 |
Annual
Report
October 1, 2000
to October 1, 2001 |
| Submitted: 01/01/2002 |
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Table of Contents:
| The AHCCCS Administration provides this Annual KidsCare Report to the
Governor, President of the Senate, Speaker of the House of
Representatives, Secretary of State, and the Director of the Department of
Library Archives and Public Records under A.R.S. 36-2983 and A.R.S.
36-2996. |
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KidsCare, Arizona's State Children's Health Insurance Program
(SCHIP), began on November 1, 1998. Many uninsured children have
benefited from this program. The purpose of this report is to describe
the following elements for FFY2001:
- Population
- Budget
- Program and key health goals
- Seriously and chronically ill children
- Outreach achievements
- Coordination and innovation
- Future projects and developments
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As of October 1, 2001, KidsCare has enabled a total of 131,047
children, who were previously uninsured, to gain access to health
insurance. Of this number, 77,362 (59%) have been found eligible for
Medicaid rather than KidsCare. In addition, as of October 1, 2001, 5,190
Native American children are enrolled, an increase of 1,446 (38%) over
October 1, 2000. The following chart illustrates the total number of
children approved for health insurance because of KidsCare applications.
Chart 1
The following chart shows the ethnicity of KidsCare
children as reported by the applicant.
Chart 2
ETHNICITY
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 State
and Fiscal Expenditures
State
Fiscal Year
2000 |
State
Fiscal Year
2000 |
State
Fiscal Year
2002 (Projected) |
| $35,595,392. |
$59,638,017. |
$82,568,500. |
Based on current enrollment numbers, federal funding percentages
are sufficient to fund the program for the upcoming year.
 Premiums
Implemented
On October 1, 1999, KidsCare implemented premiums for families with
an income above 150% of the Federal Poverty Level (FPL). The premium
amounts are represented in the following chart:
Chart 3
PREMIUM AMOUNTS
| Federal
Poverty Levels (FPL) |
1st
Child |
More
than 1 Child |
| Above 150% - 175.00% |
$10.00 |
$15.00 Total |
| Above 175% - 200.00% |
$15.00 |
$20.00 Total |
As of October 1, 2001, there were 10,513 households with 18,264
enrolled children required to pay a premium. These children represent
34% percent of the children enrolled in KidsCare. From 10/1/00 through
9/30/01, premium collection payments represented 1,337,710, of which
76.04% was returned to CMS.
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KidsCare provides a mechanism under which more children are covered
for immunizations and other primary and preventive health services.
AHCCCS and its contracted health plans have implemented interventions to
improve access to primary and preventive health care services by
children, as well as monitor progress toward goals. These goals are
based on national "Healthy People" objectives for the years
2000 and 2010 and the "Arizona 2000, Plan for a Healthy
Tomorrow."
The rates presented here should be viewed as indicators of access to
services, rather than absolute rates for how successfully AHCCCS and/or
its contracted health plans provide care to KidsCare members. Many
factors affect whether health plan members use services. But, by
analyzing trends over time, AHCCCS and its contracted health plans can
identify areas for improvement and implement interventions. The results
for immunizations and access to Primary Care Practitioners (PCPs) are
based on a selected group of members, who were continuously enrolled in
an acute-care health plan during the reporting year, rather than the
entire population. The rate for annual dental visits is for all children
enrolled during the year, regardless of how long they were eligible.
Preventive
Care: Immunization & Well-Child Care
AHCCCS and the contracted health plans are working to achieve state
and national public health goals to increase the proportion of
children who are fully immunized by age two
The immunization rate for three combined antigens for KidsCare
members who turned two years old during the federal fiscal year ending
Sept. 30, 2000, was 78.5 percent. This rate represents completed
immunizations for Diphtheria, Tetanus and Pertussis (DTaP); Polio
(IPV); and Measles, Mumps and Rubella (MMR), and is known as the 4:3:1
series. Being the longest standing set of immunizations, this
combination is most often used as a benchmark. The national Healthy
People goal for this series is 90 percent by the year 2010.
