1

Texas Medicaid

Medical and Dental Information Series

Module 2Version 1.2 (6/22/2010)

2/22/2013

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Module 2

Medicaid Curriculum Overview

Module 1: General Structure of the Texas Medicaid System

Module 2: Understanding Medicaid Clients and Health LiteracyModule 3: Texas Health Steps

Module 4: Navigating Insurance and Managed Care

Module 5: Interfacing with Medicaid as a Provider

Module 6: Special Medicaid Programs

Module 7: Special Medical Issues

Module 8: Special Dental Issues

Module 2

Understanding Medicaid Clients

and Health Literacy

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Module 2

Module 2: ObjectivesAfter completing this module, you should be able to:

Explain how poverty is defined and measured in the U.S.

List at least three characteristics of children living in poverty

Contrast the terms generational poverty and situational poverty

List at least five barriers to health care caused by poverty

List at least three ways that emergency department usage is affected by poverty and unemployment

Define health literacy and its effect on health and provision of health care

List Texas Medicaid initiatives to address adverse effects of poverty and disability

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Module 2: Identifying Patterns

This module attempts to describe poverty in terms of the

patterns observed in the research literature– but all patterns have

exceptions. Patterns involve broad generalizations about large

groups of people. The goal of this presentation is to describe

poverty, its barriers and its health implications to help providers

improve their patient care– not to create or perpetuate stereotypes.

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True or False?Test Your Knowledge about Texas Medicaid:

In 2011, nearly 1 in 20 people and 1 in 15 children lived in poverty.The federal government requires that state Medicaid programs set service eligibility at 100% of the FPL.A family in generational Poverty is one that has been in poverty for two or more generations.Nationally, a 1% decrease in the employment rate adds about 1 million new enrollees to Medicaid & CHIP.Only about 12% of adults have a health literacy level that could be considered proficient.

REVIEW:What is Medicaid?

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Medicaid is a federal health care program that is jointly funded by federal and state money. Medicaid is jointly funded by the state and federal governments:

About one-third funded by the State of TexasAbout two-thirds funded by the Federal Government

In December 2011, about 1 in 7 Texans relied on Medicaid for health insurance or long-term services (3.7 million of the 25.9 million).Medicaid was created through Title XIX of the 1965 Social Security Act, and established in Texas in 1967.

In Texas, Medicaid is administered by the Texas Health and Human Services Commission (HHSC).

Medicaid is an entitlement program, which means:

The number of eligible people who can enroll cannot be limited.Any services covered under the program must be paid.

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REVIEW:Who can receive Full Medicaid Benefits?Categories of Eligibility

Families and ChildrenBased on income level, depending on age, or pregnancy

Cash Assistance RecipientsBased on receipt of Temporary Assistance for Needy Families (TANF) or Supplementary Security Income (SSI)

Aged and Disabled IndividualsBased on income, age, and physical and/or mental disability

Some Dual Eligible Individuals: Qualified Medicare Beneficiaries

Based on age, income, and disability status

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REVIEW:Who can receive Limited Medicaid Benefits?Categories of Eligibility

Some Dual Eligible Individuals: In the Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, Qualified Individuals, and the Qualified Disabled Working Individuals Programs, Medicaid pays for some or all of Medicare premiums

Based on income, assets, age, and/or disability

Non-CitizensUndocumented persons who are not eligible for Medicaid based on citizenship status may receive emergency services

Qualified Legal Permanent Residents are eligible for limited Medicaid services

Special programs for women (e.g., family planning services, cervical and breast cancer coverage, community attendant services)

Available to women and based on income level and age

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REVIEW:What Does Medicaid Cover?

Long-term services for elderly and disabled clients

Mental health and substance abuse treatment

Acute and preventive health care for all ages

Physician visits

Inpatient and outpatient services

Pharmacy, lab, and radiology costs

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Dental services for patients under the age of 21

Preventive

Therapeutic

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

1.872.10

2.492.68

2.88 2.79 2.83 2.88 3.003.30

3.54

Texas Average Monthly Medicaid Enrollment

SFYs 2001-2011

Mill

ions

At any one time, how many individuals are enrolled in Medicaid? About 3.54 million

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REVIEW:How Many People Does Texas Medicaid Serve?

