Break the Stigma

Author : CareSource

May 2nd, 2012 | by CareSource

May is Mental Health Awareness Month. To bring light to Anti-Stigma, members of our Health Services team will reflect on their own careers and the fight against stigma. For updates, subscribe to NAMI’s Stigmabuster Alerts.

Lisa is a Registered Nurse at CareSource and has worked in behavioral health most of her career.

“I just fell in to it. It was a natural transition for me,” explains Lisa. “Some people gravitate towards maternity and babies; I gravitated towards mental health.”

You might think that’s strange, but Lisa doesn’t. She has a passion for helping people that have mental illnesses. In fact, mental illness hits close to home.

Lisa has two teenage sons – 19 and 17 – that struggle with schizophrenia, depression, anxiety and bi-polar disorder.

“Mental illness runs in our family; both my father and my husband struggle with it.”

When her oldest son was 3 years old, she took him to the doctor because she knew something just wasn’t right.

“He was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). My doctor told me to socialize him and involve him in activities. That seemed to help, but there were still other things going on that we weren’t yet aware of.”

Both sons were diagnosed at early ages and will probably be on medication the rest of their lives. However, there have certainly been bright spots along the way.

Her 17 year old son recently received his GED and will be attending college this summer.

Lisa’s 19 year old is attending college and involved with Goodwill Easter Seals to help him with housing and employment. Even his college professors are aware of his struggles and reach out to help when things get a bit overwhelming.  Recently he had to take a break from school and work due to feelings of “losing control” but he is receiving the support and services he needs to get back on track.  This is very common in people who try to manage their mental illness.

“A person with a mental illness can become easily overwhelmed. It’s important for people to have a support system to help them take a step back and put things in to perspective.” ”

Despite their daily struggles, Lisa is hopeful that people with mental illnesses can lead healthy, productive lives.

“The good news is mental illness is a disease you can live with if you are willing to work hard, accept help, allow support and recognize the ‘triggers’.”

Twenty years ago, mental illness was never discussed or addressed but simply swept under the rug. Today, education and communication are key. There are resources available but, the person has to be ready and willing to accept help. 

Mental illness is more common than you might think. In fact, in Ohio there are approximately 418,000 adults and 124,000 children living with serious mental illnesses.

Some people think those who are mentally ill can just snap out of it, take some medicine and get better. That’s not the case. It’s a lifelong challenge, but it can be done with proper support and hard work.

“Mental illness is hard for people to talk about and admit. But the silence must be broken if we truly want to get people the help they need and deserve.”

If you or someone you know needs help, talk to your doctor or contact the National Alliance on Mental Illness (NAMI) at 1-800-950-6264. You can also follow NAMI’s updates on Facebook and Twitter.

Resource: National Alliance on Mental Illness

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A New Year’s Resolution To Help Our Children Stay Healthy

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Dec 28th, 2010 | by

To all those that help children with Medicaid coverage, we have a simple request – please make this New Year’s Resolution: I will help promote the importance of the Early Periodic Screening, Diagnosis & Treatment (EPSDT) program to those that I serve.

So it doesn’t sound that inspiring, but the benefits that we all realize when Medicaid children (all the way up to age 21) get their EPSDT exams are profound and long lasting.

For those unaware of what EPSDT is, here is the definition as stated by the US Department of Health and Human Services:

The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is the child health component of Medicaid. It’s required in every state and is designed to improve the health of low-income children, by financing appropriate and necessary pediatric services.

Early- Identifying problems early, starting at birth
Periodic – Checking children’s health at periodic, age-appropriate intervals
Screening – Doing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
Diagnosis – Performing diagnostic tests to follow up when a risk is identified
Treatment – Treating the problems found.

In Ohio, the EPSDT program is called HealthChek. In Michigan, there is no official name for the state’s EPSDT program, but information can be found under Michigan’s MIChild and Healthy Kids Medicaid programs. Regardless of what it’s called, the program is the foundation for which the Medicaid program is built.

Why are we making this request? And why are we also dedicated to promoting EPSDT utilization? Because the exam helps millions of children stay healthy or find the care they need to get healthy. And the only way to make sure our most vulnerable children are cared for is to promote, promote, promote.

