DEPARTMENT  OF HEALTH  & HUMAN  SERVICES  Office  of  Inspector  General 
Date: 
From: 
Subject:  nters  Outreach  Activities  for  SCHIP  and 
Medicaid  Expansions,  OEI-06-98-00322 
To: 	 Marilyn  H. Gaston,  M.D. 
Assistant  Surgeon  General 
Associate  Administrator  for  Health  Resources  and  Services  Administration 
This  report  responds  to  a request  from  staff  of  HRSAs  Bureau  of  Primary  Health  Care,  Office  of 

State  and  National  Partnerships,  for  our  latest  information  on  SCHIP  and  Medicaid  Expansions 

outreach  activities  by  the  community  health  center  grantees  and their  States.  Although  by  this 

summer  we  expect  to  release  a full  inspection  report  on the  experiences  of  community  health 

center  grantees  in the  implementation  of  SCHIP  and  Medicaid  Expansions,  we  are happy  to 

accommodate  HRSAs  current  data  needs  by  presenting  the  preliminary  results  for  a subset  of  our 

data.  This  report  has  been  revised  to  reflect  informal  comments  on content  that  we  received  from 

HRSAs  Bureau  of  Primary  Health  Care  and  HCFA. 

SUMMARY 

Eighty-three  percent  of  the  health  center  grantees  reported  that  they  were  conducting  outreach 

activities  to  enroll  uninsured  children  in SCHIP  and  Medicaid  Expansions;  Seventy-four  percent  also 

reported  they  were  aware  of their  respective  State  governments  involvement  in such  activities. 

Thus,  one  of  four  health  center  grantees  did  not  experience  any  State  level  outreach  activities  and 

one  of  six  health  center  grantees  did  not  conduct  any  type  of  outreach  activities  on their  own. 

Sixty-one  percent  of  health  center  grantees  did  not  have  outstationed  eligibility  workers,  despite 

the  fact  that  very  few  of them  were  designated  as low  use  sites,  i.e. having  few  Medicaid 

eligible  clients.  Of those  that  had  outstationed  eligibility  workers,  most  received  some  State 

funding. 

METHODOLOGY 

In  1999,  we  published  CHIPs  Impact  on  Changing  Service  Delivery  of  Federal  Health  Centers:  Six 

Case Studies,  OEI-06-98-00320.  Subsequently,  based  on issues  developed  from  these  case 

studies,  we  developed  survey  questions  and  collected  national  data .from  Federally  funded  health 

center  grantees  via  the  Internet  and  mail  surveys  from  January  4 to  February  19,  2000.  Using  the 

HRSA  1998  UDS  database,  we  had  selected  a simple  random  sample  of  462  Federally  funded 

health  center  grantees  from  a total  of  615  that  included  Primary  Health  Centers,  Homeless  Centers 

and  Migrant  Heath  Centers  (Section  330  Grantees).  A total  of  405  (88%)  of  the  sampled  health 

center  grantees  returned  completed  surveys  including  health  center  grantees  from  50  States,  the 

District  of  Columbia,  and  Puerto  Rico.  Since  the  focus  of the  study  was  the  health  center 

grantees  experiences  with  SCHIP  and  Medicaid  Expansions,  we  did  not  validate  their  responses 

