Local Access to Care Programs

September 17, 2014

From the desk of

SHADAC Director Lynn Blewett

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I was recently invited to attend a meeting of Local Access to Care Programs (LACPs) from Michigan, Pennsylvania, New York, Minnesota, Texas, and Maryland.[1] Funded by Kaiser Permanente and organized by the Center for Health Care Strategies, the group has been meeting for the past four years to share best-practices and learnings about the changing role of the safety net. Given the many changes being implemented as part of the ACA — including increased access to coverage through state Medicaid expansions and the Health Insurance Marketplace — their world is changing. But the need for safety net providers and programs to connect patients to free or discounted care is still a key component of our health care system.  Here are a few things I have learned:

• Several of the LACPs actually eliminated their existing plans, developed new eligibility and enrollment processes, and had members sign up again.  People eligible for Medicaid or Marketplace plans were routed to them.
• Most of the LACPs have taken on Navigator and Consumer Assistance Program (CAP) roles to assist with eligibility and enrollment.  It has been difficult for these programs to be the liaison between members and a rocky enrollment process.
• Affordability continues to be a key issue, with many members complaining that the costs are still too high. People are attracted to plans with low premiums, which tend to have higher deductibles. 
• There is concern that once members enroll and start to pay premiums, they may drop coverage if they don’t see value in the plans. On one hand, people who don’t use health care services may think, “why should I keep paying $200 a month when I don’t use it?”  On the other hand, people who use health care services may wonder, “why am I paying $200 a month when I still have to pay the full cost of my treatment – or even the $40 copay?”
• Another concern was that members who typically pay $25-$50 a month for LACP primary care access don’t want more than this. Moving to a $100 or $200 plan could double or triple their monthly costs, causing people to question, “why would I give this up to enroll in a qualified health plan?”
• Renewals continue to be a concern: Who needs to renew and by when?
• The process of hospital presumptive eligibility requirements for Medicaid is still unclear for many states, and some have established standards that are so difficult to meet that hospitals are choosing not to participate. There already is a backlog of new enrollees and of enrollees who signed up more recently because they qualified for special enrollment periods since the end of open enrollment, and this occurred while new IT systems were being implemented.
• There is concern that specialists are not taking patients without health insurance because they are focused on treating patients who recently gained coverage through Medicaid or qualified health plans. 
• While the federal government has ramped up its efforts, health insurance literacy was a key topic of conversation. There will be a need for continued education of new enrollees even after federal funding for outreach and enrollment dries up.
• Hospitals have provided a significant amount of funding for LACPs, but they are tightening their budgets in preparation for reductions in Disproportionate Share Hospital payments and additional public and private payment reforms. This puts additional pressure on the LACPs.