Welcome

• James Pogue, Comprehensive Life Resources
• I has been a couple weeks since I’ve seen you.  We didn’t meet last week because of the holiday – even though many of us worked because that is the line of work we are in.
• Will shut down the Chronically Homeless Master List e-mail soon – please use the fullcoalition@pchomeless.org
• If you’d like to join the listserv, go to http://www.pchomeless.org/Home/Listserv and signup.

Presentation

Molina Healthcare - https://www.molinahealthcare.com/ - Molina presentation powerpoint

• Jorge Rivera, State Director for community engagement, Molina Healthcare - rivera@molinahealthcare.com - 425-424-7119
• Thanks you for the work all of you do.  I have been in 34 of the 39 counties (I’m just curious to know which counties you skipped – was one Garfield County? It is tiny, but has the cutest Courthouse in the State – not that I’ve ever had to report there, or anything even remotely like that.  –ed) – in meetings like these – presenting or being part of a coalition.  We are so humbled and grateful you decided to do this work.  The highest reward is when clients look you in the eye and say thank you (I don’t know, aggregating data that shows amazingly successful housing outcomes is pretty high on the reward ranking – or is that just me? –ed). 
• Keep three things in mind
  • Molina Healthcare if here and wants to help and can help.  We have ways to help the work you do.
  • Healthcare is super complex (for starters, I’m not even sure if Healthcare is one word or two – and I just read a whole article on it - https://www.arcadia.io/final-word-healthcare-vs-health-care/  –ed) – the connections between healthcare and homelessness are complex.  You don’t need to understand anything today to know that Molina is working to serve folks experiencing homelessness.
  • Molina is blessed to have Carrie Ching in this community, she is a great asset and is a super connector and is very resourceful.  She gets things done for the community.  (Hear! Hear! –ed.)
• About Molina
  • Can be called an insurer, or a payer – formally we are a Managed Care Organization (MCO).  Molina works for vulnerable people in states across the County. 
  • Our profit is limited by the State to no more than 3%.  We work to put the money to use for the people we serve.
  • With 750k people, Molina is the largest Managed Care Organization in Washington State- double the size of the next larger Medicaid provider in Washington.  
  • 5 years ago – there were just 2 Managed Care Organizations.  State invited 3 more Managed Care Organizations in, and even in that time Molina has grown dramatically.  The growth was by the choice of the people.  When you are accepted into Medicaid, you are offered a choice, and many folks choose Molina. 
  • We have been able to keep up the quality of our services and keep up the highest level of accreditation.  Also have “multicultural healthcare” distinction, which shows we care for and serve well everyone.
  • Have the largest medical provider networks, including 101 of all 102 state hospitals ( I just have to know, which hospital didn’t make the cut?  I hope it isn’t the Garfield County Hospital, because they have a “compassionate and dedicated staff supported by the latest technology and current treatment options”, or so says their website – and I’ll have to take their word for it, as I certainly have no personal experience there –ed), and more than 25,000 providers of primary and specialty care in all 39 counties.
  • Carrie can provide information on all the different options available. 
• Integrated Managed Care – an invention of the State and a trend across the County. 
  • For a long time, we separated mental health, physical health, and substance use disorder.  Before integrated managed care, coordinating their care was very difficult.   
  • If you have a team that integrates services, you get better outcomes. 
  • By 2020, Managed Care Organizations must integrate care.  Molina decided to be an early adopter – started serving 80,000 members 3 years ago.  Added another 70,000 recently.  Pierce County is coming live on January 1^st.  You now have options to treat people in an integrated way – the Primary care doctor becomes a point of entry.  Integrating care will make it easier by just going to see someone who is your primary care provider – it creates more access and works around many of the stigmas of mental health services or substance use services.    
  • We are proud of scoring so well in state competition to operate the Integrated Managed Care.
  • Some say it is just integrated financing, but it is also integrated teams that work together. 
  • Provide services that range from case management to substance use disorder.  (seems like there should be some more words on the end of that sentence, but I must have missed them –ed)
  • Comparing pilot program data for 2 years -  outcomes – like reduction of unnecessary ER visits or people that exit a hospital and do not come back, most of the metrics improved more in integrated care compared to other regions that did not implement integrated managed care.  We believe in integrated care, and the data shows it works.  You pick someone up on the streets, connect them to physical care, connect them to housing, and start giving them space to work on things
