ALAMEDA HEALTH CONSORTIUM
Oakland, CA

§        Objectives

Our goals in Phase Two of the Alameda County Communities in Charge project are to move Alameda County toward universal health insurance coverage and improve access to high quality care in Alameda County's safety net system.

Objectives

Expand enrollment in Alliance Family Care, a managed health coverage product for eligible Alameda County families.  This product was developed and is administered by our partner, the Alameda Alliance for Health, the local not-for-profit managed care plan.

Target Population

• Children and parents with a particular focus on immigrants, including undocumented immigrants

• Families with at least one child enrolled in Medi-Cal Healthy Families (S-CHIP), or Alliance Family Care through the Alliance

• Families with income up to 300% of the Federal Poverty Level

Work with the Alameda Alliance for Health to implement new healthcare coverage products for uninsured adults.

Target Population

• In-home Supportive Services (IHSS) workers (over 3500-7000 individuals)

• Childcare workers/early educators

• Adults with dependent children

Pilot a system to assist high utilizing disabled, indigent patients in obtaining SSI/Medicaid coverage and provide intensive care management systems.

Target Population

• High outpatient utilizing adult indigent patients already being served in our safety net program

• All are under 200% of the Federal Poverty Level; a majority are people of color; and have one or more chronic medical and/or mental health conditions.

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§        Program Design

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§        Financing & Outreach Strategies

Alliance Family Care

• $14.87 million for five years from Alameda Alliance for Health's reserve funds

• $400,000 for two years from a California Endowment grants specifically to subsidize coverage for undocumented children

• $1 million per year in County Tobacco Master Settlement Agreement funds to subsidize coverage for children and enroll through a school-based readiness program

• $1 million from a California Health Care Foundation grant to subsidize coverage

• Alliance Family Care has enabled us to enroll entire families into coverage programs even when family members are eligible for different programs and has allowed us to develop a non-wrong-door, single-point-of-entry approach to outreach and enrollment.  The goals is to have a seamless enrollment system that makes the actual enrollment in the various programs "invisible" to the enrollee and the determination of which programs families are eligible for the responsibility of the system itself.  Outreach is conducted using an out-stationed model.  Families enroll at over 40 clinic and community based enrollment sites across the county an at County-sponsored enrollment events (via a State S-CHIP Grant).  They can enroll in Alliance Family Care, Medi-Cal, Healthy Families and other programs.

IHSS Workers

• $1 million per year from County Tobacco Master Settlement Agreement funds to subsidize coverage for IHSS workers

• $500,000 per year from the Alameda County Social Services Agency to subsidize coverage

• $5.5 million per year from State/Federal matching funds to subsidize coverage

• Outreach conducted through mailers from the Alliance and the employer of record (the Public Authority) as well as direct outreach through the IHSS workers' union (SEIU 616). 

Childcare/Early Educators

• $30,000 from the United Way of the Bay Area through Bank of America's Success By Six Program to enroll workers, their families, and clients at childcare centers in existing coverage programs.

• Outreach for the campaign is being conducted through grassroots organizaing and associations

Independent Adults

• To be determined.

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§       Accomplishments to Date

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Alliance Family Care

• Enrollment for Alliance Family Care began in July 2000

• 7400 members currently enrolled as of August 2002; this is well above the original estimate of 2000 over five years and highlights are extreme success in enrolling members and the value our community members place on affordable coverage

• The Alliance Board increased the reserve fund allocation from $4.1 million to $14.87 million

• The County allocated $1 million per year in County Tobacco Master Settlement Agreement funds to subsidize coverage

• Obtained $1 million from a California Health Care Foundation Grant to subsidize coverage

• With the Community Voices Project and the Alliance, completed member focus groups in English, Spanish, and Cantonese and enrollment specialist focus groups regarding benefits, costs, enrollment processes, and member services; member responses were overwhelming and positive.

The Alameda County Access to Care Collaborative

• This group which meets monthly is comprised of the leadership of the county safety net system.  It focuses on issues related to healthcare coverage, access to high quality healthcare, and racial and ethnic health disparities.  Communities in Charge and the Community Voices Projects provide staff to the Collaborative.

Members Include:

• The Alameda Alliance for Health

• The Alameda County Health Care Services Agency

• The Alameda County Medical Center

• The Alameda County Social Services Agency

• The Alameda Health Consortium

• The W.K. Kellogg Community Voices Project

• The County of Alameda Uninsured Survey (CAUS), the first multi-language county-specific coverage survey was completed, and a summary report was distributed to over 2800 county, state and federal community-based organizations, policymakers, healthcare advocates, etc.