REVIEW:Texas Medicaid Recipients State Fiscal Year 2011

Gender

Age

Ethnicity

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

55%

36%

54%

45%

30%

22%

11%

17%

17%

8%

6%

12

Female Male

0-5 6-14 15-20 21-64 65+

Hispanic Caucasian African-American

Other

Unduplicated ClientsSFY 2011 = 4,567,077

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REVIEW:Who is Eligible for Medicaid Benefits?

Medicaid primarily serves:Low-income families

Foster children

Pregnant women

The elderly

People with disabilities

Babies born to mothers receiving benefits at time of delivery(Services available for one year)

Caseload Costs0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Aged & Disability Re-lated30%

Aged & Disability Re-lated58%

Non-Disabled Adults 9%

Non-Disabled Adults 10%Non-Disabled Children

61%

Non-Disabled Children32%

Texas Medicaid 2011

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Medicaid and Poverty

A family crisis such as death, disability or divorce that leads to loss of incomeLoss of a job or other economic distressLong-term poverty that persists for more than one generation

Medicaid serves primarily low-income or disabled

families and individuals– those likely to be in poverty.

Why might a family or individual qualify for

Medicaid?

What is poverty?What is the link between poverty and health care?How does health literacy affect health care?What Texas Medicaid programs help reduce health disparities caused by poverty or disability?

This module focuses on helping providers

understand some of the challenges faced by their

Medicaid clients that lead to health disparities:

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Why Is It Important to Learn About Poverty? Poverty and Health

Research points to a strong negative relationship between Income and Health Status: As income declines, health status also declines

1 2 3 4 5 6 7 8 9 100

5

10

15

20

25

30

35

40

45

Income and Health

Income Decile

% o

f ind

ivid

uals

repo

rting

poo

r/fai

r he

alth

Fair/Poor He...0%

5%

10%

15%

20%

25%

17% 16%

20%

Health Status of Adults at or below 133% FPL

Uninsured Childless Adults

Uninsured Parents

Medicaid

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Why Is It Important to Learn About Poverty? Poverty and Dental Care

Poor (≤100%FPL)

Low Income (100-200% FPL)

Middle Income (200-400% FPL)

High Income (400%+ FPL)

26.5%

29.9%

41.9%

57.9%

Percentage of people who visit a dentist at least once a year, by family income

Why Is It Important to Learn About Poverty? Poverty and Cultural Competency

Health providers and organizations that are culturally competent demonstrate the ability to recognize role of cultural diversity—including values, traditions and language preferences—in making positive health outcomes.

Linking poverty to culture is controversial, especially explanations that blame victims of poverty or that cast doubt on the values or morals of the poor, but recent scholarship recognizes a link between culture and persistent poverty.

The characteristics of socioeconomic status—income level, educational attainment, and employment position—often also affect traditions and language preferences.

Thus, understanding the effect of socioeconomic status and poverty on health is a first step in achieving competency regarding the culture of poverty.

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Understanding Medicaid Clients

What is poverty?Definitions & measurementsChildren living in povertyPoverty across the US & TexasGenerational vs. Situational poverty

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How Poverty is Defined and Measured in the U.S.

The Census Bureau uses a set of money income, or poverty thresholds (or Federal Poverty Level, FPL) that vary by family size and composition (but not by region of the country) to determine who is in poverty.

If a family's total income is less than 100% FPL, then that family and every individual in it is considered poor or in poverty.Families with incomes between 100-200% FPL are considered to be low income.In 2011, the FPL is $22,350 per year for a family of 4, or $1863 per month.