We want consumer advocacy groups that help underserved families and communities to talk with their families about the importance and availability of the EPSDT program, and to help them work with their Medicaid plan to find a doctor to administer the exam.

We want providers that take care of our underserved families and communities to proactively reach out to their Medicaid patients, and remind them that the EPSDT exam is so important – and free to the patient. Also, we encourage providers to make sure their billing staff is aware of the proper billing codes to ensure EPSDT services are reported and reimbursed correctly. In fact, in Ohio, each of the seven Medicaid health plans have partnered with the Ohio Department of Job and Family Services to hold a series of webinars with CEUs to educate providers about the importance of administering the full gamut of services covered by EPSDT as well as appropriate coding and billing procedures. Over 200 provider offices have participated in these webinars, and more will be scheduled in 2011.

We want our policy makers – as they are entrenching themselves in their district neighborhoods this holiday season – to remind their constituents about the importance of making sure our children are getting these important health care screenings early – BEFORE an illness becomes an emergency.

So the call to action is this…let’s all use our networks (social media networking and face-to-face networking) to increase awareness of the importance of an EPSDT exam, and promote, promote, promote. Point them to this article, as we are providing below all the necessary information to be educated on EPSDT exams, and their importance to making sure our underserved populations make preventive health care a priority.

And feel free to print and distribute the materials found at the following sites.

EPSDT Resources:

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A Year of Milestones

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Oct 6th, 2010 | by

This year has marked a series of milestone anniversaries for many of our nation’s most well known public programs. Programs that have become synonymous with stability, security and health care. They are: Social Security, Medicare and Medicaid. And, let’s not forget one of the most significant pieces of legislation our nation has seen in the last 20 years – the Americans with Disabilities Act (ADA).

You may be wondering why a large health plan like CareSource would care about the ADA or public programs in general. It’s actually pretty simple. It’s because each of our members is touched by at least one of these programs every day. Moreover, our members have tenaciously navigated the pitfalls of bureaucracy to secure and retain a benefit that is fundamental to their sheer existence. And, a good portion of them are just beginning to realize the opportunities that now lay before them as a result of the ADA (which, by the way, strives to remove significant barriers for individuals with disabilities. More on this later.)

Social Security – Celebrating 75 Years of Security
Despite being well past the age where most Americans can begin to receive benefits, the Social Security program is still viewed as one of the most important programs in our country. In fact, according to the AARP, nine out of ten adults held this view consistently in 1995, 2005 and 2010. Social Security underscores the importance of many of the values we advocate for today – independence, safety and financial peace of mind. As technology and innovation allow us to live longer, these values will remain essential to a more secure and productive tomorrow.

Medicare and Medicaid Turn 45
When Lyndon B. Johnson signed Medicare and Medicaid into law in 1965, do you think he ever dreamed it would result in health coverage for more than 100 million Americans just 45 short years later?

It’s a dream that many of us are proud to fathom. It’s a fiscal challenge we’d like to forget. But without these two programs, America would be a very different place. While not necessarily perfect, these programs have driven us as a society to build a health care system that allows us to live longer, employ millions of Americans and provide the strength a nation needs to forge ahead. Yes, some might agree that we have lost our footing along the way, but the passage of the Patient Protection and Affordable Care Act will be a milestone that will be celebrated just four short years from now.

ADA Celebrates 20 Years
July 26, 2010 marked the 20th anniversary of this historic legislation enacted to break down barriers in housing, the workplace, schools, malls, telecommunications and public transportation for people with disabilities. Despite its worthwhile advancements, leading advocates realize there is still much more work to be done. Our nation has focused heavily on supporting disabilities financially and medically, but not really as much on merging these ideals in a way that fosters inclusion and independence.

As we reflect on the needs of the more than 65,000 members with disabilities we serve in Ohio and Michigan, it is with great humility that we continue our advocacy to extend our reach to cover more individuals with disabilities. Doing so will ensure that they receive health care in a way that is person-centered, comprehensive, coordinated and in a setting where they can thrive and succeed.

Charting New Milestones
As a non-profit health plan, we recognize the foundation these programs have established for the current generation and for generations to come. The programs mentioned above as well as countless others have truly inspired the advent of companies like ours that are adamantly focused on supporting the underserved. In this commemorative year, we want to take this opportunity to honor each person who works tirelessly every day to help our nation’s most vulnerable reach their next important milestone. Happy Anniversary!

