patient access versus privacy and security.” [Read more]

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(Almost) Welcome Our New VISTA – Tim Morton

We were hoping to onboard our new VISTA on April 13^th. However, in response to COVID-19, the Corporation for National Service has delayed all new positions until May.

Tim graduated from CU Boulder last spring with a degree in Integrative Physiology and a minor in Spanish:

“I’ve been aspiring to improve the health of our society since high school and am looking for the best way to make the biggest impact. Working for underserved populations with MHHA is a great way for me to combine my interests in science and research with my passion for community service. Outside of work, I try my best to live an active lifestyle. My hobbies include skiing, ice hockey, and helping my mom train guide dogs.”

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ReFUND Colorado – An Easy Way to Support MHHA

If you get a state income tax refund in 2020, you will have a new opportunity to donate some or all of it to support our ongoing work in the community. Since Mile High Health Alliance is a project of the Colorado Nonprofit Development Center (CNDC), all donations will be made using their name and tax ID number.

The new program described by the ReFUND CO initiative puts you in charge of where your donation goes. It’s as simple as 1,2,3:

1.       Decide how much of your refund to donate.

2.       Enter Colorado Nonprofit Development Center and their registration number 20023005384 in the Donate to a Colorado Nonprofit Fund line on your state income tax return or tax software. NB: In order for these funds to be allocated to Mile High Health Alliance, please use this link to provide information about your donation.

3.       Smile knowing you’ve helped a cause that matters to you!

As always, we’re grateful for your past support and hope you’ll consider donating again through this new program to maintain our mission.

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Quote: “It’s no longer sufficient to segment the population into those individuals who are most likely to have high costs; we need to segment by those whom we can help in partnership with other sectors, and build those partnerships to ensure their long-term recovery.“

David Labby, MD, MPH, Health Strategy Advisor and former Chief Medical Officer at Health Share of Oregon. [Read more]

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Newsletter (November 2019)

In This Issue:

Medicaid Enrollment Decline
Medical-Legal Partnership Convening
Enhancing Vision for Older Montbello Residents
Specialty Care Update
Grant Updates
Colorado Gives Day

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Medicaid Enrollment Decline

In the two years between August 2017 and August 2019, Medicaid enrollment in Denver dropped by almost 12%, or about 25,000 people. The decline in Medicaid-insured residents wasn’t steady – there were some peaks and valleys during this period – but the overall downward trend is very concerning for MHHA members and the safety net in general.

Through the Medicaid expansion under the Affordable Care Act, along with the “welcome mat” effect, over 100,000 new Medicaid holders enrolled in Denver, which helped cut our uninsured rate by half. These newly-enrolled now had the opportunity to access regular healthcare, as well as the additional care coordination services provided through the Colorado Access, Denver’s Regional Accountable Entity.

For safety-net providers, fewer uninsured patients meant stronger revenues. With increased resources, safety-net providers expanded capacity, programs, and services in order to deliver better care to their patient populations. These advances are at risk as Medicaid enrollment continues to fall. Furthermore, if the people dropping off Medicaid rolls are eligible-but-not-enrolled, HCPF is likely to end up paying for expensive care at emergency departments instead of at primary care practices.

The Colorado Center on Law and Policy recently released an in-depth analysis of HCPF data, noting that the “rate of decline in enrollment in Medicaid and CHIP in Colorado is more than threefold the national average.” What’s Causing Colorado’s Decline in Medicaid and CHIP Enrollment? suggests that operational and process factors contributing to the decrease include:

• Functioning of redetermination processes
• County management of validation documentation
• Obstacles to real-time eligibility
• Impact of the returned mail policy

There’s no time to waste; further erosion of Medicaid enrollment could affect the stability of the safety net, which serves many of the communities that face the greatest social and economic barriers to healthcare. Have you noticed an increase in uninsured patients? We’d like to hear from you about how it’s affecting your organization.

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Medical-Legal Partnership Convening

This past October, MHHA hosted MLPs: Past, Present, and Future. The event itself focused on bringing together stakeholders who work with, have worked with, or are interested in working with Medical-Legal Partnerships (MLPs). The goal was to create/launch a learning community about MLPs and explore alignment on issues such as data, screening tools, sustainability, etc. 