This is the first year AHCCCS has measured the immunizations status
of children enrolled under Medicaid (Title XIX of the Social Security
Act). The rate for KidsCare members for the completed 4:3:1 series of
immunizations during the federal fiscal year ending Sept. 30, 2001,
will be available in April 2002.
The immunization rate for five combined antigens for KidsCare
members who turned two years old during the federal fiscal year ending
Sept. 30, 2000, was 63.4 percent. This rate represents completed
immunizations for Diphtheria, Tetanus and Pertussis (DTaP); Polio
(IPV); and Measles, Mumps and Rubella (MMR); Haemophilus influenzae
type B (HiB); and Hepatitis B (Hep B). The Healthy People 2010 goal
for this series is 80 percent.
The rate for KidsCare members for the completed series of these
five immunizations during the federal fiscal year ending Sept. 30,
2001, also will be available in April 2002.
AHCCCS does not collect a rate of well child visits for KidsCare
members separately from children enrolled under Medicaid. For the
federal fiscal year ending Sept. 30, 2000, the rate of all children
continuously enrolled in an acute-care health plan for one year who
turned 15 months old and had all the required well child visits was
58.3 percent, a 5.5-percent relative improvement over the previous
year's rate. Among children 3 to 6 years old who were continuously
enrolled during the same year, 44.5 percent had at least one
well-child visit.
Access
to Care: Primary Care Practitioners (PCPs)
The rate for children enrolled in AHCCCS through KidsCare who had
at least one visit to a health plan PCP (family or general
practitioner, pediatrician, internist, obstetrician/gynecologist,
physician's assistant or nurse practitioner) was 63 percent during the
federal fiscal year ending Sept. 30, 2000. The rate is a relative
improvement of 5 percent over the previous year's rate of 60 percent.
One-year-olds enrolled in the KidsCare program had the highest rates
of access to care, with 86.4 percent having a PCP visit during the
year. Among members 2 through 6 years old, 71.5 percents visited a PCP
during the year. The "Healthy People" goal for the year 2010
is that 95 percent of children and adolescents 18 years and younger
have a specific source of ongoing primary care.
The rate of access to PCPs by KidsCare members for the year ending
Sept. 30, 2001, will be available in October 2002.
Access
to Care: Oral Health Care
All children enrolled in AHCCCS through KidsCare should receive an
oral health screening by their PCP as part of their routine well-care
visits. Children 3 and older are to be referred to a dentist for an
annual visit, regardless of whether or not problems are identified by
their PCPs. The rate of KidsCare members 3 to 20 years old who had an
annual dental visit during the year ending Sept. 30, 2000, was 34
percent.
This is the first year AHCCCS has calculated a rate for dental
services separately from children enrolled under Medicaid (Title XIX
of the Social Security Act). AHCCCS also collects and reports a rate
for annual dental visits by all children continuously enrolled in an
acute-care health plan for one year. For the federal fiscal year
ending Sept. 30, 2000, this rate was 43.5 percent, compared with the
previous year's rate of 42.6 percent. The "Healthy People"
2010 goal is that 90 percent of children entering school for the first
time will have received an oral health screening, referral and
necessary follow-up services.
The rate of annual dental visits by KidsCare members for the year
ending Sept. 30, 2001, will be available in April 2002.
Satisfaction
with Care: Rating of Health Plan
In June 2000 AHCCCS conducted the Health Plan Member Satisfaction
Survey. This was the first time that AHCCCS had conducted a member
survey for all its health plans since the inception of KidsCare.
AHCCCS used the Consumer Assessment of Health Plans Survey (CAHPS),
which is a standardized member survey that is used nationally by
Medicaid as well as commercial health plans. One objective of the
survey was to assess how KidsCare members felt about their health
plan. In order to assess the significance of this rating, AHCCCS
submitted its results to the National CAHPS Benchmarking Database
(NCBD) which would enable AHCCCS to compare the results from its
health plans to national averages. Members were asked to rate their
health plan on a 0-10 scale. KidsCare members rated their health plans
at a rate that was notably higher than the national Medicaid average
and considerably better than how members rated commercial health
plans. The results are illustrated on the chart below.