< 100% FPL21%

100-199% FPL22%

≥ 200%

FPL57%

Children by Family Income, 2010

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In 2011, there were over 311 million people in the

United States

In 2011, more than46 million of these

people lived in poverty (a 15-year high)

1 in 7 people overall1 in 5 children

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In 2011, more than46 million of these

people lived in poverty (a 15-year high)

1 in 7 people overall1 in 5 children

Children Living in Poverty

Compared with children in higher income families, poor children are more likely than non-poor children to:

Be in single-parent familiesHave parents with low educational attainmentLive in areas called “food deserts” with limited access to fresh groceries and healthy foodBe exposed to chronic stress that is linked to chronic diseaseSuffer developmental delaysGive birth during the teen yearsBe in poor or fair health

2000 2009 % Change

Low Income 26,784,244 31,298,590 17%

Poor 11,502,067 15,325,974 33%

The percentage of children living in low-income and poor families has increased since 2000:

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Federal Poverty Level (FPL)

Total Number of People Living in Poverty based on Household Income (In Thousands), 2009

Persons in Family or

Household

Annual Pre-Tax Income48 Contiguous States and Washington DC

1 $11,170

2 15,130

3 19,090

4 23,050

5 27,010

6 30,970

7 34,930

8 38,890

> 8 Add $3,960 for each additional person

Texas4.26 million

2012-13 US Poverty Guidelines

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Poverty in TexasTexas (2010-2011) vs. US (2011)

White Black Hispanic Other Total0%

10%

20%

30%

40%

By Race/Ethnicity

Texas US

0%

10%

20%

30%

40%

By Age

Texas US

Adults w/Kids Adults No Kids Total0%

10%

20%

30%

40%

By Family Structure

Texas US

Female Male Total0%

10%

20%

30%

40%

By Gender

Texas US

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Generational Poverty vs.Situational Poverty

Generational Poverty Situational Poverty

Poverty that persists for two or more generations

Generational Poverty has its own:• Culture• Hidden Rules• Belief Systems• Approach to Language

Poverty that caused by circumstance (such as

death, illness, divorce) and has a duration of one

generation or less

Situational Poverty maintains an orientation toward middle class codes and mores.

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Understanding Medicaid Clients

Income & Medicaid eligibilityHealth implications of povertyEffects of unemployment & income fluctuationsImpact on emergency department (ED) use

What is the link betweenpoverty and health care?

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FPL and Social Services

The Department of Health and Human Services develops and publishes the Poverty Guidelines, which are updated annually and form the basis for eligibility for Medicaid and other programs.

The federal government sets minimum FPL criteria for eligibility to federally funded programs, but states can set higher FPL eligibility to cover a broader range of income levels.

Program eligibility is often expressed as a percentage of the FPL. The higher the percentage, the greater the income limit, or more generous the benefit.

Children 6-18: up to 100% FPL, or up to $23,050/year for a

family of 4

Elderly and Disabled: 75% FPL or $11,348/year for a family of 2

Examples of Texas Medicaid Eligibility by FPL

Pregnant Women: up to 185% FPL, or up to $35,316/year

for a family of 3

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Federal Poverty Levels in UseMedicaid Eligibility in Texas, 2012

FPL = Federal Poverty LevelFBR = Federal Benefit Rate* SSI is awarded to individuals and couples only

Medically Needy

Long-Term Care at up to 300% of SSI FBR*

SSI, Aged & Disabled up to 100% SSI FBR*

Pregnant Women at up to 185% of FPL

Newborns up to age 1 at up to 185% of FPL

Children ages 1-5 at up to 133% FPL

Children ages 6-18 at up to 100% of FPL

Temporary Assistance for Needy Families (TANF)

$0

$500

$1,00

0

$1,50

0

$2,00

0

$2,50

0

$3,00

0

$3,50

0

$275

$2,094

$698

$2,943

$2,943

$2,116

$1,591

$188

Maximum Monthly Countable Income Limit (family of 3 unless otherwise specified)

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Income Guidelines

www.chipmedicaid.com

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www.chipmedicaid.com

Common Medicaid Myths

National Center for Children in Poverty data for Texas, 2008:

38% of children in poor families (<100% FPL) have at least one parent who is employed full-time, year-round

33% of children in poor families have at least one parent who is employed either part-year or part-time

30% of children in poor families do not have an employed parent

In contrast, 88% of children in families that are not poor have at least one parent who is employed full-time, year-round

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MythMost Medicaid-eligible children

have parents who are unemployed.

FactMedicaid primarily serves the working poor—families with at

least one parent who works full or part-time but with a family income less than 100% FPL and no other

source of insurance.