with  the  States,  nor  did  we  attempt  to  determine  any  plans  or implementation  schedules  States 
 Page  2 - Marilyn  H. Gaston,  M.D. 
may  have  had  in place.  This  representative  sample  allows  the  national  results  presented  here  to  be 
statistically  significant  at a 95%  degree  of  confidence.  Although  our  study  was  designed  for  the 
national  level,  the  high  response  rates  from  health  center  grantees  within  the  States  should  also 
provide  a meaningful  description  of the  SCHIP  and  Medicaid  Expansions  outreach  activities  at the 
State  level  from  the  health  center  grantees  perspective. 
FINDINGS 
Eighty-three  percent  of  the  health  center  grantees  reported  they  were  engaging  in  SCHIP  and 
Medicaid  Expansions  outreach  activities.  The  most  frequent  outreach  methods  are screening  and 
identifying  eligible  children  from  existing  clients  (76%),  posting  SCHIP  and  Medicaid  Expansions 
information  fliers  and/or  posters  in their  health  centers  (73%),  and  providing  SCHIP  and  Medicaid 
Expansions  information  through  their  health  providers  (64%). 
Seventy-four  percent  of  health  center  grantees  said  they  were  aware  of  SCHIP  and  Medicaid 
Expansions  outreach  activities  conducted  by their  States.  The  most  frequent  State  outreach 
methods  reported  by  health  center  grantees  are  public  service  announcements  (60%),  information 
through  schools  (46%j  and  newspaper  advertisements  (42%).  Another  13  percent  indicated  that 
such  activities  are  in the  planning  stage.  However,  12  percent  of  the  health  center  grantees  were 
unaware  of  any  State-conducted  SCHIP  and  Medicaid  Expansions  outreach  activities. 
Sixty-one  percent  of  health  center  grantees  did  not  have  outstationed  eligibility  workers,  despite 
the  fact  that  very  few  of  them  were  designated  as low  use  sites,  i.e.  having  few  Medicaid  eligible 
clients.  Of those  that  had  outstationed  eligibility  workers,  most  received  some  State  funding.  Of 
the  health  center  grantees  with  eligibility  workers,  45  percent  indicated  that  the  States  provided 
full  funding  for  the  position  and  another  30  percent  indicated  that  the  positions  were  partially 
funded  by the  States.  Twenty-five  percent  of  hea!th  center  grantees  provided  their  own  funding  for 
eligibility  workers.  Among  the  61  percent  of the  health  center  grantees  that  did  not  have 
-	 outstationed  eligibility  workers,  only  7 percent  were  reported  to  be  low  use  sites.  The  number 
of  outstationed  eligibility  workers  in terms  of  full  time  equivalents  (FTEs)  varied  widely  from  0.1 
FTEs to  13  FTEs  per grantees  with  68  percent  reporting  FTEs  up to  1 .O. 
PRELIMINARY  DATA 

The  attached  tables  show  preliminary  results  for  SCHIP  and  Medicaid  Expansions  outreach  activities 

on the  national  level.  The  State  level  raw  data  is provided  in a matrix  format.  In the  near  future, 

we  expect  to  release  a full  inspection  report  which  will  focus  on:  health  center  grantees  and  State 

Primary  Care  Associations  involvement  in the  SCHIP  and  Medicaid  Expansions  planning,  outreach 

activities  and  enrollment  process;  managed  care  contracts  and  reimbursement;  and  altering  health 

center  grantees  business  infrastructure  and  operational  adjustments.  We  hope  this  preliminary 

data  is helpful  to  HRSA.  If you  or your  staff  have  any  questions,  please  contact 

Elise  Stein  at  202-619-0480  or Judy  Tyler  at 214-767-3310. 

Attachments: 