The first part of the convening featured speakers from the Health Equity Advocacy Cohort, 9to5, and a keynote speaker, Kirby Mitchell, who gave great insight into pulling together different stakeholders from South Carolina to create an MLP. The afternoon consisted of a panel with partners who are invested in MLP efforts in Denver. After the panel, attendees split into working groups. These groups discussed opportunities, challenges, and next steps for screenings tools, policy, and data/evaluation.

The convening was a resounding success. Many people remarked that they found the day useful and inspiring. It is our hope to continue this energy and conversation around MLPs with interested parties. In the new year, we are planning to bring this group back together for further discussions around working as a collaborative to sustain metro Denver’s MLPs.

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Enhancing Vision for Older Montbello Residents

According to the Latino Community Foundation, the Colorado Latino Age Wave (LAW) “is an initiative that supports the well-being of a rapidly growing Latino older adult population in Metro Denver through innovative services and programs.”  Through a limited grant, the LAW awarded funding to MHHA to coordinate a vision testing and eyeglasses initiative for adults 65+, who reside in the Montbello neighborhood.  As a result, MHHA is collaborating with the LAW Connectoras (Spanish-speaking connectors), to identify and refer eligible (un-insured) individuals to MHHA. The alliance monitors the initiative and is responsible for ensuring direct payment is made to the vendor, America’s Best. To date, the initiative has provided services to 20 individuals and anticipates serving additional residents, prior to the conclusion of the grant in 2020.

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Specialty Care Update

After careful consideration, we have decided to revamp our Mile High Specialty Care SPAN working group. As we look towards the new year, we want to bring a diverse set of health experts as well as feasible action steps to address specialty care access. We are looking to relaunch at the beginning of January of next year. If you are interested or know of someone who is addressing specialty care access and would like to participate in the conversation, please reach out to Vicente Cardona @vicente@milehighhealthalliance.org.

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Grant Updates

Department of Local Affairs Census Grant: The Mile High Health Alliance recently support for our 2020 Census outreach efforts through the funding appropriated by HB19-1239. Our workplan is already coming together, as we will need to move quickly in order to reach hard-to-count communities in Denver. Keep an eye out for an email from MHHA staff inquiring about how we can support our members and partner in their Census work. We have the capacity to provide collateral materials, training, education, and technical support.

Together We Count Mini-Grant: The Mile High Health Alliance received additional funding through a mini-grant from Together We Count. This money will join the DOLA funding in the census support pool to help us reach our program goals.

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Support Mile High Health Alliance This Colorado Gives Day!

Regional Health Connector (RHC) Funding: The University of Colorado Department of Family Medicine has received approval to fund comprehensive practice transformation, including financial support to the RHC program. Each RHC region will be eligible to receive up to $30,000 for one year starting November 1, 2019, with the possibility of two additional years of funding. 

The Mile High Health Alliance is a coalition of organizations committed to achieving better health through collaboration, working together to increase access to healthcare for the uninsured, underinsured, and Medicaid-insured residents of Denver. Donations through Colorado Gives Day will support our Medical-Legal Partnership, which connects patients who access care at safety-net clinics with legal services that can help address issues of housing safety and stability for individuals and families in our communities.

Schedule your donation now!

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Newsletter (September 2019)

In This Issue:

Executive Director Update
Stephanie Salazar-Rodríguez receives an award
Community Engagement Work
All Things Census
Mile High Specialty Care Network
Prime Health
New Initiative: Budtenders Program
Home Equity Report

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Access Monitoring Review Plan Comments Due October 4th

On September 5^th, the Department of Health Care Policy and Financing released a draft of the 2019 Access Monitoring Review Plan, triggering a 30-day comment period. The AMRP reports on whether access to care is sufficient for Medicaid-holders in five categories:

• Primary Care
• Specialty Care
• Behavioral Health Fee-For-Service
• Home Health Services
• Pre-Natal including Labor and Delivery

The Centers for Medicaid/Medicare Services requires every state Medicaid office to submit the AMRP every three years. “Sufficient” for Medicaid-holders is defined by CMS as equivalent to access by people with commercial insurance. For many rural geographies, as well as urban and suburban areas, this means that access to care is sufficient even though no one can get the care they need.