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Health Implications of Poverty: Barriers to Care

Money to pay for co-payments, medications or other health costsInadequate or unreliable transportationLow educational levelsFood insecurityLow literacy levels or limited understanding of EnglishPoor health literacyConflicting priorities and needs

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The Face of Poverty: Implications for a family’s health

Rhonda is a 31-year-old single mother ofTamika (14) and Andre (10) living in Dallas.

Rhonda lives in a low income housingdevelopment, near her mother and olderbrother, who is mentally handicapped.

Rhonda’s job in a call center earns $332 per week, but offers no benefits. She also receives $40 per week in child support from Andre’s father, who lives in Louisiana. Her total monthly pre-tax income is $1488 (93.5% FPL) or $17,856 per year.

Rhonda’s mother has Type 2 diabetes and hypertension. Her father, a lifelong smoker, died of lung cancer 5 years ago.

Rhonda limits her own smoking to a half-pack of cigarettes a day.

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The Face of Poverty:Rhonda’s Family

According to the National Center for Children in Poverty, as a single mother with 2 children in Dallas, Rhonda could expect the following monthly expenses, even to be considered low-income (132% FPL):

Expense Monthly Cost

Rent & utilities $871

Food $569

Child care for Andre (He stays with Rhonda’s mother or Tamika after school)

$0

Health insurance premiums $0

Out-of-pocket medical $57

Transportation $277

Other necessities $389

Debt $0

Payroll taxes $148

Income taxes (includes credits) -$381

Total $1930

Actual Amount Available: $1488

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Linking Financial Status and Health Care

"Yes" to any of the above

Had problems getting mental health care

Cut pills in half or skipped doses of medicine

Skipped a recommended medical test or treatment

Not filled a prescription for a medicine

Put off or postponed getting health care needed

Skipped dental care or checkups

Relied on home remedies or over-the-counter drugs instead of going to see a doctor

54%

9%

20%

25%

26%

32%

36%

37%

Percent who say they or another family member living in their household have done each of the following because of the cost

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Health Implications of Poverty for ChildrenPhysician Care

No Usual Source of Care

No Well-Child Checkup in Past 12 Months

0%

5%

10%

15%

20%

25%

30%

35%

6.9%

14.9%

3.0%

10.6%

Physician Care Among Poor and Non-Poor Children

(1 to 5 years)Poor Nonpoor

No Usual Source of Care

No Well-Child Checkup in Past 12

Months

0%

5%

10%

15%

20%

25%

30%

35%

8.2%

30.1%

4.4%

27.0%

Physician Care Among Poor and Non-Poor Children

(6 to 17 years)Poor Nonpoor

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Health Implications of Poverty for ChildrenOverweight and Obesity

Overweight Obese0%

5%

10%

15%

20%

25%

18.6%

14.0%

10.6% 9.8%

Overweight and Obesity Among Children

(2 to 5 years)Poor Nonpoor

Overweight Obese0%

5%

10%

15%

20%

25%

16.3%

23.8%

15.2%16.9%

Overweight and Obesity Among Children (12 to 17 years)

Poor Nonpoor

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Health Implications of Poverty for ChildrenDental Care

Never Seen a Dentist 1+ Year Since Last Dentist Visit0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

43.6%

18.1%

44.1%

10.5%

Dental Care Among Poor and Nonpoor Children

PoorNonpoor

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The Face of Poverty: Implications for a family’s health

Provider’s Concerns Rhonda’s ConcernsJuggling competing demands in an extended family despite limited resources:

Keeping her kids fed

Paying her bills

Keeping her car running

Getting to work on time

Helping her extended family

Bringing in a copy of the kids’ shot records

Setting a quit date for smoking

Keeping appointments for dental referrals

Getting regular exercise and avoiding junk food

Filling and taking prescriptions

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2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

2

4

6

8

10

12 Unemployment Rate

USTexasPe

rcen

tage

of l

abor

forc

eEffects of Unemployment and Income Fluctuations

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Linking Financial Status and Health Care

<200% FPL >200% FPL0%

10%

20%

30%

40%

50%

60%

52%

24%

By Income

19-34 35-49 50-640%

10%

20%

30%

40%

50%

60%

51%

36%

24%

By Age

Percent of workers who become uninsured (6+ months) after leaving a job, among workers previously insured through their employer

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Effect of Employment Rate on Medicaid & CHIP

National Employment

Rate

Medicaid and CHIP Enrollment1%

1 Million

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Effects of Poverty, Unemployment & Uninsurance on ED Usage

Key Findings from a 2009 Kaiser FamilyFoundation study of Emergency Departments (EDs):

ED capacity is strained and almost all EDs report rising volume.

