Convening local partnerships in the safety net to inform, influence, and implement health policy
Medicaid Enrollment Cleveland, OH

Providers in Cleveland collaborated to increase outreach and Medicaid enrollment in their community

The Partnership for Cleveland Health Care Safety Net came together with the support of the National Partnership to address concerns about the future of Medicaid in their state. The Cleveland Partnership aimed to increase Medicaid enrollment and ensure the sustainability of Medicaid expansion in Ohio with enrollment process improvements and information sharing among key stakeholders across the city and the region and educating government officials and policy makers.

Increasing Coverage and Improving Medicaid Enrollment Processes in Ohio

Medicaid expansion had a considerable impact on the Cleveland community and their health care system by providing coverage to over 360,000 newly eligible Ohioans (as of August 2014). In 2014, although Ohio Governor John Kasich expanded Medicaid to cover more uninsured residents through the Controlling Board, the full state legislature had not approved it. This meant that Ohio was able to accept Medicaid funds from the federal government, but to continue doing so, the legislature must reauthorize this decision as part of a two-year budget cycle. Medicaid coverage allows individuals to get needed health care and supports the safety net infrastructure.

The Partnership for Cleveland Health Care Safety Net is the collaboration of five federally qualified health centers (FQHCs) and the area’s largest safety net hospital system, MetroHealth.

To achieve its goals, the Cleveland Partnership engaged in:

  • Planning and executing events that highlight the increase in coverage and access to care because of Medicaid expansion.
  • Educating policymakers about the importance of Medicaid for Cleveland’s safety-net providers and their patients.
  • And convening a policy roundtable with key stakeholders to discuss the implications of the State Budget.

Resources and Support from the National Partnership

The National Partnership supported this initiative by providing information on policy options that could improve outreach and enrollment in Medicaid, as well as linking the partners with resources at the national level. The National Partnership also facilitated and participated in discussions with local stakeholders to help plan their educational efforts in Cleveland and statewide. The Cleveland Partnership had the unique opportunity to leverage their experiences with a Medicaid Waiver Demonstration that involved MetroHealth and two of their partner health centers. The National Partnership also assisted in examining any legislative or regulatory issues that are identified during the 2015 legislative session.

The Power of Collaboration in Increasing Coverage and Improving Medicaid Enrollment Processes

Addressing the issues of increasing coverage and improving Medicaid enrollment processes required a high degree of collaboration, as the Medicaid program significantly affects safety net providers and their patients. Historically, collaboration had been present amongst the FQHCs, and with MetroHealth, on various issues including local efforts to expand Medicaid coverage in Ohio, as well as improve access to care for uninsured and underinsured patients. Below are examples of past collaborative efforts:

  • Northeast Ohio Medicaid Expansion Coalition (NEO-MEC): NEO-MEC is a partnership of religious congregations, health care providers, community organizations, businesses, insurers, medical professionals, consumer groups, and advocates working together to help the state expand Medicaid to all Ohioans now eligible under the Affordable Care Act.
  • 1115 Waiver that involved MetroHealth and two FQHCs in their service area: The demonstration provided coverage to uninsured adults who have family income at or below 113% of the Federal Poverty Line, who reside in Cuyahoga County, and who are not otherwise eligible for comprehensive benefits under the Medicaid state plan. Eligible adults received benefits through the MetroHealth System and its community partner network providers.
  • Cuyahoga Health Access Partnership (CHAP): is a non-profit organization dedicated to providing a coordinated system of healthcare access for the county’s low-income, uninsured adults. CHAP was founded on the principle of shared responsibility and is represented by its founding members, including hospital systems, community health centers, free clinics, local governments, foundations, and other key organizations in the Cuyahoga County health arena. CHAP’s first major initiative is the Access Plan, which makes it easier for uninsured adults to get the health care they need. Through its coordinated network, CHAP connects patients without insurance to providers whom offer discounted primary care and specialty care.
  • Better Health of Greater Cleveland: Better Health Greater Cleveland is a regional healthcare improvement collaborative. Established in February 2007, initiatives and integrated programs are aimed at improving health care, health and reducing cost by providing high-quality and appropriate care. Primary care is the principal focus of Better Health’s work. Since 2007, Better Health has doubled the number of primary care providers to more than 600 in 69 practice sites of 10 health systems.