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Beginning October 1, 2001, KidsCare was permitted to enroll seriously
and chronically ill children whose families voluntarily terminated health
insurance within the three months proceeding the enrollment date As of
October 29, 2001 no children had been enrolled under this waiver. |
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AHCCCS
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The KidsCare
Administration has four Regional Outreach Coordinators and a
manager to direct statewide outreach activities. Together these
coordinators have developed an outreach plan which includes:
- Supporting and collaborating with the community based
organizations on outreach events and in setting up community
coalitions,
- Training and education,
- Creating uniform outreach training materials,
- Developing a business packet to target the small business
and minority business companies, and
- Working with schools.
The Outreach Coordinators work closely with coalitions in
their communities. These coalitions include grantees, health
plans, community organizations and community volunteers. The
members supported the promotional events for KidsCare. They
regularly attend immunization, health fair events and other
community events. AHCCCS contracted Health Plans are also
contributing to the KidsCare outreach efforts. Health Plans
statewide have promoted the KidsCare Program at Health Fairs and
community events such as block watch gatherings and cultural
events. Health plans have participated in coalitions, which
promote sign ups for KidsCare.
Please see Attachment 3 regarding the counties targeted for
KidsCare outreach by AHCCCS employees. |
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Through a grant from the Flinn Foundation, Arizona State
University (ASU) is currently compiling the outreach program data for
Children's Action Alliance, St. Luke's Charitable Trust, and the Flinn
Foundation. The summary report is expected at the end of the three-year
projects. While it is too early for outcomes, these grants are allowing
communities the opportunity to provide outreach that was previously
unavailable.
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Children's
Action Alliance (CAA)
CAA dispersed $1 million in grants from the Robert Wood
Johnson Foundation to El Rio Community Health Center in Tucson,
Phoenix Day School Health Links Project, and Yuma Department of
Public Health. The purpose of these grants are to:
- Decrease the number of uninsured
- Increase access to care
- Provide technical assistance in outreach
- Produce publications
- Increase collaboration
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Flinn
Foundation
In addition to the evaluation grant to ASU, the foundation
has awarded KidsCare outreach grants totaling $130,825 to
Children's Action Alliance in Phoenix, Interfaith Cooperative
Ministries in Phoenix, North Country Community Health Center,
Inc. in Flagstaff, Phoenix Day Child and Family Learning Center,
Pinal County Division of Public Health in Coolidge, and Yavapai
Big Brothers Big Sisters in Prescott. These organizations
provide:
- Information through employer-based activities
- Assistance in the application process
- Follow up to assure that all eligibility and enrollment
processes are completed
- Compilation and analysis of data for community projects
(ASU)
The grants funded by the Flinn Foundations have expired
except for one-Yavapai Big Brothers and Sisters-which ends March
2002. All grants were a one-time only and they do not renew or
fund continuations. |
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St. Luke's
Health Initiatives
The KidsConnect initiative is a three-year program that began
in the spring of 1999. The initiative granted a total ofV
$840,213 to Maricopa County East Valley Boys & Girls Clubs,
Lake Powell Medical Center which also covers Page and Chapter
Houses on the Navajo Reservation, Patagonia School Districts in
Patagonia and Santa Cruz County, Phoenix Children's Hospital
& Native American Community Health Center, Pima Prevention
in Tucson, Scottsdale Prevention Institute, and Valley
Interfaith Project for central and western Phoenix. The goal is
to increase the number of children enrolled in Medicaid and
KidsCare in order to foster a consistent source of health care.
This initiative works through seven community based
organizations to:
- Identify children not receiving health care who are
eligible but not enrolled in AHCCCS or KidsCare
- Assist parents with the application process
- Ensure that the child receives health care
This program is intended to complement AHCCCS and KidsCare by
testing innovative strategies to reach these populations.