Many EDs observe a new “recession” population of those who have lost jobs and insurance or those who can’t afford deductibles or cost-sharing costs in the doctor’s office.

EDs are seeing more insured patients who come because they cannot obtain timely or affordable primary care in the community.

Both insured and uninsured patients are refusing medically recommended care because of cost.

ED physicians see anxiety and depression among patients who lost their jobs.

The inability to arrange for follow-up care for uninsured patients is a huge problem, which impacts how ED physicians practice and how patients fare.

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Characteristics of ED UsersBy Insurance Status

Total Population

Non-ED Users

Low ED Users

High ED Users

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

14%

12%

18%

28%

9%

8%

12%

23%

60%

63%

54%

28%

15%

15%

14%

17%

3%

2%

3%

5%

MedicareMedicaidPrivateUninsuredMixed

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Characteristics of ED UsersBy Chronic Condition

Total Population

Non-ED Users

Low ED Users

High ED Users

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

47%

45%

54%

66%

2%

2%

2%

2%

5%

4%

7%

16%

46%

49%

36%

16%

1+ Physical Condi-tions

1+ Mental Conditions

Both Physical and Mental Conditions

No Physicial or Men-tal Conditions

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Characteristics of ED usersBy Reason for Visit

Total Population

Low ED Users

High ED Users

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

19%

16%

31%

81%

84%

69%

Visit Related to Chronic Condition

Visit Not Re-lated to Chronic Condition

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The Link Between Poverty and Health Care: Barriers Caused by Patient and Provider Knowledge & Attitudes

Provider Quotes“I can’t get the mother to

turn the TV off and bring her kid in to get a checkup.”

“My patients don’t want to pay the $5 co-pay, so they come to the ED and wait 6

hours to be seen for a cold.”

Patient Quotes“I didn’t know people went to

the doctor. I thought everyone went to the

emergency room.”

“I never saw a dentist. Didn’t even know you were supposed to until you needed false teeth.”

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Addressing the Link Between Poverty and Health Care

A strong and positive provider-patient relationship has a positive and significant effect on treatment adherence and outcome

Conflicting norms and behaviors among patients and providers of different social groups may create barriers to effective communication or positive relationships

Suggestions for providers:Recognize norms as adaptive and socially constructed, and avoid assigning positive or negative value

Do not assume that someone will see how their choices today will affect their health tomorrow.

Learn more about the effects on health of poverty, unemployment and uninsurance

Get to know your patients. Understanding their perspective can improve the services you provide.

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Health Literacy

Definition & importance of health literacyMeasurement and extent of health literacyAddressing health literacy in health care settings

How does health literacy affect health care?

What Is Health Literacy?

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.Health literacy is dependent on both individual and systemic factors:1. Communication skills of lay people (such as patients) and

professionals (such as health care providers)

2. Knowledge of lay people and professionals of health topics

3. Culture

4. Demands of the healthcare and public health systems

5. Demands of the situation/context

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Health Literacy: A National Priority

American Dental Association: American Medical Association:

Poor health literacy is a stronger predictor or a person’s health than age, income, employment status, education level, and race.

Limited health literacy is a potential barrier to effective prevention, diagnosis and treatment of oral disease.

Why Is Health Literacy Important?

Health literacy affects people’s ability to:

Navigate the healthcare system, including locating providers and services and keeping appointments

Fill out forms and give informed consent

Share personal and health information with providers

Engage in self-care and chronic disease management

Adopt health-promoting behaviors, such as exercising and eating a healthy diet

Act on health-related news and announcements

Costs of Low Health Literacy:• Poor health outcomes• Increased health care

costs through higher utilization of hospitalization and emergency services

• Reduced quality of care

• Treatment non-adherence and medication errors

• Poor health behavior choices

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Common Reasons for Poor Health Literacy

Lack of educational opportunityPoor English-language skillsLow reading levels

Reading abilities are typically 3 to 5 grade levels below the last year of school completed (i.e. a high school graduate likely reads at a 7th or 8th grade level).

