1. Maternity Care Coalition American Public Health Association – October 2001 Trends in Managed Care Services to Pregnant Women A Case Study of Maternity Care Coalition’s Experience in Southeastern Pennsylvania American Public Health Association Atlanta, Georgia - October 2001 JoAnne Fischer Heidi Worley

2. Maternity Care Coalition American Public Health Association – October 2001 Maternity Care Coalition Programs MOMobile Case-finding & referral Case Management Follow-up Supporting Pregnant, New Parents Early HeadStart Intensive interventions Child development Women’s Health, Children’s Futures, Research, Education, Advocacy Healthy Living HIV Prevention Community Education

3. Maternity Care Coalition American Public Health Association – October 2001 MOMobile Outreach 2012 New Families Enrolled 10 Sites 39 Site Staff

4. Maternity Care Coalition American Public Health Association – October 2001 MOMobile Families 20% Teens 59% African-American; 21% Latino/Hispanic; 10% White; 10% Others 66% on public benefits

5. Maternity Care Coalition American Public Health Association – October 2001 MOMobile Case Management, Education and Family Support 3,339 Families Served 21,951 Education Contacts 45 Parent Outreach Meetings, 560 Participated 3,301 Home Visits 5,281 Referrals

6. Maternity Care Coalition American Public Health Association – October 2001 Negotiating Health Insurance Last year, assisted 241 & signed up 68 families for CHIP Refer uninsured and immigrant families to federally funded health centers Assist families on how to negotiate mandated managed care & plan contractor changes

7. Maternity Care Coalition American Public Health Association – October 2001 Medicaid Managed Care in PA Enrolled 1999 Southeast ( Philadelphia 5 county ) 454,000 Southwest ( Pittsburgh 10 county ) 250,000 Lehigh/Capital( Allentown 10 county ) 167,000* Total Medicaid managed care PA 871,000 Total Medicaid population PA 1,415,926 62% of total Medicaid population covered by managed care *eligible population; program started 10/01/01

8. Maternity Care Coalition American Public Health Association – October 2001 Babies Total Southwest Births: 7,739 Total Southeast Births:14,075

9. Maternity Care Coalition American Public Health Association – October 2001 Southeast PA 28% 24% 48%

10. Maternity Care Coalition American Public Health Association – October 2001 MCC History with Managed Care Managed Care in Pennsylvania 10 years (1915 HIO waiver) HealthChoices - mandated in Feb 1997 75% enrolled voluntarily Nearly 500,000 recipients enrolled MCC History with MCOs Collaborative program sponsorship and pilots Statewide Advocacy Relationships with Decision makers MCC Market research Focus groups 1996 Survey 1997 Campaign 1997

11. Maternity Care Coalition American Public Health Association – October 2001 Medicaid Managed Care Evolves in Southeast PA Early years New market Learning curve Capitation and Selection Inclusive rates Maturation Mandatory participation Experience Special needs population Behavioral health carve out

12. Maternity Care Coalition American Public Health Association – October 2001 MCC Heyday MOMobile clients demand provider inclusion MCC contracts with all 4 Medicaid MCOs Contracted services vary and include: –Outreach, Case Finding & EPSDT Enrollment –Assessment, Home Visiting & Case Management MCC builds capacity for electronic data and claim submission Total MCO revenue FYE 6/1999: over 100,000 (4% of budget) MCC is national model for community based organizations contracting with MCOs

13. Maternity Care Coalition American Public Health Association – October 2001 MCC Tried to Make It Work Necessary but not sufficient Good reputation and customer satisfaction and demand Significant number of members in the region Strong infrastructure –MIS reporting –Financial billing capacity –Direct services protocols & QA

14. Maternity Care Coalition American Public Health Association – October 2001 Upstaged by welfare reform Families confused, in denial, panicking Caseworkers misinformed, hesitant to impart information Role of public sector not fully defined & coordinated Regional media market not providing county-specific information for consumers MA consumers were incorrectly dropped because they were linked to welfare rolls

15. Maternity Care Coalition American Public Health Association – October 2001 MCC’s Response Developed brochure; 5 languages, distributed 20,000 Assisted City with urgent, targeted outreach With Legal Services, challenged TANF work requirements for teen parents in school With Women’s Law Project, advocated for State to change domestic violence exemption rule

16. Maternity Care Coalition American Public Health Association – October 2001 Upstaged by CHIP 1997 – SCHIP legislation passed Pennsylvania becomes national model for private HMO based CHIP plan PA develops Reaching Out – CHIP outreach initiative MCC Responds MCC key in RWJ Covering Kids pilot MCC trains staff and develops protocols and database enhancements for CHIP enrollment

17. Maternity Care Coalition American Public Health Association – October 2001 Lessons Learned Interest from MCOs in early stages of market development Commitment to community shifted, as did the leadership, ownership, relationships and visibility of plans When the going gets tough, community groups go first Public health not an MCO priority

18. Maternity Care Coalition American Public Health Association – October 2001 MCC’s Agenda Moving Forward Continued commitment to Medicaid sponsored outreach and case management services CBOs and community health workers can help beyond enrollment – essential to reaching most isolated groups Understanding of public benefits and system navigation a major strength of CBOs More dialogue necessary within PA and nationally