Table  A:  Sample 

Table  B: Survey  Questions 

Table  C: National  Results 

Table  D: Data  by  State 

cc:  Tim Westmoreland 
Director, 	 Center for Medicaid 
and State Operations, HCFA  I 
= Table  A:  Health  Center  Population  and  Sample  Size  by State  I 
State  Date State CHIP  Program  # 330 Grant  Health  # Health  Centers  # Health  Centers 
Plan Approved  Type*  Centers (CHC, HO, MHC)  Sampled  Responding 
IN = 515)  (n=452)  In=4051 
co  02198  S  14  8  8 
CT  04/98  C  8  5  5 
DC  09198  M  1  1  1 
DE  09198  s  3  1  1 
FL  03198  C  29  19  15 
GA  -09190  S  19  14  13   
HI  01199  .- M  4  2  2 
IA  09198  C  5  3  3 
ID  05198  M  7  5  6 
-	 IL  04l98  M  17  13  13 
IN  05198  M  5  5  5 
KS  09198  s  5  3  4 
KY  1II98  C  10  9  8 
LA  1O/98  M  9  8  7 
MA  05198  M  20  17  13 
MD  07198  M  9  8  8 
ME  08198  C  5  2  3 
Ml  04198  C  21  14  10 
MN  07198  M  9  7  5 
MO  04198  M  11  8  8 
MS  10198  C  20  15  12 
MT  09198  S  7  5  6 
NC  07198  S  20  13  13 
ND  1Of98  M  2  2  1  Date State CHIP  # 330 Grant Health  # Health  Centers  # Health  Centers 
PR  -0519%  M  18  13  7 
RI  05198  - M  5  3  3 
SC  0219%  M  18  13  IO 
SD  08198  M  5  4  4 
- TN  09199  M  19  17  15 
TX  05198  M  29  22  17 
UT  07198  S  8  8  7 
VA  1019%  S  14  9  8 
VT  12198  S  2  1  1 
WA  09199  S  23  20  17 
WI  05198  M  10  8  7 
WV  09198  C  11  9  9 
WY  09199  S  3  2  2  z  Table  B:  Health  Center  Survey  Questions  on Outreach 
Q. 	 Thinking  only  about  STATE  activities,  what  types  of outreach  activities  does  your  STATE 
conduct  for  SCHIP  ? 
0  state  IS conducting  outreach  activities 
0  NONE,  but  outreach  activities  are  under  development 
0  NONE,  but  state  has allocated  money  for  outreach;  activities  not  developed 
0  state  is NOT  conducting  outreach  activities 
Q.  You  said  your  state  is conducting  outreach  activities.  What  are they?  (Select  all that  apply) 
0 
public  service  announcements  on television  or radio 
0 
billboards 
0 
direct  mailing  of SCHIP  materials 
0 
newspaper  advertisements 
0 
information  through  school 
0 
through  the  parental  consent  process  for  school-based  health  services 
0 	
through  receiving  health  services  in the  school-based  health  center  (SBHC)  or school-linked 
health  center  (SLHC) 
0 
through  health  education/promotion/outreach  activities  in the  school  from  the  SBHC  or SLHC 
0 
other 
Q. 	 Thinking  only  about  your  HEALTH  CENTERS  activities,  is your  HEALTH  CENTER  conducting 
outreach  activities?? 
0 
my  center  IS conducting  outreach  activities 
0 
my  center  IS NOT  conducting  outreach  activities  Table  B:  Health  Center  Survey  Questions  on Outreach 
Q. 	 You  said  your  health  center  is conducting  outreach  activities.  What  are they?  (Select  all that 
apply) 
0 
screening  and  identifying  eligible  families  from  existing  clients 

