Goal:

To assist Medicaid/Health Choice eligible beneficiaries to access and appropriately use their Medicaid benefits.

Strategy Description:

  The following strategies will be implemented to achieve the identified goal: Receipt of and prioritization of referrals and activities will be provided to: Pregnant & postpartum woman Newborns and children under two Children with special health care needs Children 2-21 years of age Adults with special needs Family Planning beneficiaries. All recipients will have a minimum of three contacts prior to proceeding to unable to locate status (phone calls, mailings, and home visits as necessary). Adequate attempts of reaching the client will be completed within the 30 day timeframe. The initial attempt to contact a pregnant woman will be within (7) business days of the referral. An attempt to contact a beneficiary will be made within (15) business days. An additional strategy will include coordinators conducting general information sessions for Medicaid recipients by increasing awareness of Medicaid programs. Potential medical assistance eligible clients will be encouraged to apply for programs. Awareness to the public may include phone calls, bulletin board postings, mailings, letters, newspaper articles, etc. At initial contact with Medicaid recipient, information will be provided regarding the HealthChoice Helpline and complaint resolution services. There will always be a Care Coordinator available during working hours to assist with care coordination. The information provided to a beneficiary will be limited to that which will enable the beneficiary to access covered Medicaid services in an appropriate, timely, and cost-effective manner. Coordinators will be knowledgeable about Managed Care Complaint and Grievance and Appeals process. Prenatal risk assessments are received from four prenatal clinics, strategies to increase the number of assessments include: provider education by visiting the prenatal clinics (at least quarterly), contacting them by phone (weekly).  

Level of Change:

Programs

Primary Focus Area:

Maternal, Child, and Adolescent Health

Data Category Tag:

GCHD Personal Health

Strategic Planning Alignment:

Education

Estimated Implementation Date:

2017-01-02

Estimated Completion Date:

2022-06-30

Estimated Ease of Implementation:

Moderate

Estimated Cost of Implementation:

Moderate

Potential Community Benefit:

High

Health Equity:

Every pregnant women has the right to be as healthy as possible during their pregnancy.

Research:

https://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html