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Care Coordination In Action

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Sep 17th, 2010 | by

Last week, we posted a blog about our involvement in the Ohio Association of Health Plans‘ campaign – “Get Your Well On.” As part of this campaign, we developed a couple of videos that tell the stories of how care coordination is delivered. These videos reveal how real Ohio families have benefited as a result of Medicaid Care Coordination.

“Making a More Productive Family Future”
This is a wonderful, heart-felt story of a little girl who needed cochlear implants, and how our facilitation of the health care system resulted in a truly transformational experience for the family.

“Partnering with Providers”
A real look at how CareSource, and the Health Care Home philosophy of care coordination, enhances the patient-provider relationship.

So take a look, and let us know what you think.

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The Rituals of Back to School

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Sep 1st, 2010 | by

Where did summer go? It’s back to school time once again. The “Back to School” season has almost become a holiday. There are so many rituals associated with back to school:

Buying new school supplies like pencils, notepads, crayons, calendars, folders…maybe a new backpack?

Examining the clothing situation–new shirts, pants, socks…perhaps replacing those shoes that were outgrown during the summer?

Checking your schedule twice to make sure you’re ready to adapt to a new normal for the next nine months!?!?!?

How about getting that doctor’s appointment for an annual check-up?
Unfortunately, this ritual doesn’t always seem to make the list, which is why we partnered with our state-level association, Ohio Association of Health Plans, to launch a statewide campaign called “Get Your Well On.”

The goals of the “Get Your Well On” campaign are simply stated:

  • Promote the importance of having a consistent relationship with your primary doctor
  • Encourage responsible health care engagement and healthy living

Simply stated…but profoundly inspiring. Frankly, it’s our responsibility as Medicaid Care Coordination plans to forever promote the benefits of good health to our members. But this partnership with our industry in Ohio has been an inspirational experience.

Our organization – OAHP – has partnered with associations and communities across the state to bring this message to the urban, suburban and rural. Organizations like the Ohio PTA, Ohio Benefit Bank, Ohio Association of Second Harvest Food Banks, Ohio Child Care Resource & Referral Association, Ohio Council of Churches, Special Olympics Ohio, Family Children First Councils, Ohio After School Network, and many, many more have been instrumental in championing our cause.

We are meeting at a true grassroots level with people that are touching the lives of hundreds of thousands of Ohioans. And they are so appreciative of the materials we are giving to them:

Get Your Well On Cards

Get Your Well On Coloring Book

We’ve been organizing events in Columbus, Cleveland, Dayton, Toledo, Akron and more…inviting the passionate agencies at the community level to hear our message. We’ve partnered with large conferences to voice our point of view to hundreds at a time.

The basic comment we get most often as we engage with communities—

“This information can never be promoted enough. Thank you for giving me the tools to help promote this to the people I work with.”

Medicaid Care Coordination plans are forever promoting healthy living and prevention to our members. It’s the philosophy of this type of health care delivery. Our “Get Your Well On” campaign is casting a larger net across Ohio, touching lives beyond the underserved.

So maybe a new back-to-school ritual for all of us should be a reflection on our health in general…and then the drive to take action. Our Governor made it official this week with his proclamation. Now we all have a friendly reminder to “Get Our Well On.”

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Moving Hope To Reality

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Jul 22nd, 2010 | by

Dear President Obama,
Thank you…thank you for the release of the Patient’s Bill of Rights. This public proclamation that describes how patients will be protected by the rising costs and complexities of the health care system is exactly what this country needs. It is fundamentally consistent with the philosophies of our nation. The Patient’s Bill of Rights builds a foundation that allows opportunities to exist, opportunities open to all, and most notably our country’s underserved population.

Underserved people continue to suffer in our country. And one of the most profound challenges to this demographic is having the forum to voice opinion. Underserved communities struggle to be heard…struggle to tell their stories…struggle to instill empathy in those most able to be helpful.
The Patient’s Bill of Rights gives the underserved a voice. It protects them from elements that have been traditionally uncontrollable. It protects our children, it protects those with pre-existing conditions, and it protects women. But most importantly, it protects the integrity of our country and the goodwill we extend to our citizenship.