Strategies have included outreach activities at:
- Youth rodeos
- Wal-Mart
- Churches
- Health fairs
- Schools
These grants with the exception of one (Scottsdale Prevention
which ends on April 2002) are complete. Please see Attachment 1
regarding the counties targeted for KidsCare outreach by
Foundations. |
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Health Plans
AHCCCS strives to decrease the barriers members may
experience in accessing services by requiring contracted health
plans and program contractors to make every effort to educate
new or current members about covered services. Health plans and
programs contractors use a variety of mechanisms to communicate
this information and facilitate the delivery of services, such
as: member handbooks, member newsletters, reminder postcards to
members' parents, telephone calls and, if necessary, home
visits. Lists of members due/overdue for preventive
visits/services also are sent to members' Primary Care Providers
(PCPs). Health plans participate in community health fairs and
make available information about their services. They also
network with community organizations such as Women, Infants and
Children (WIC) offices, Head Start programs, perinatal outreach
programs and churches. Other partnerships with state health
initiatives include: Healthy People 2010, Arizona Community
Action Association, Arizona Community Councils, Community Action
Planning Grantees, and Health Subcommittee of the Collaboration
for a New Century.
Recent legislative changes to KidsCare will facilitate
eligibility for more children and allow them to receive Health
Risk Assessments commonly known as Early and Periodic Screening,
Diagnosis and Treatment (EPSDT) services. These changes also
include behavioral health benefits and availability of
transportation to medically necessary services. The
AHCCCS-contracted health plans have implemented a variety of
outreach and tracking mechanisms to ensure that all members,
including those covered under KidsCare, receive necessary
medical and support services. For example:
- Many contracted health plans assist parents with first
time appointments. Using the AHCCCS EPSDT Periodicity
Schedule, health plans send postcard reminders or letters to
parents of children who are due for periodic exams. If a
visit does not occur (by proof of claims resolution data or
encounter submission), then a second reminder usually is
sent. Health plans have various processes for following up
on children who still do not have an exam. One plan refers
the case to a Coordination of Care Committee, which utilizes
a multidisciplinary approach to develop a plan of care with
specific goals. Another health plan's EPSDT/Immunization
Coordinator will send reminder postcards, call if there is
no response to the postcard, and/or visit the member's home
in order to assist with getting the member in to care.
- One health plan has developed a "Reach Out To
Children Program (ROTC)" program that identifies, on a
quarterly basis, members who have not had a dental visit in
the last year. Participating dentists receive a copy of the
list of members residing within their service area. The
dentist will contact the member directly to schedule
appointments. Dental reminder post cards are sent to the
member as well.
- Another unique process this same health plan created to
increase EPSDT participation was hosting a "Well Child
Express Day," where providers are available for parents
to bring their children in for screenings on a Saturday, in
order to make access to care more convenient. The health
plan works with a doctor's office or clinic to provide the
services. It then coordinates a fun, health-fair event and
publicizes it to its members in the area.
- Several health plans have developed incentive programs to
encourage members to get well-child visits, dental exams or
immunizations. Upon receiving proof of completing the visit
from their providers, health plans will send families gift
certificates for groceries or general merchandise and also
may enter them in a drawing for a quarterly prize giveaway.
- AHCCCS's Cultural Competency Policy requires that all
contracted health plans/program contractors must describe
and monitor how care and services will be delivered in a
culturally competent manner. Parents and members who do not
speak English must be provided with translation services.
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Native
American
Indian Health Service (IHS) facilities, statewide, have been
and continue to be very diligent in screening and assisting
families with the completion of KidsCare applications. They are
part of the success in the substantive increase in Native
American KidsCare enrollment. KidsCare outreach staff have
partnered with the Native American representatives. to offer
training and to review policy and procedures. The KidsCare
outreach staff have participated at health fairs held at IHS
facilities. The KidsCare outreach staff with Arizona Community
Health Centers have trained Native American benefit coordinators
from around the state. This training provided an overview of the
KidsCare application, the processes and verification required.
AHCCCS is also working diligently to increase the enrollment of
Native American families in both reservation and urban
communities. The KidsCare News is a newsletter that provides
KidsCare information that is of specific interest to tribal
communities. The informative publication includes KidsCare
updates, AHCCCS outreach efforts and events, tribal enrollment
statistics as well as, the KidsCare eligibility requirements and
income limits.
The number of Native American children in the KidsCare
program has continued to increase at a modest but steady level.
