Amerigroup

• Nataly Renteria, Amerigroup - Community Relations and Marketing Representative, renteria@amerigroup.com
• Value added benefits/member benefits for Medicaid
  • Amerigroup is one option under Washington Apple health – here since just 2012 – but growing
  • We encourage whole person care.  Help folks be a better person – look at social determinates of health (in care you’re not familiar with Social Determinates of Health, the Center for Disease Control and Prevention – CDC – has a useful explanation at https://www.cdc.gov/socialdeterminants/index.htm -ed).
  • Benefits
    • No-cost eye glasses – up to $100 per year for adults
    • GED testing fees – if you are part of an agency that helps folks get their GED, we’ll provide a voucher to cover the folks costs.
    • Acupuncture – up to 3 session per year (wonder why acupuncture has just one c in “acu”, but Accurate has two c’s in accu?  I did.  Acupuncture comes from the latin acus – “needle” - and the word puncture, whereas Accurate is from latin ad – “to” and the latin curare – “towards a cure”.  Which somehow gets smooshed into accurate.  Anyway, I always thought acupuncture was “accurate puncturing”, but it really means “needle puncturing”.  Which makes sense, especially, since you probably don’t need to be accurate with acupuncture- some studies have shown you can just stick acupuncture needles nearly anywhere to get results - https://thebrain.mcgill.ca/flash/capsules/experience_bleu08.html -ed.)      
    • Youth – no-cost boys and girls club member fees.  Provides transportation from school to the club.
    • No-cost Sports Physicals – for members 7-18.
    • Rewards program for mothers –
      • Get $75 gift card at Riteaid or Walmart (no Tabaco, alcohol or firearms purchases, though)..
      • Breast pump     
      • Male Circumcision (there is an ongoing, sort of benign debate between folks for and folks against circumcision.  For some reason, I find opinions on this fascinating – mostly because many of my friends had no opinion on circumcision until the doctor asked what their plans for their son’s foreskin was, and they had to decide, and weren’t sure what the “right” answer was.  If you didn’t know the debate existed, I recommend this somewhat-not-safe-for-work article that does a good job presenting the pros and cons of male circumcision - https://sciencebasedmedicine.org/circumcision-what-does-science-say/ -ed). 
    • Web-based portal – called myStrength – will help with no-cost memberships to many organizations – you can try it with a provider code to see what you clients will be able to use.   if you’d like to try it out email me for a code - renteria@amerigroup.com
    • No-cost cell phones are available (limited monthly minutes, though).
    • Peer support specialist registration and renewal program – for client who want to participate in peer support
    • Life transition kit – for members discharged or who are homeless.  Blanket, gift card, first-aid kit – just call member services to tell them where to deliver it. 
    • Light box for Seasonal Affective disorder – for the Seattle blues or whatever – (I’m a bit of an Seasonal Affective Disorder denier – based on studies like this one - https://www.scientificamerican.com/article/study-finds-seasonal-affective-disorder-doesn-t-exist/ -ed)
    • Weightwatchers (I’m no denier of weightwatchers – it is a super effective program –ed)
    • Fitness Coach program
    • One-time Non-medical transportation benefits – $50 orca lift card in King County or a $50 gas card – can be used for anything.  State covers non-emergency medical transportation.  Every member can get that (family of 6 could get 6 gas cards).
    • National Call Center will send it out to you
      • American Indian and Alaskan Native Group – try to partner with other healing methods.  - we cover costs, for smudging (I’d never heard this word before - https://en.wikipedia.org/wiki/Smudging -ed), sweat lodge, storytelling and talking circles – although many are free, we will help with costs.
• Amerigroup Foundation – Anthem Amerigroup foundation.  If you have project that you’d like to apply for funding – present the proposal to the foundation.  Will do sponsorships.  Done some sponsorships for homeless events (someone needs to take them up on this funding opportunity. –ed).
• Go to http://myamerigroup.com/  – enter zip code to learn about community. 
• Emily – how aware are the health care providers in the community about these resources?  Nataly -  we are working to present to providers to let them know about it. 
• Carolyn – this coverage includes surgeries and such.  Nataly – these are just the value added benefits.  Medicaid covers the usual medical needs.  The member handbooks have more information about what medical stuff is provided. 
• Maureen – can you print information in other languages?  Nataly – sure.
• James – do you ask which MCO your clients have? 
  • Molina and Coordinated Care attend these meeting – they can inform you about the differences in these program. 
  • Next is Foundational Community Supports, which can offer services of PSH wherever someone is living in the County. 
• Foundational Community Supports  (Presentation is attached. –ed)
  • Jacob Avery, Foundational Community Supports Manager - Avery@amerigroup.com
  • This program is separate from the Amerigroup Health Plan.  This is for almost everyone on Medicaid, not just Amerigroup members
  • This program comes out of the 1115 Medicaid Waiver – an agreement between Washington Health Care Authority to use medicaid funds for different things.  One part is foundation community supports.  One is supportive housing and the other is supportive employment (more info at https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation -ed)
  • Many of the services aren’t that different from what your agencies do.
  • Supportive Housing Benefit – covers the cost of services with help filling out applications, help finding housing, housing retention, dispute resolution. 
  • Doesn’t cover rent, move-in, furniture, utilities, application payments (don’t want to make it too easy...-ed).
  • This is a pilot program 1/1/2018 through 12/31/2021.  The real opportunity for this program is to pair with other funding that is out there. 
  • I want agencies to see how they can leverage this funding.
  • This doesn’t solve homelessness, but is a new funding stream
  • Supportive Employment – about 2/3 of the programs are doing this
    • Outreach to employers
    • Employment assessments
    • Job retention
    • Help filling out applications
  • Who is eligible – not everyone on Medicaid qualifies.  But you do need to be on Medicaid to qualify.