0 
distributing  information  through  your  health  providers 

0 
direct  mailing  of SCHIP  materials 

0 
posters  and/or  fliers  placed  in your  clinics 

0 
school-based  health  centers 

0 
school-linked  health  centers 

0 
basic  preventive  health  services  in schools 

0 
health  fairs 

0 
distributing  program  information  at local  business  sites 

0 
door  to door  visits  to potentially  eligible  families 

0 
collaborate  with  other  community  organizations 

0 
other 

Q.  Does  your  center  have  an outstationed  eligibility  worker? 

0 
yes 

0 
no 

Q.  You  said  that  your  center  HAS  an outstationed  eligibility  worker.  How  is the  position  funded? 

0 
fully  funded  by the  state 

0 
partially  funded  by the  state 

0 
not funded  by the  state 

Q. 	 How  many  FTEs  (full  time  equivalents)  of outstationed  eligibility  workers  does  your  center 
have  ? (Use  decimals.  For example,  2% = 2.5) 
FTEs 
Q. 	 You  indicated  that  your  health  center  DOES  NOT  HAVE  an outstationed  eligibility  worker.  Has 
the  state  designated  your  health  center  a low  use  site for  the  purpose  of out-stationing 
eligibility  workers  ? 
(4  0  yes 
0 
(b)  no  \  Table  C-l  : All  Health  Centers  -- Point  Estimates  and  Confidence  Intervals 
for  Survey  Questions  on  Outreach  (n=405) 
Point  Estimate  Standard  Error  95% Confidence 
Proportion  of All Health  Centers  (in percent)  (in percent)  Interval 
Are States  conducting  outreach 
activities 
+ yes 
 74  1.3  71.5 - 76.5 
no 
 12  0.9  10.1 - 13.9 
l 
no,  but funds  allocated 
 8  0.8  6.5 - 9.5 
l 
b  no,  but  developing 
 5  0.6  3.8 - 6.2 
.  dont  know 
 1  0.3  0.4 - 1.6 
Of States  conducting  outreach,  the 
top  3 activities: 
.  PSAs  on T\j,  radio  60  1.4  57.2  - 62.8 
.  info.  through  schools  46  1.5  43.2  -48.8 
t  newspaper  ads  42  1.4  39.2 - 44.8 
Centers  reporting  they  &  conduct 
outreach  ativities  _  83  1.1  80.9 - 85.1 
Of centers  conducting  outreach, 
the  top  3 activities: 
.  screen  current  clients  for  76  1.2  73.6  - 78.4 
eligibility 
b  posters/fliers  in clinics  73  1.3  70.5 - 75.5 
.  info  through  health  providers  64  1.4  61.3  - 66.7  Table  C-2.1 : All  Health  Centers  -- Point  Estimates  and  Confidence  Intervals 
for  Survey  Questions  on Outstationed  Eligibility  Workers 
*(n=405);  **(n=15g);  ***(n=246) 
Point  Estimate  Standard  Error  95% Confidence 
Proportion  of All Health Centers  (in percent)  (in percent)  Interval 
Centers  having  outstationed 
eligibility  workers*  39  1.4  36.2 - 41.8 
Of centers  having  outstationed 
eligibility  workers,  State  funds  the 
position:** 
  fully  45  3.4  38.3 - 51.7 
t  partially  30  3.1  23.9 - 36.1 
.  not  at all  25  3.0  19.1 - 30.9 
Of centers  not  having  outstationed 
eligibility  workers,  State 
designated  as low  use  *** 
.  yes  -.  7  1.3  4.5 - 9.5 
_ 
b  no  82  1.9  78.3  - 85.7 
b dont  know  - 11  1.5  8-14 
Table  C-2.2:  All  Health  Centers  -- Survey  Questions  on Outstationed  Eligibility  Workers: 
Number  of Full  Time  Equivalents  (n=159) 
#  of Health  Centers  Percent 
Of centers  having  outstationed 
eligibility  workers,  their  number  of 
FTES 
  up to 0.5  44  28 
. 0.6 to  1.0  64  40 
  1.1 to 2.0  20  13 
  2.1 to 5.0  24  15 
  5.1 to  10.0  6  4 
b more  than  10  1  --  I 
Table  D-l  : Health  Center  Outreach  Activities  by  State  I 
0.  Is your  health  center  conducting  outreach  activities  for  SCHIP? 
State  # of Health  Centers  Yes  No 
Responding 
AK  1  1  __ 
AL  8  6  2 
AR  6  6  __ 
AZ  10  9  1 
CA  29  25  4 
co  8  7  1 
CT  5  5  -_ 
DC  1  1  -- 
DE  1  1  __
FL-- 16  15  1 
GA  13  11  2 
HI  2  2  __
IA  3  3  _-
ID  6  6  -- 
IL  13  13  _-
IN  6  6  __
KS  4  4  _-
KY  8  8  -_ 
LA  7  6  1 
MA  13  11  2 
MD  8  6  2 
ME  3  3  -- 
Ml  10  7  3 
MN  6  4  2 
MO  8  8  __
MS  12  IO  cA  2 
MT  6  6  __ Table  D-l  : Health  Center  Outreach  Activities  by  State 