The 2016 AMRP and the 2019 draft AMRP both conclude that access to care is sufficient for Medicaid-holders in all categories. These findings by HCFP are incongruent with a report released in June by the Colorado Health Institute, which estimates that Medicaid patients forgo 486,000 specialty care appointments every year. That’s roughly 87 appointments annually for each specialty care physician in Colorado. 

The Merrick Hawkins 2017 Survey of Physicians Wait Times and Medicaid-Medicare Acceptance reports that even though physician-to-population ratios are at a historic high, in the Denver metro area the wait time for dermatology can be as much as 365 days. 

Comments on the AMRP are due on Friday, October 4^th. Please, if you can, provide feedback regarding your experiences and challenges with access to care for Medicaid holders – qualitative or quantitative – to amrp@state.co.us. 

Thanks so much.

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Director of Community Engagement/Regional Health Connector is honored at the Public Health in the Rockies Conference

On August 27, 2019, Stephanie Salazar-Rodríguez received a prestigious “General Recognition” award at the annual Public Health in the Rockies (PHiR) conference.  The award recognized her contributions to public health through her commitment to improving overall health outcomes for residents in Denver.

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Community Engagement Work

On June 30, 2019, Stephanie Salazar-Rodríguez’s primary role as the Regional Health Connector (RHC) concluded, as the State Innovation Model (SIM) funding sunsetted.  In the final RHC Social Network Analysis for Region 20, 55 survey respondents reported that the “new and strengthened relationships, facilitated by the RHCs were more valuable than pre-existing relationships in terms of the time commitment, resources contribution, and influence offered by new or strengthened partnerships. They also reported higher levels of trust among the new and strengthened relationships,” while 100% of survey respondents stated they believe that the role of an RHC is imperative to a stronger community health system in Denver.

Stephanie’s work continues as the Director of Community Engagement/RHC.  The most recent priorities of the Director of Community Engagement are working with the Latino Age Wage in Montbello, Phase III of the Immigrant Drop-Off the Medical/Legal Partnership and promoting the importance of a complete count in the 2020 Census. 

Stephanie’s community engagement work in Southwest Denver remains a priority.  On August 6, 2019, Stephanie and Karen attended the Southwest Denver National Night Out event. They hosted a resources table where they provided information on the healthcare focus for the Census 2020. The MHHA staff, conducted an informal poll that revealed nearly everyone who participated in the poll, plan to respond to the upcoming Census. Denver’s Mayor, Michael Hancock stopped by the MHHA table to congratulate us on our commitment to the Census work.

Additionally, as part of the work in Montbello, on August 17, 2019, MHHA (Karen Trautman and Vicente Cardona) participated in a Wellness Fair held at the Montbello Recreation Center.  There were approximately 200 individuals in attendance, including 40 people from the Latino Age Wave, who received health screening services through the CREA Results Mobile Health Van and the distribution of 10 home monitoring blood pressure cuffs.

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All Things Census

Ignite at Public Health in the Rockies

Earlier this month, Dede de Percin, our executive director, presented an Ignite Talk at Public Health in the Rockies. Her five-minute presentation featured 20 slides highlighting the importance of the census for Coloradans, as well as why folks in the room should pay attention and take action. We should mention, she did this all while sporting fashion-forward “Star-Spangled Leggings.”

Census Grants

Department of Local Affairs

The Mile High Health Alliance recently submitted a proposal to support 2020 Census outreach, education, and promotion to the Department of Local Affairs for state funding appropriated by HB16-1239. We will be notified by November 1st whether we are successful. 

Together We Count

Together We Count has opened an RFP for additional census outreach funding. MHHA plans to submit a proposal for this grant as well – every little bit helps! Click here for more information.

What the Census Tells Us: Health Insurance Coverage Edition

The Census recently released an extensive report on health insurance coverage. The percentage of insured individuals in Colorado held steady, despite the national downward trend. The number of individuals enrolled collectively, in both public and private insurance, remains equivalent to previous years.

Interestingly, Colorado’s Medicaid-insured numbers are down, consistent with the national trend reported in Census data. Theories about the reason for the decline include the impact of the “chilling effect” of Public Charge and other federal policies. Colorado has apparently been able to maintain our percentage of insured because of an uptick in commercial insurance enrollment. Click here for more information.

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Mile High Specialty Care Network

The Mile High Specialty Care Network has been active in its new role within the Kaiser Cohort. Mile High Health Alliance is leading the conversation about our system change goals and focusing our efforts by utilizing various levers to ensure impactful change towards better access to specialty care.