The majority of these children were enrolled through the efforts
of the IHS facilities. Each IHS facility is mandated to explore
alternative health care resources for Native Americans.
Throughout the state, the IHS facilities have contributed to the
expanding enrollment for children who reside on reservations.
Accordingly, most eligible families have opted to enroll their
children with IHS as their health plan.
Tribally operated health care programs have also contributed
to the enrollment of Native American children. Each tribe
designed their outreach plans based on the uniqueness of their
communities:
- Many tribal health care departments have organized
community health fairs and other events focusing primarily
on children's health.
- Other tribally operated programs have incorporated the
application process into their daily routines, capturing
information that can also be used to complete the KidsCare
application.
- Such programs as Women, Infants and Children, Head Start,
and other social service and educational programs have also
played an active role in assisting families enroll their
children in KidsCare.
There are other programs in the state's metropolitan areas
that target the Native American community. Through a grant from
St. Luke's Charitable Trust, the Native American Community
Health Center and the Phoenix Children's Hospital have hired
outreach and enrollment specialists to assist families in
completing application forms. These programs have hired staffs
of Native American heritage who are able to interact with Native
American families residing in urban areas. The staff also
follows up with families by:
- conducting home visits,
- assisting potential applicants with verification of income
documents, and
- generally provide consumer education to make an informed
choice regarding health plan selections.
Please see Attachment 2 regarding IHS facilities targeting
KidsCare population.
Chart 4: Number of KidsCare
Applications
Chart 4 represents the 34,292 applications received from
October 2000 to October 2001. The chart below indicates the
increase in number of applications illustrating the continuing
success of these and numerous other outreach efforts by
community based organizations and AHCCCS. This number does not
include the conversions from state programs or the conversions
from Medicaid when children become ineligible due to excess
income. During the same time period, the KidsCare hotline
received 51,617 calls.
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Health
Plans
As mentioned in the previous section, health plans
participate in community health fairs and make available
information about their services. They also network with
community organizations such as Women, Infants and Children
(WIC) offices, Head Start programs, perinatal outreach programs
and churches. AHCCCS and its contracted health plans participate
in local and statewide partnership activities that remove
barriers to services and raise public awareness about the
importance of preventive health care. These include The Arizona
Partnership for Immunization (TAPI), the Arizona Early
Intervention Program (AzEIP), and the Governor's Advisory
Council on Head Start Collaboration. Health plans have developed
innovative outreach programs, such the "Well Child Express
Day" and "Reach Out to Children" programs
mentioned in the previous section. |
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Partnership
with the Arizona Asian Health Initiative Coalition
AHCCCS Community Relations Unit has worked closely with the
Arizona Asian Health Initiative Coalition to assist them in
organizing as a group. AHCCCS also has assisted them in applying
for several federal grants for family care and continues to be a
part of the coalition. KidsCare is very important to this
coalition and we anticipate that there will be substantial
outreach efforts for KidsCare. |
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Partnership
with Department of Education
AHCCCS and the Department of Education (DOE) partnered to
notify families of the KidsCare program through the Child
Nutrition Program. School districts that participate in the
Child Nutrition program were sent letter, and a sample KidsCare
flier asking that these be sent home with the students with the
reduced lunch application. AHCCCS printed and sent one million
fliers to 381 school districts. Families completed the simple
form, answering three self-screening questions, and returned it
to the school if their child was uninsured, and they wanted an
application mailed to them. The schools then submit the flier to
the KidsCare office for follow-up. Upon receipt of the flier,
AHCCCS staff enters the request for an application into a
database, mails an application, a thank you letter with
instructions about the required verification, and a postage paid
return envelope to the client. To date we have received 18,274
requests, resulting in over 1,385 children being approved for
health insurance. |
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Partnership
with the City of Phoenix Department of Parks, Recreation and
Library Administration
The outreach staff distributed information to the after
school programs, recreation programs, inserted information in
the department's newsletter and in employee's paychecks. |
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Partnership
with the Arizona Interagency Farmworker Coalition (AIFC)
Regional Outreach Coordinators have worked closely with the
Arizona Interagency Farmworker Coalition (AIFC) to enroll the
farmworkers' children in KidsCare. AIFC has been provided with
information packets in both English and Spanish for
distribution. They also participated in the Celebration of
Farmworker Day in Queen Creek and in Somerton collaborating with
other community organizations to disseminate information and
assist in completing applications. |
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Partnership
with Additional Outreach Groups
- Mexican Consulate
- Concilio Latino de Salue
- African-American Health Committee
- Border Health Initiatives:
Border Fronteriza Project
Arizona Border Health Commission
Western Arizona Health Education Center Promotora Project
Arizona Ecumenical Council
Catholic Diocese of Phoenix
Southwest Human Development Council
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Pilot
Project with the Hospitals
Hospitals have piloted with AHCCCS in a project to reach the
"treat and release" emergency and urgent care patients. They
have trained clerical staff to offer the KidsCare flyer to
families with uninsured children. This form is then forwarded to
a coordinator who contacts the family and provides assistance.