    • Any of the 5 managed care organizations works fine.
    • You can be dual eligible with Medicare or tribal health
    • Exceptions –
      • Medicaid plans entirely paid for by the state of Washington – if they don’t use federal funds, they are excluded
      • Folks on spend down
      • Folks only using Medicaid part B
    • Age limit of 18+ for housing
    • Age limit of 16+ for employment
    • Must have a health needs based criteria and a risk factor –
      • Medical Need
        • Substance use or mental health diagnosis
        • Needing assistance with activities of daily living
        • Being homeless with a disability
        • On Housing and Essential Needs (HEN) or Aging, Blind or Disabled Case Assistance (ADB)
      • Risk Factors
        • Frequent stays in crisis setting (2+ per year)
        • Others
        • Chronically Homeless – can accept attestation – meaning enrollees can self-declare their chronic homelessness. 
  • Maureen – are you the only program in Pierce County using this part of the Medicaid waiver?  Jacob – for this program, we are a third party administrator.  Agencies all over the state provide these services.  We contract and credential .  James – 8 agencies do one of the two programs.  Sea mar, MDC, CLR, CCS (King county) and more. 
  • James – folks can get this no matter what MCO they use. 
  • We measure outcomes and do tracking to see if it is effective.  If it is effective, it will be transferred into all the MCO programs. 
  • The program has been in the implementation state for years.  Signed in 2017. Went live in January of 2018. 
  • Pierce County was one area we needed help – still trying to grow our provider area here.  If your agency is interested, contact me. Need from you a Tax ID, Medicaid ID, National Provider Identifier and a Business License.
  • Currently contracted:
    • MDC, GLMH, Share and Care House, Northwest Integrated Health, many that do supportive employment – Goodwill isn’t on yet.  Compass career, CLR. 
    • Current enrollment is around 3,000.  Only some 200 in Pierce County. 
    • Anyone can refer a potential enrollee.  The best way can be to refer directly to the provider.
    • We refer to a local provider and they have 5 days to reply – to get situated quickly, call us to get the best response
  • Maureen – you said at the beginning you were surprised at the number of supportive employment was higher than supportive housing.  Why?  Is that county specific?  Jacob – state was surprised too.  Since housing wasn’t funded directly, it is tough to take on clients they can’t house.  Employment agencies had an easier time.  Housing funding is very complicated – housing providers are cautious in signing up for housing that may supplant existing funding. 
  • Rates – a case load of 20 looks sustainable.  The per diem rate is challenging for housing providers. 
  • We have a process to request an exception to request more hours for a client – just want to know why a client needs more
  • Medicaid is the payer of last resort. 
  • Can get HEN and Medicaid services at the same time. 
  • Division of Behavioral Health and Recovery (DBHR) support teams are available for:
    • On-site trainings and technical assistance for housing and employment –
    • Coordinating between behavioral health organization and fCS providers and provide shared learning opportunities. 
  • Aging and long term care is a partner
    • Give us referrals – aging and long term care will send referrals
  • Provider website and resource guide available
  • Al – minimum qualifications for providers?  Jacob – 1-2 years and AA or BA in an appropriate field, or 1-2 years in supportive housing or supportive employment.  We contract all our agencies as faculties – they don’t bill us as individual providers
  • Al – was fantasizing over here and I wanted to hire folks who received your service to provide that service to other folks, could I hire someone on your program as a peer support to provide those services.  Can hire folks receiving services, but they need to be completely separate from the employment – separating clinical files from HR files. 
  • David – clients challenged by Mental Health and Substance Use – and then diabetes or neuropathies and fibromyalgia – I struggle working with community health care clinics.  Because of the place she is at, there are lots of bad activities in the building.  Trying to work with a community health care clinic.  How can a care coordinator.  Jacob – Foundational Community Supports is a good match, but sometimes when there are a lot of different needs, it isn’t clear where to turn.  James – these services are a great place to get a case manager from this program. 
  • Larry – you talked about a 16 year old needing supportive employment – what would a typical 16 year old in this scenario be like?  Jacob – we didn’t start out with many under 18 enrollees – but have seen that change in the last 6 months.  Community Youth Services – in Olympia - has a lot of young people in the program.  Larry – should alternative high schools talk to you?  Jacob – the funding stream often doesn’t work very well. 
  • Kelly - Boys and Girls Club – does this cover childcare?  Jacob – talk to boys and girls club or Nataly
  • What is the 3^rd waiver?  1115 – agreement between HCA of WA and federal govt. 
    • Initiative 2 – long term care
    • Initiative 1 – ACH and integration of services
    • Initiative 3 – supportive employment and housing
  • Maureen – the # of options for support can be overwhelming for providers – is there anything in the funding that will allow for outreach workers that a clients.  Is coordination of services covered?  Jacob – yes, it is in the contract.
  • Al – are you coordinating with the ACH in this county?  Jacob – not directly – but with individual county approaches.  We talk to folks on the ACH, but most of them are a little separate.  
  • James – client come in for Mental Health, often need employment.  We can take them to Valeo – and when we get them there, we find out t the client sis  ready.  Comes back to Comprehensive Life Resources – where they can work on getting employment ready.  Ge them ready by talking to Greg about what they need. Then give them back to Valeo when they are ready to work.
  • James – it is skill building, helping them access housing.  Allows us to add more housing and employment case managers.  Maybe shelter providers call CLR when a client is ready to move in – they start navigating the client. 
  • Inclement Weather – no updates. 
    • Youth is ending it
    • Other agencies ending it Sunday night
  • Al – Hospital Charity Care – would you like that presentation in this group.  Everyone – yes.
  • James – trainings - Had Point in Time county training- have had the crisis management system to identify the crisis lines. If there’s is a spot we need training – that would be great.