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 HRSA’s 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 HRSA’s 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 

HRSA’s 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 government’s 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 CHIP’s 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 FTE’s (full time equivalents) of outstationed eligibility workers does your center 

have ? (Use decimals. For example, 2% = 2.5) 

FTE’s 

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 

(b) 0 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 

l no 

l no, but funds allocated 

b no, but developing 

. don’t know 

74 1.3 71.5 - 76.5 

12 0.9 10.1 - 13.9 

8 0.8 6.5 - 9.5 

5 0.6 3.8 - 6.2 

1 0.3 0.4 - 1.6 

Of States conducting outreach, the 

top 3 activities: 

. PSA’s 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) 

Proportion of All Health Centers 

Centers having outstationed 

eligibility workers* 

Of centers having outstationed 

eligibility workers, State funds the 

position:** 

’ fully 

t partially 

. not at all 

Of centers not having outstationed 

eligibility workers, State 

designated as “low use” *** 

. yes -. 

_ b no 

b don’t know -

Table C-2.2: All Health Centers 

Number 

Of centers having outstationed 

eligibility workers, their number of 

FTE’S 

’ up to 0.5 

. 0.6 to 1.0 

’ 1.1 to 2.0 

’ 2.1 to 5.0 

’ 5.1 to 10.0 

b more than 10 

Point Estimate Standard Error 95% Confidence 

(in percent) (in percent) Interval 

39 1.4 36.2 - 41.8 

45 3.4 38.3 - 51.7 

30 3.1 23.9 - 36.1 

25 3.0 19.1 - 30.9 

7 1.3 4.5 - 9.5 

82 1.9 78.3 - 85.7 

11 1.5 8-14 

Survey Questions on Outstationed Eligibility Workers: 

of Full Time Equivalents (n=159) 

# of Health Centers Percent 

44 28 

64 40 

20 13 

24 15 

6 4 

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 

Responding 

AK 1 

AL 8 

AR 6 

AZ 10 

CA 29 

co 8 

CT 5 

DC 1 

DE 1 

FL-- 16 

GA 13 

HI 2 

IA 3 

ID 6 

IL 13 

IN 6 

KS 4 

KY 8 

LA 7 

MA 13 

MD 8 

ME 3 

Ml 10 

MN 6 

MO 8 

MS 12 

MT 6 

Yes No 

1 __ 

6 2 

6 __ 

9 1 

25 4 

7 1 

5 -_ 

1 

__ 1 

15 1 

11 2 

__ 2 

3 _-

6 

13 _-

__ 6 

4 _-

8 -_ 

6 1 

11 2 

6 2 

3 

7 3 

4 2 

__ 8 

IO cA 2 

__ 6 
-- 

-- 

-- 

-- 

-- 

-- 

Table D-l : Health Center Outreach Activities by State 

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

I State 

NC 

ND 

NE 

NH 

NJ 

NM 

NV 

NY 

OH 

oli 

# of Health Centers 

Responding 

13 

1 

2 

4 

7 

7 

1 

20 

7 

3 

Yes No 

I 

9 4 

ms 1 

2 

4 

6 1 

6 1 

1 

17 3 

6 1 

2 1 

5 1 

9 4 

1 6 

3 _-

6 4 

4 _-

6 10 

14 3 

7 

8 __ 

1 

13 4 

6 1 

9 

2 f 

_ 

OR 6 

PA 13 

PR 7 

RI 3 

SC 10 

SD 4 

TN 16 

TX 17 

UT 7 

VA 8 

VT 1 

WA 17 

WI 7 

9 

2 
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 20 I 9 14 5 1 

co 8 '3 5 

CT 5 2 3 

DC 1 1 0 

I DE I I 0 I 1 

I FL I -

- 16 _ I 6 I 10 

GA 13 4 9 

HI 2 2 0 

II31310 IA

I ID I I 5 I 1 

I IL I I 8 I 5 

I IN I 

1 MA 1 13 1 7 I6 

I 4 * I 4 

1 ME 1 I 2 I 1 

Ml 10 2 8 

MN 6 1 5 

I 3 I 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 Don’t 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 

MT 6 4 I 0 I 4 0 I 
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