with the application. This process has proven successful for
hospitals to receive reimbursement if the chill is Medicaid
eligible and to ensure future care if the child is approved for
KidsCare. |
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EPSDT
Tracking Forms
AHCCCS, in cooperation with health plans and pediatric
providers, designed EPSDT tracking forms that have been cited
nationally as a "best practice." These forms help
guide physicians in providing all the necessary components of a
well-child visit at any given time in the child's life, as well
as making the necessary referrals for follow-up treatment. A
copy of the tracking form, which is completed for each
well-child visit, is maintained in the child's medical record
and a copy is sent to the child's health plan. This allows the
health plan to concurrently track whether children are receiving
all the necessary services at the appropriate intervals.
Information from the EPSDT tracking forms are entered by each
health plan in a database. These forms, which were developed
several years ago, continue to be evaluated for possible
improvements. |
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Promotional
Events
AHCCCS contracted with the media firm, Genesis/Hill &
Knowlton from January 1, through June 30, 2001. They arranged
for five sign-up drive events around the state, two in Phoenix,
one in Tucson, Flagstaff and Yuma.. Radio, newspaper ads, fliers
for community outreach use, posters, brochures and a new logo
were developed and provided. The use of Paid Public Service
Announcements, Billboards and Press Releases were some of the
media products produced to enhance the KidsCare program |
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Brochure
- The newly developed brochure will enable the client to
have two options to obtain an application. The brochure
offers the option to call for an application, or to send in
an attached postage paid post card to request an
application. The 800 number to request an application is
part of the new logo. (See Cover page.)
During 2001, AHCCCS also developed a new partnership with its
health plans and with the Arizona Office of Oral Health to
address barriers to children's oral health services, including
routine preventive care. This partnership has developed
strategies that may be implemented over the next few years. |
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- Expand our work with small businesses. We are developing a flier for
business and are planning to do a mass mailing to 20,000 to 30,000
small businesses. In addition the outreach staff are currently making
contacts by phone and in person.
- Develop partnerships with various Interfaith groups. We will be
offering training for applications, and promoting increased
involvement within their communities to enroll and promote KidsCare.
- Continue to work with the Arizona Department of Juvenile Corrections
(ADJC) to submit applications on incarcerated juveniles during their
release processing so that medical and behavioral health services are
available the day they leave the facility.
- Expand the use of the self-screening flier at immunization events.
- Work with businesses, physician's offices, dental offices,
hospitals, and any other sites that will display posters, and
brochures.
- Work with the Child Care Agency and HUD to explore methods that can
reach the clientele within their agencies.
- Work with libraries asking them to display posters and brochures and
adding that they can use the Internet to obtain an application.
- Work with the Native American community in their chapter houses and
swap meets to promote enrollment and to communicate the benefits of
being on KidsCare.
- Work closer with hospitals to reach the "treat and release"
emergency and urgent care patients.
The AHCCCS KidsCare Administration, in partnership with health plans,
foundations and many community organizations, has made a difference. The
KidsCare Administration continues to partner with the community in
outreach efforts. AHCCCS is researching best practices on an ongoing basis
and receiving input from the community regarding more effective strategies
in enrolling Arizona's children in health care.
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