So thank you, Mr. President, for embracing our country’s underserved, and moving hope to what is tangible. And we’re happy to answer your request and spread the word about the new Patient Bill of Rights.

The Patient’s Bill of Rights
“Starting in September, some of the worst abuses will be banned forever. No more discriminating against children with pre-existing conditions. No more retroactively dropping somebody’s policy when they get sick if they made an unintentional mistake on an application. No more lifetime limits or restrictive annual limits on coverage. Those days are over.” – PRESIDENT BARACK OBAMA

President Obama announced a Patient’s Bill of Rights made possible under health reform—a basic set of consumer protections.

The Patient’s Bill of Rights:

  1. Prevents insurance companies from canceling your policy if you get sick. Right now, insurance companies can retroactively cancel your policy when you become sick if you or your employer made an unintentional mistake on your paperwork.
  2. Stops insurance companies from denying coverage to children with pre-existing conditions. Beginning in September, discrimination against children with pre-existing conditions will be banned—a protection that will be extended to all Americans in 2014.
  3. Prohibits setting lifetime limits on insurance policies issued or renewed after Sept. 23, 2010. No longer will insurance companies be able to take away coverage at the very moment when patients need it most. More than 100 million Americans have health coverage that imposes lifetime limits on care.
  4. Phases out annual dollar limits on coverage over the next three years. Even more aggressive than lifetime limits are annual dollar limits on what an insurance company will pay for your health care. For the people with medical costs that hit these limits, the consequences can be devastating.
  5. Allows you to designate any available participating primary care doctor as your provider. You’ll be able to keep the primary care doctor or pediatrician you choose, and see an OB-GYN without referral.
  6. Removes insurance company barriers to receiving emergency care and prevents them from charging you more because you’re out of network. You’ll be able to get emergency care at a hospital outside of your plan’s network without facing higher co-pays or deductibles or having to fight to get approval first.

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The 2010 Census – It’s easy. It’s important. It’s safe.

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Apr 1st, 2010 | by

It’s that time of year again. Census time. Yes, this year we have to take 10 minutes out of our busy schedules and answer 10 easy questions… and we’re done – for 10 years! Simple questions that determine how $400 Billion – yes, that’s BILLION -get distributed to each state.

During the 2000 Census collection, over 70% of Americans sent their surveys back as instructed. But many surveys had to be completed with the help of U.S. Census workers who traveled door to door canvassing the streets to find individuals who just couldn’t find the time to make this a priority. And why shouldn’t they just wait for a knock on the door?

Get this: For each percentage point we can raise the response rate, the feds reportedly will save about $85 million on door-to-door workers. Isn’t that reason enough?

But the population that traditionally struggles to complete their Census forms is the people we serve each day here at CareSource. Why? Because this population tends to be transient – not typically staying at one residence for any prolonged period of time. They also may not have an official address, or they may be homeless, or they live in a communal living situation. Whatever the case, during this census period, it’s extremely important that we get the people in our underserved communities counted.

That’s why CareSource is joining the national effort to reach out to our members to reinforce the importance of completing their census form. Our 820,000+ members qualify for Medicaid coverage and have income below 200 percent of the poverty level. Because the deadline is quickly approaching, we are posting information to our Web site as a reminder for both members and our vast provider network (22,000+ providers, 210 hospitals). We’re also adding a hold message on our customer service line (pending state approval) to encourage our members to “Be Counted” and why it’s so important.

But we didn’t stop there. As a large employer, we have also encouraged our 900 employees to complete their census forms and have reiterated why it’s so important for a publicly funded, not-for-profit company like CareSource to support this national endeavor. Recurring messages will be sent to employees to provide constant reminders prior to the April 15th deadline.

According the NAACP and the federal government, here is why it is so important to get everyone counted – especially families struggling with poverty:

  • Federal Funds: For each 100 people not counted, a community risks losing an estimated $1.2 million over the next decade for federally funded programs including: Medicaid, public housing assistance, child health programs, Head Start, transit programs, and more.
  • Political Representation: States use census numbers to redraw all political boundaries and determine which states gain or lose representation, including Congressional Districts, state house and senate districts for city councils, school committees and county board.
  • Public Infrastructure: All levels of government rely on census numbers to locate vital public works like schools, health centers, public transportation, highways, and affordable housing.
  • Private Investment: Businesses large and small use census numbers to identify new markets, select sites for operations, make investment decisions and determine the goods and services offered.