Further collaboration was fostered during the planning of a National Health Center Week 2014 event via the following steps:

  • a team of staff from all organizations met on a consistent basis,
  • all organizations were represented at the event,
  • all partners shared responsibilities that were key to the success of the event (i.e. identifying and inviting speakers, venue, fundraising, budget, invitation, etc.),

Educating Government Officials and Policy Makers

The Partnership focused on raising awareness around the impact of Medicaid expansion through an effort entitled “Why Medicaid Matters” which featured two major events:

  • The Cleveland Partnership celebrated National Health Center Week 2014 with an event that took place on August 13 highlighting the strides and accomplishments that Cleveland’s FQHCs have made in the past year with the expansion of Medicaid, and enrolling the uninsured in the community. To bring attention to the importance of Medicaid to safety net providers and their patients, the Cleveland Partnership reached out to key stakeholders and policymakers in the community including the Department of Health, state legislators, as well as members of Congress. The Keynote Speaker was State Representative Nickie Antonio, who is a member of the Finance Subcommittee on Health and Human Services, as well as ranking member on the Committee for Health and Aging. Other notable attendees included:
    • Bill Patmon
    • Valarie Molaison, Senator Sherrod Brown’s Office,
    • Beverly Charles, Congresswoman Marcia Fudge’s Office,
    • Councilman Joe Cimperman,
    • And Cleveland Dept. of Public Health Director Toinette Parrilla and Commissioner Myron Bennet.
  • National Health Center Week 2015

Furthermore, the Cleveland Partnership investigated state or local policies that could help increase Medicaid enrollment. The Partnership engaged in talks with the Department of Jobs and Family Services to better understand barriers and issues, and to explore strategies for improving enrollment processes, such as using presumptive eligibility or streamlining administrative processes.

The Partnership for Cleveland’s Safety Net

The Cleveland Partnership consists of five Federally Qualified Health Centers (FQHCs) and one public hospital:

  • MetroHealth Medical Center -The MetroHealth System is one of the largest, most comprehensive health care providers in Northeast Ohio, serving the medical needs of the Greater Cleveland community since 1837. MetroHealth has 17 locations throughout Cuyahoga County with a large teaching hospital and more than 400 primary care and specialty care physician’s practices.
  • Asian Services In Action -ASIA’s mission is to empower and advocate for Asian Americans/Pacific Islanders (AAPIs) and to provide AAPIs access to quality, culturally, and linguistically appropriate information and services. The health center services opened in 2014.
  • Care Alliance-Care Alliance was founded in 1985 as one of the original Homeless pilot projects. Care Alliance provides comprehensive medical and dental care, patient advocacy and related services to over 10,000 Clevelanders, most of whom are chronically ill and homeless. In May 2015, Care Alliance will open a state-of-the-art clinic in Cleveland’s Central Neighborhood.
  • Free Clinic of Greater Cleveland –The Free Clinic has a long history of providing health care including behavioral health and dental at its location in East Cleveland. The organization has a long history of advocacy and became an FQHC in 2013.
  • Neighborhood Family Practice -Neighborhood Family Practice provides health and behavioral health services to the West Side of Cleveland in five locations serving over 16,000 in 2014. The organization was founded in 1980 and became an FQHC in 2000.
  • Northeast Ohio Neighborhood Health Services–NEON has been an FQHC for over 40 years. Services at NEON’s seven sites include family and adult medicine, pediatrics, OB/GYN, behavioral health, dental care and pharmacy services.