Learning disabilitiesCognitive declinePoor health

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To accomplish health tasks, patients may need to be:• Visually literate (able to

understand and read graphs and charts)

• Computer literate (able to operate a computer)

• Information literate (able to obtain and apply relevant information)

• Numerically or computationally literate (ability to calculate or reason numerically)

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Health Literacy and Shame

People with limited health literacy often report feeling a sense of shame about their skill level.

Individuals with poor literacy skills are often uncomfortable about being unable to read well, and they develop strategies to compensate.

Possible indicators of low health literacy:Excuses for not reading: “I forgot my glasses.”

Lots of papers folded up in purse/pocket

Lack of follow-through with tests or appointments

Few questions or only simple questions

Difficulty explaining medical concerns or how to take medications

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Measuring Health Literacy2003 National Assessment of Adult Literacy (NAAL) Survey

Literacy LevelsProficient: Can perform complex and challenging literacy activities.

Intermediate: Can perform moderately challenging literacy activities.

Basic: Can perform simple everyday literacy activities.

Below Basic: Can perform no more than the most simple and concrete literacy activities.

Nonliterate in English: Unable to complete a minimum number of screening tasks or could not be tested because did not speak English or Spanish.

Lite

racy

Sc

ales

• Prose (reading comprehension)

• Document (finding & using information)

• Quantitative (performing computations)

Hea

lth C

are

Dom

ains

• Clinical• Prevention• Navigation of the health

care system

Difficulty of Selected HealthLiteracy Tasks

Proficient310-500

Intermediate226-309

Basic185-225

Below Basic0-184

Average Score245

Circle the date of a medical appointment on a hospital appointment slip. (101)

Give two reasons a person should be tested for a specific disease, based on information in a clearly written pamphlet.

(202)

Determine what time a person can take a prescription medication, based on information on the drug label that

relates the timing of medication to eating. (253)

Calculate an employee’s share of health insurance costs for a year, using a table. (382)

Use a BMI index to determine a healthy weight range for a person of a specific height (290)

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Percentage of Adults in Each Literacy Level

-20% 0% 20% 40% 60% 80% 100%

Below Basic14%

Basic22%

Intermediate53%

Proficient12%

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Percentage of Adults in the Below Basic Literacy Level

Did not graduate from high school

Did not speak English before starting school

Adults reporting poor health

Hispanic adults

Black adults

Age 65+

No medical insurance

0% 10% 20% 30% 40% 50% 60%

51%

39%

10%

35%

19%

31%

36%

15%

13%

4%

12%

12%

15%

18%

% in Total Population % in Below Basic Category

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Poverty, Insurance Coverage and Health Literacy

Poverty ThresholdAverage Health Literacy Score

Below 100% FPL 205

100-125% FPL 222

126-150% FPL 224

151-175% FPL 231

Above 175% FPL 261

Insurance TypeAverage Health Literacy Score

Employer-Provided 259

Military 248

Privately Purchased 243

Medicare 216

Medicaid 212

No Insurance 220

Adults at poverty levels 100-125% FPL scored in the Below Basic levels of

health literacy. Average health literacy levels for those above 175% FPL was in

the Intermediate range.

Among adults who received Medicare or Medicaid, 27% and 30%,

respectively, had Below Basic health literacy. Among adults who had employer-provided, military, or

privately purchased insurance, the percentages with Below Basic health

literacy were 7%, 12% and 13%, respectively.

Addressing Low Health LiteracyUsing Plain Language

Strategies to improve patient comprehension:

Limit the amount of information provided at each visit

Begin with the most important information

“Slow down”

Avoid jargon

Provide patient education materials at the appropriate reading level

Use pictures or modules to explain important concepts

Use the “show-me” or “teach-back” methods

Encourage questions

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Addressing Low Health LiteracyTesting for Understanding

Suggestions for providers:

Use a medically trained interpreter if necessary:Ensure that all language access services, including translation, use plain language

For those who do not speak English, plain English alone will not be enough to ensure understanding

Ask open-ended questions:Elicit cultural beliefs and attitudes: “Tell me about the problem and what may have caused it.”