• The CAUS press conference resulted in extensive print, television and radio coverage in English, Spanish, Cantonese, Vietnamese, and Korean outlets.

• Developed a proposal for universal healthcare coverage on behalf of Access to Care Collaborative; developed preliminary cost data for families as part of the proposal; supported by the County Board of Supervisors; this document provided a blueprint to our efforts in the county.

• Participated in the Children and Families Health Insurance Task Force and Implementation Planning Group sponsored by a County Supervisor, influenced the inclusion of families, not just children in preview in front of the task force and provided all the data on the uninsured and coverage cost estimates.

• With assistance from Medimetrix, the Collaborative developed a brochure to highlight its members and efforts; currently developing a media strategy/communication plan to be implemented at the end of 2002.

• In June of 2002, the United Way of the Bay Area awarded the Collaborative with $10,000 to support its efforts

• Presented Alameda County showcase to the leadership of The California Endowment to solicit their support for a broad county proposal to increase healthcare coverage; submitted a concept paper/initial proposal for funding for subsidies, outreach and enrollment, and policy work.

IHSS Workers

• Working with the Alliance and the local unions, successfully leveraged funds for IHSS workers; the County allocated $1 million per year in County Tobacco Master Settlement Agreement funds and $500,000 per year from the Alameda County Social Services Agency to subsidize coverage; this drew down $5.5 million per year from State/Federal matching funds.

• Alliance implemented Alliance Group Care, the product for IHSS workers, in June 2002.

• Designed comprehensive Alliance Group Care evaluation, including non-member survey and member focus groups in Cantonese, Spanish, English; implementation of evaluation began August 2002.

Childcare Workers/Early Educators

• Joined the steering committee of Work and Family Coalition a group of childcare workers/early educators, childcare agencies, labor and other advocates working to secure healthcare coverage for childcare workers.

• Solicited support from County Board Supervisors

• Obtained $30,000 on behalf of the coalition from the United Way of the Bay Area through Bank of America's Success by Six program to enroll workers, their families, and clients at childcare centers in existing coverage programs; developed system and hired contractor to coordinate project.

• Developing a strategic plan to focus the campaign work in a difficult budgetary environment.

• Working with Insure the Uninsured Project to develop the recommendations for the legislative and financing mechanisms.

SSI/Medicaid Enrollment Project

• Obtained buy-in from key stakeholders throughout County

• Convened work group to design system and identify policy targets; group includes; Alameda County Medical Center Leadership, Alameda County Health Care Services Leadership, Social Services Agency staff, Clinic leaders, homeless and mental health advocates, etc.

• Negotiated contract with the Homeless Action Center to have access to their community ties and policy expertise

• Convened policy subgroup and briefed key County Supervisors

• Gathered best practices and county data to identify target population and pilot location

§       Challenges      

Sustaining and Expanding Alliance Family Care:  At 7400 members two years into the five year commitment, enrollment in Alliance Family Care has already exceeded its initial 2000-member target.  Unfortunately, though, it is not clear that there will be enough funding to increase (or even sustain current program membership).  Given the impact of California's budget crisis on the Alliance, it is not certain that the Alliance will be able to continue generating the surpluses necessary to full support the product.  Realizing that foundation support has limitations, the Alliance and the Access to Care Collaborative are exploring other funding sources, including developing business partnerships and hiring development staff.

Identifying more funding mechanisms for healthcare coverage and pilots:  Aside from the 9300 residents who have been successfully enrolled in Alliance Family Care, or First Care, their unsubsidized product there are still an estimated 175,000 uninsured residents in Alameda County, the largest portion of which are adults without dependent minor children.  The challenge will be to find creative strategies to move more people into coverage and build the capacity of the safety net and the local healthcare system to adequately meet their needs.  Additional funds also will be needed for the SSI/Medicaid Enrollment Project to continue beyond the duration of the Communities in Charge grant.

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§        Contact Us

Luella Penserga
Interim Project Director
Community Voices Project
Communities In Charge Project
Alameda Health Consortium
1320 Harbor Bay Parkway, Suite 250
Oakland, CA  94502
Ph: 510-769-2240
Fax: 510-769-2247
Email: luellap@chcn-eb.org

Alameda County Website Links:

Alameda Alliance for Health:  http://www.alamedaalliance.com

Community Voices Healthcare for the Underserved:  http://www.communityvoices.org

Community Health Center Network:  http://www.chcn-eb.org

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