When families do not participate in the census, it means their communities lose access to money, resources and power. On behalf of our country’s underserved communities, please encourage the families and organizations you interact with to complete and return their census form. It’s easier than ever. The 2010 Census form asks 10 questions and takes about 10 minutes to complete. But the key is – IT MUST BE MAILED BACK TO BE COUNTED. Simply mail it back using the postage-paid return envelope by April 15, 2010. Telephone assistance in filling out the form is also available by simply calling 1-866-872-6868.

For those who do not respond, census workers will visit households that do not return forms to take the count in person. But don’t forget – the higher the participation rate, the cheaper the census will cost taxpayers. Just think – if we increase the rate of response from 70 to 80 percent, that’s an estimated $850 million in savings!

It’s easy. It’s important. It’s safe. For more information about the 2010 Census and the “Take 10″ initiative, visit

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A Commitment To Our Children

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Mar 16th, 2010 | by

Ohio’s underserved population got a positive boost this past week from our Federal government and Governor Ted Strickland. The first was Ohio receiving over $700-million in federal assistance for Medicaid. The second is our Governor’s commitment to U.S. Health and Human Services Secretary Kathleen Sebelius’ challenge to get all eligible children enrolled in Medicaid/State Children’s Health Insurance Program (SCHIP) and keep them covered longer. These are tremendous strides that our Federal and State governments have taken to further its commitment to America’s children.

In Ohio, where we have an unemployment rate of 10.8% and a multi-million budget gap, we are seeing more and more people needing the many social services that help keep our Ohio families afloat. Medicaid is one program in particular that has experienced a surge in enrollment. So receiving more federal assistance is extremely helpful in keeping Medicaid enrollees covered and making sure they are accessing the health care system responsibly.

Next, our Governor’s commitment to making sure every child eligible for Medicaid/SCHIP is enrolled is also greatly needed. There are 77,000 children in Ohio that are currently uninsured but actually eligible for Medicaid/SCHIP today. The income limit for children to receive health care through Medicaid/SCHIP is currently capped at 200% of the poverty level (or a little over $44,000 for a family of four). So we stand equally committed to finding these children, and making sure they all get access to primary and preventative health care.

But finding all children eligible to be enrolled with Medicaid/SCHIP is a little trickier than you might think. In addition to concentrated grassroots outreach, we need Ohio’s Medicaid program to implement new strategies that lessen the barriers to entry. Here are three strategies to consider:

  • Express Lane Eligibility – Essentially, this will help get children covered when their families opt to receive assistance through other public programs like school lunch or food stamps. States can use the relevant findings from these other public programs to determine their eligibility for Medicaid/SCHIP without requiring the family to resubmit and/or re-verify their personal information.
  • 12-month Continuous Coverage – In Ohio, families with children receiving Medicaid/SCHIP need to re-apply every 12 months to maintain their coverage. During this 12 month period, a child can become ineligible for Medicaid/SCHIP for a variety of reasons. Most notably, is not keeping their redetermination appointment for other public assistance programs (e.g., cash assistance or food stamps). This causes children to inappropriately lose their coverage. By guaranteeing 12 months of coverage to children, we ensure our eligible kids don’t lose coverage while ultimately improving overall health outcomes.
  • Presumptive Eligibility – Allows trained qualified entities to screen a child or pregnant woman’s eligibility for Medicaid/SCHIP. If presumed eligible, a child or pregnant woman can receive all health services covered under Medicaid until a final determination is made. Presumptive eligibility would allow uninsured children and pregnant women to begin the Medicaid application process, obtain needed medical services while also ensuring the health care provider is reimbursed for services rendered.

It’s clear that needless administrative barriers are simply making health care access harder and harder for underserved populations. These three strategies are common sense approaches that will ensure the nation’s underserved get the coverage they need – when they need it.

Questions for our readers – What do you think of the Federal and state measures described above? Is it a good use of federal dollars to help states with their Medicaid programs? Are these suggestions for CHIP enrollment enough to capture all the children eligible for the program?

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