Check for understanding:Use the “teach-back” method: Have the person restate the information in his or her own words.

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Medicaid Programs

Case ManagementOutreach & InformingTransportation AssistanceEnsuring accommodations for the disabled

What Texas Medicaid programs help reduce health disparities caused by poverty or disability?

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Case Management

Case Management for Children and Pregnant Women (CPW) provides services to children with a health condition/health risk, birth through 20 years of age and to high-risk pregnant women of all ages, in order to help them gain access to medical, social, educational and other health-related services

Dependent upon a client’s needs, a CPW case manager may complete a variety of tasks that include the following:

Linking a client to community resources

Coordinating medical services and supplies

Locating mental health services

Assisting with medical transportation problems

Referring a client to waiver programs, ECI and other resources

Advocating for a client at school meetings

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Outreach and Informing Program

The Outreach and Informing Program provides outreach, informing, and support services to THSteps recipients.

The Outreach & Informing program seeks to improve patients’ interactions with providers through:

Helping patients and families locate a provider

Scheduling appointments

Providing information for patients on the importance of checkups

Performing outreach after missed appointments

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Eligible recipients:• Children birth through age 20 who are newly-certified or recertified for Medicaid

(including parents/caretakers required to have a Health Care Orientation) • Children birth through age 20 years who are due or overdue for a medical or

dental checkup• Pregnant women in the fourth month of pregnancy • Special outreach groups who are at high risk for health problems (e.g., children

of migrant farm workers)

Medicaid Transportation Program

Provides free rides for Texas Health Steps and other Medicaid eligible patients

Helps clients miss fewer appointments

Allows scheduling of multiple appointments at one time

Results in fewer no-shows

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THREE WAYS TO GET TO THE DOCTOR

Module 2

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Module 2

Americans with Disabilities Act (ADA)

ADA: Title III: The term "disability" means, with respect to an individual:

(A) a physical or mental impairment that substantially limits one or more major life activities of such individual;

(B) a record of such an impairment; or

(C) being regarded as having such an impairment.

“No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation.”

Professional offices of a health care providers and hospitals are included under the definition of “place[s] of public accommodation

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Module 2

Americans with Disabilities Act Requirements

Title VI of the Civil Rights Act requires health providers give their limited-English-proficient patients meaningful access to their services, which may entail offering translation services

People with disabilities must be able to access an office building and suite. Barriers to access must be removed if alterations are “readily achievable”

Providers have a duty to provide effective communication, including services for vision- or hearing-impaired patients, such as:

Qualified readers, Braille or large print materials

Sign language interpreter, written forms and information sheets, or exchange of written notes for non-complex situations

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True or False?Test Your Knowledge about Texas Medicaid:

In 2011, nearly 1 in 20 people and 1 in 20 children lived in poverty.The federal government requires that state Medicaid programs set service eligibility at 100% of the FPL.A family in generational poverty is one that has been in poverty for two or more generations.Nationally, a 1% decrease in the employment rate adds about 1 million new enrollees to Medicaid & CHIPOnly about 12% of adults have a health literacy level that could be considered proficient.

Medicaid Resources

Texas Health & Human Services Commissionwww.hhsc.state.tx.us/medicaid

Texas Medicaid & Healthcare Partnershipwww.tmhp.com

Texas Health Stepswww.dshs.state.tx.us/thsteps/providers.shtm

www.dshs.state.tx.us/dental/thsteps_dental.shtmwww.dshs.state.tx.us/thsteps/default.shtm

CHIP/Children’s Medicaidwww.chipmedicaid.org

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This Texas Medicaid curriculumwas prepared by

Betsy Goebel Jones, EdDProject Director

Tim Hayes, MAMProject Designer

Authors: Module 2 Betsy Goebel Jones, EdD

David Trotter, MADepartment of Family & Community Medicine

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