Q. Is your  health  center  conducting  outreach  activities  for  SCHIP? 

I 
State  # of Health  Centers  Yes  No 
Responding  I 
NC  13  9  4 
ND  1  ms  1 
NE  2  2  -- 
NH  4  4  -- 
NJ  7  6  1 
NM  7  6  1 
NV  1  --  1 
NY  20  17  3 
OH  7  6  1 
oli  _  3  2  1 
OR  6  5  1 
PA  13  9  4 
PR  7  1  6 
RI  3  3  _-
SC  10  6  4 
SD  4  4  _-
TN  16  6  10 
TX  17  14  3 
UT  7  7  -- 
VA  8  8  __ 
VT  1  1  -- 
WA  17  13  4 
WI 	 7  6  1 
9  9  -- 
2  2  f  I-
Table  D-2:  Number  Of Outstationed  Eligibility  Workers  And  Funding  By State 
Outstationed  workers  If yes, does your  state  provide 
at your  health  center?  funding?  I 
State  # Health  Centers 
Responding 
AL  8  3  5.  2  1  0 
AR  6  6  0  6  0  0 
I  AZ I 
1  2  1  8  0  0  2 
I  I 
20  9  14  5  1 
co 
8  '3  5 
CT  5  2  3 
DC  1  1  0 
I  I 
DE  I  0  I  1 
I  _  I  I 
FL  I  -- 16  6  10 
GA  13  4  9 
HI  2  2  0 
II3131IA0 

I  I  I  I  1 

ID  5 
I  I  I 
IL  I  8  5 

I 
IN  I 

1 
MA  1  13 	 1  7  I6 
I  *  I 
4  4 
1  ME 1  I  2  I  1 
Ml  10  2  8 
MN  6  1  5 
I  I 
3  5 
MS  12  4.  8 
] 
I 
MT  6  2  4 
NC  13  4  9  Table  D-Z:  Number  Of Outstationed  Eligibility  Workers  And  Funding  By State 
Outstationed  workers  If yes, does your  state  provide 
at your  health  center?  funding? 
State  # Health Centers  Table  D-3:  Health  Centers  Designated  As A Low  Use Site  by State 
When  No  Eligibility  Workers  Outstationed 
Outstationed  workers  If no outstationed  workers, 
at your  health  center?  designated  as a low  use site? 
State  # Health  Centers  No  Yes  No  Dont  Know 
Responding 
AK  1  0 
AL  8  5 
AR  6  0 
AZ  10  8 
CA  .29  9 
co  8  5 
CT  5  3 
DC  1  0 
DE  ..  1  1 
FL  V+  10 
GA  13  9 
HI  2  0 
IA  3  0 
ID  6  1 
IL  13  5 
IN  6  2 
KS  4  3 
KY  8  6 
LA  7  2 
MA  13  6 
MD  8  4 
ME  3  1 
Ml  10  8 
MN  6  5 
MO  8  5 
MS  12  8 
I  I  I 
MT  6  4  0  4  0  Table  D-3:  Health  Centers  Designated  As A Low  Use Site  by State 
When  No  Eligibility  Workers  Out&ationed 
Outstationed  workers 
at your  health  center? 
NE  2  2 
NH  4  3 
NJ  7  0 
NM  7  6 
NV  1  1 
NY  20  15 
OH  7  7 
OK  :  3  0 
OR  6"  1 
PA  13  13 
PR  7  7 
RI  3  1 
SC  10  5 
SD  4  4 
TN  16  15 
TX  17  10 
UT  7  4 
VA  8  8  0  8  0 
VT  1  1  0  1  0 
WA  17  11 
WI  7  2 
WV  9  8