During our cohort meetings, there have been discussions around system change and how the cohort can make a significant impact within Colorado. Mile High Health Alliance has taken the lead to focus on four system change goals that can make a considerable impact in accessing specialty care. The goals that we will be focusing on are: tracking current policy opportunities, UC Health participation with Health First Colorado, Health First Colorado provider enrollment, and e-consult reimbursement. Though the tasks are ambitious, we feel we are up to the challenge.

For those who might not be aware, Mile High Health Alliance has been focusing on Track II of its Specialty Care Network. Track II looks at finding specialists within Denver who are accepting new Medicaid patients. We then reach out to clinics or referralists seeking assistance and provide information most suitable to their patients. If you need information about Medicaid accepting specialists in your area, please contact us at Vicente@milehighhealthalliance.org. 

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Prime Health

Within the past several months, Mile High Health Alliance has had the privilege to participate as judges for the 2019 Prime Health Challenge. We have used our knowledge and resources from our network to ensure that each company concept embodied innovation, community, and was equitable for all. As the Prime Challenge comes to an end, only seven companies remain. To learn more about the dates and the seven finalists click here.

On October 23, at the Asterisk Event Center in Denver, Prime Health will be hosting a live “Shark Tank” style event. Seven finalists will pitch their product for an opportunity to win a portion of $150,000 provided by the Colorado Health Foundation. The seven companies that will be participating will be Babyscripts, Manatee, Meru Health, phas3, Moving Analytics, Care Cognitics, and STREAMD. If you haven’t already registered, click here to get your tickets to the main event.

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New Initiative: Budtenders Program

We have a very exciting update on a new strategic initiative that MHHA has been working hard on – Budtenders Program. This project came out of a male mental health crisis. In Denver, suicides disproportionately affect men, which has a ripple effect throughout the whole community. There have been many efforts to address mental health and specifically male mental health in Denver, but MHHA’s strategy is a bit different. We’re interested in meeting people where they are with information, messaging, and resources to improve health. In this case, we’re interested in meeting people at cannabis retailers. Similar models have been used at gun ranges and gun stores to provide education and resources on suicide prevention.

In collaboration with Native Roots Dispensary and Mental Health Center of Denver, MHHA has put Colorado Crisis materials on the counters of dispensaries throughout the metro area. Although some teams were apprehensive at first to engage their guests with these materials, they soon warmed up to the idea once it was clarified that they should only engage if they feel comfortable and feel that the situation called for it. In one month, 57 cards and 14 flyers were handed out. We’re keeping track of the numbers over the next few months to see if the number of cards and flyers taken stays steady or increases as the teams become more comfortable with the materials.  

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Home Equity Report

A new analysis of housing trends in Colorado reveals that the health of Coloradans is closely tied to access to affordable, stable, accessible and quality housing. Residents across the state have been harmed by the rapid increase in housing costs, and that pinch has been acute for seven distinct demographic groups, the report found.

The report details how housing instability has a direct negative effect on the health and well-being of people of color, Coloradans with low incomes, families with children, people in rural areas, people with disabilities, immigrants without documentation and Coloradans experiencing homelessness. The report, “Home Equity: A Vision of Housing Security, Health and Opportunity” was produced by the Colorado Health Institute in partnership with a cohort of 18 Colorado nonprofit organizations. The average Colorado home price increased 77 percent in the past decade, researchers found, yet the state’s median income increased just 4.5 percent.

To improve housing opportunities throughout the state, the report outlines 11 promising policy ideas created in partnership with affected communities that state and local policymakers should consider. They range from local to state-level solutions and include ways to correct historic and current policies that have created today’s inequitable systems.

One of the policy ideas promoted in this report on page 32, is “Promote Medical-Legal Partnerships.” MHHA belongs to a Medical-Legal Partnership (MLP) partnership. Starting with two Denver Health Clinics, Intensive Outpatient and Westside Pediatrics, 186 patients were screened for legal needs such as housing and utilities, education, benefits, and safety and stability. Patients were then referred to one of our three legal partners; Colorado Legal Services, Colorado Poverty Law Project, and DU Sturm College of Law. We have since received funding to expand the MLP to two additional clinics, focused on aging adults 50+. 

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