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Bexar County Hospital District as University Health Systems (Bexar UHS): PARTNERSHIPS TO INCREASE COVERAGE IN COMMUNITIES INITIATIVE (PICCI)

Bexar County Hospital District as University Health Systems (Bexar UHS)

San Antonio, Texas, 78229

Project: University Health System’s Community Partnership Program to Increase Health Coverage through Access, Outreach, Education and Enrollment

Amount: $236,394

Project Abstract

Texas ranks eighth in the US for individuals living in poverty and 51st in the nation for adults and children with health insurance. As Texas opted out of Medicaid expansion, individuals who have no health care coverage are less likely to receive preventative services, more likely to die of serious acute conditions, and more likely to experience financial hardship connected to medical care. In 2013, University Health System formed Bexar Health Marketplace (the Health System) in partnership with community-based health care organizations to facilitate enrollment in the Health Insurance Marketplace. This project proposes to build on the lessons learned from the initial health insurance enrollment period by incorporating the planning, processes, and established partnerships. It hopes to increase knowledge about health insurance available through the Marketplace, Medicaid, and the Children’s Health Insurance Program (CHIP) to develop informed health care consumers who will maximize the benefits afforded to them through the ACA for preventive care, thus increasing access to care, improving health, and decreasing the cost of health care. The target population includes uninsured individuals who are Hispanic, Caucasian, and African American, who are hard to reach due to language and literacy barriers, and are from San Antonio and Bexar County areas–with special emphasis on the downtown eastside areas of Eastside Promise Neighborhood and Eastside Promise Zone.  Also of interest are young Hispanics ages 19-34, women less than 65 years old, and children 18 years and younger within this population.

The Health System’s program consists of three major components: personnel training, expanding education through outreach, and increasing Marketplace, Medicaid, and CHIP enrollment. Bexar UHS plans to hire and train bilingual, culturally-competent Community Health Educators (CHEs) for outreach and education activities. The CHEs will receive training on the ACA and its requirements, including health insurance terminology and requirements of the law, and will also emphasize available community resources. The CHEs will educate and help participants make health care decisions and will know how to enroll participants in healthcare. CHEs will use Medicaider, an online screening tool, to determine eligibility for Medicaid, CHIP, Supplemental Security Income (SSI), or other federal and state programs. Bilingual CHEs will provide no-cost language assistance and services for clients with hearing impairments and will comply with National Culturally and Linguistically Appropriate Services (CLAS) Standards. A “Health Insurance 101” curriculum will be used to train clients on the basics of health insurance.

Once a client has been paired with Medicaid, CHIP, SSI, or another federal or state program, continued education and support will follow. Marketplace classes will be available throughout the county in various sizes and languages. Bexar County Community Resources will provide BiblioTech, a digital library, to serve as an enrollment center with enrollment assistance. They will continue to work with CareLink, University Health System’s financial assistance program for the uninsured, to conduct workshops in basic health insurance education and disseminate announcements about educational events in the monthly CareLink billing statements. Bexar County Hospital has access to 61 CMS Certified Application Counselors and Cyracom, a telephone-based translation service, both of which will help clients through the enrollment process.
The Health System expects outcomes to include increased awareness, knowledge of and enrollment in 1) the Marketplace, Medicaid, and CHIP; and 2) other health insurance costs, terms, and options.

Multiple evaluation activities will be conducted to determine whether the proposed activities made a measureable difference in the underserved minority populations. Bexar UHS plans to track the number of culturally and linguistically appropriate printed materials distributed and to whom; when and where educational activities are being provided; and, how aware the underserved, minority population is of local, state, and federal benefits. The program plans to conduct a survey with at least 2,000 participants at educational events. The goal of the survey is to capture the awareness of those in attendance regarding health care coverage benefits, baseline knowledge, attitudes, behaviors and basic demographic information. An enrollment survey for those enrolled as a direct result of the program will gather information on knowledge, beliefs, and attitudes related to the marketplace, impact of the program’s initiatives, program efficacy, customer satisfaction, and socioeconomic characteristics. A chi-square test is planned for these surveys to determine a profile of program participants.

Other measures that the grantee will collect include:

  • Number of underserved and hard to reach populations served through outreach, education and enrollment activities per year;
  • Number of persons enrolled in private insurance through the Marketplace or Medicaid/CHIP;
  • Number of workshops for consumers on accessing and obtaining health information;
  • Number of individuals from underserved and hard to reach minority populations to apply for health insurance coverage offered through the Health Insurance Marketplace;
  • Number of persons receiving appropriate and available informational materials from the TX Health and Human Services Commission (HHSC), Centers for Medicare and Medicaid Services (CMS) and/or marketplaces during outreach events, such as education and awareness sessions;
  • Number of informational materials distributed events or as CareLink inserts;
  • Number and type of culturally and linguistically appropriate communication strategies needed to effectively reach underserved minority population(s);
  • Number and type of marketplace education and enrollment assistance activities promoted through partners’ websites, newsletters, etc.;
  • Number of presentations, displays, and/or materials available to community-based organizations, faith-based organizations and others for the purpose of outreach to culturally diverse and hard to reach populations in English and other languages; and
  • Number of collaborative meetings.

Health System and Life Experience: Improve health and healthcare outcomes for racial, ethnic, and underserved populations.
Cultural and Linguistic Competency: Improve cultural and linguistic competency and the diversity of the health-related workforce.


AHS-1: Increase the proportion of persons with health insurance.
11/12/2015 6:49:00 PM