Problem Identification:
The Department’s Strategic Plan for 2000-2004 and the Operating Plan for FY2001 reflect a priority for achieving universal health coverage for all Marylanders. However, despite a number of existing Departmental initiatives, neither plan explicitly states that maximizing enrollment for those eligible in existing insurance programs is a high priority.

Recommended Action:
The Department should establish an explicit high priority to identify Baltimore City residents who are eligible for existing public insurance programs and assist in the enrollment of those residents. Additionally, the Department should sustain a campaign to encourage enrollment in employer-based programs for those who work and do not elect health insurance coverage. Current efforts should be expanded to encourage employers who do not offer insurance to assist in encouraging eligible employees to apply for insurance programs and/or take advantage of reduced cost and free services. Employer sponsored incentives for employees should be explored.

Revenue Enhancement, Service Improvement

Functional/Operational Area:
BCHD: Baltimore Health Care Access, Inc. and other appropriate agencies of the Department in concert with Department of Health & Mental Hygiene.

Estimated Annual Impact:
The immediate financial impact cannot be estimated because reliable information on the number of uninsureds who are eligible for some type of insurance is not readily available.

Estimated Implementation Costs:
The absence of reliable estimates of the size of the target
population makes cost estimates difficult.

Barriers to Implementation:
BHCA, Inc. has many established effective relationships
with individuals and organizations in the community that have greatly enhanced BHCA’s ability to identify and enroll children and pregnant women in the Health Choice and MCHP programs. These organizations have established considerable credibility in the community. However, BHCA’s mandate stops with pregnant women and children. Responsibility for the more difficult populations of single males under 65 are spread among the various agencies that have contact with that population. The process of recovering medical assistance for individuals who have left welfare but are still eligible for Medical Assistance is a State managed process for which the BCHD (through BHCA) has an advisory and coordinating role only.

Next Steps:
Work closely with State officials to establish a working data base for estimating current numbers of uninsured by age, gender, family income/employment status. Such a database would be critical to measuring progress.

At every level within the Department there is a keen
awareness of the barriers to quality health care for people who are uninsured and the public health implications. There is also ample evidence of a Department-wide commitment to increasing insurance coverage for pregnant women and children and to improving the health care infrastructure’s ability to provide quality care for all uninsured and underinsured residents. Examples include the Men’s Health Program, successful competition for national private foundation grant funds to improve services to the uninsured, and a recent application for funds under a new federal initiative for the same purposes. While working toward a long-term goal of universal coverage, some short-term measurable goals should be established for maximizing coverage in existing programs. This is well underway for pregnant women and children through a well-orchestrated program to work with the schools to identify children eligible for MA or MCHP and a program of expedited eligibility for pregnant women who have so-called associated cases. An equally aggressive and coordinated effort is needed for the other populations. For instance, BHCA makes considerable effort to inform pregnant women and parents of the availability of reduced-fee and free care in community health centers and other health care facilities. Likewise a more definitive role should be developed for BCHD in working with the state to restore Medical Assistance coverage to those who were inadvertently dropped from the roles as a result of welfare reform. The extensive network of community contacts and outreach workers nurtured by BHCA such as the faith community should be tapped. Likewise, strategies to deploy the electronic and print media as well as other advertising vehicles to promote Health Choice and MCHP enrollment should be extended to all underserved and uninsured target groups.