  • Molina provides over half of the Medicaid services in the region. 
• Benefits and incentives for Medicaid with Molina
  • Provide virtual Urgent Care -  through cleint phones or computers at 3am (or whenever).  Can get a doctor on the screen within 8 minutes.  For many conditions, you can get a prescription right there. 
  • Free cell phones for members – so member can have cell phone for access to services.  Community Connectors make extensive use of these resources. 
  • HealthinHand app – new features
  • Health Incentives – members get paid to use the services.  This is for working families and very vulnerable individuals and everyone.
  • We provide services to LGBT community.  Molina (and every Managed Care Organizations is required to provide these services)
• Social Determinants of Health – when you are homeless, it is impossible to address health issues.
• Molina Dental Managed Care.  Dental services have been underfunded and difficult to access.  If 100 individuals could get dental care from the state, only a few would actually get appointments.  We did not bid for this work, but have a partnership with Delta Dental.
• Call Center Operations.  New automatic renews for many members.  Many folks do need to renew, and we make about 30,000 calls per month to remind and assist clients renewing.  We can help clients that haven’t renewed. 
• Molina and Medicare Dual Eligible Needs Service Plan (DNSP)
  • Jim Maguire, Medicare Sales Manager - maguire@molinahealthcare.com - 253-441-9182
  • Medicare health insurance card is a new change.  If they are on Social Security Disability or are 65 or over.  Molina offers a dual care option.
  • Provide Medicare A coverage – hospital stays and skilled nursing
  • B coverage - Medical coverage for outpatient and doctor visits
  • C – Medicare advantage – Managed Care Organizations manage their healthcare.  Coordination of care is fundamental – outcomes are better – Part C plans see improvements with wellness programs and such.
  • D – prescription coverage
  • Offered in 8 Counties, including Pierce (but not Garfield, I noticed… -ed)
  • Must have Medicare Health Insurance and Provider 1 card to be in the Dual Special Needs Plans, and be in service area.
  • Medicare does a great job for our seniors and the folks on it.  Molina adds on to that – adds fitness, hearing aids, transportation, dental.
  • Model of Care – used to be to treat individual by body part – but chronic conditions and behavioral health require coordinated care. 
• Next month, 14,000 members will be moved to a different health plan.  Community Health Plan is going away, which will create confusion.  It is important that you know Carrie can be a resource to figure out what is going on.  We care and want to help on this.  Clients did not lose coverage – they were moved to other plans.
• Molina focuses on the most vulnerable.
• Our Benefits are focused on improving our people’s health and helping direct providers such as community health centers to engage more with members. 
• Our regional engagement team is here to help. 
• Question - Are benefits free or is there a co-pay?  Jorge – if you are on Medicaid – there is no deductible – the state covers the entire cost.   There are no maximum out of pockets.
• Abiodun – I want to commend Carrie and Pamm – honestly, they are doing the footwork – coming to where our clients are to just allow clients to ask questions.
• Marcus – this is the right direction.  What do we do when the needs outweigh the resources?  Need more detox beds – we have folks with needs but no facilities for them.  Jorge – the needs will always be larger than our financial abilities to support them.  I don’t have a solution, but know that we need to keep this connection going.  With the Accountable Communities of Health, we are trying to working on getting better resources.  The healthcare providers are now talking with different agencies – we are trying to keep integrated and are on a good pathway. 
• Al – your program and presentation is very impressive.  I think you for that.
• Al – a systems question – you key this all to the Primary Care Providers – these folks are the least paid and have the least time to do care coordination.  Jorge - I agree this is an issues – there is a lot of advocacy to better pay Medicaid doctors.  We need to continue to build capacity around doctors. 
• Kelley – I love Molina – thanks for the support.  At goodwill, we have the Center for Strong Families – supporting folks getting livable wage jobs.  Mothers lose Medicaid when they get around $20 per hour.  They are opting for no Medical Care at all.  Is there any talk about eliminating that benefits cliff.  Jorge - The Affordable Care Act has been under attack since it was passed – since ½ of the County does not believe your clients need that help.  We do have a Qualified Health Plan (QHP) in the County – but if the Federal Government cuts funding that makes it difficult.  We are committed to the Qualified health Plan – we don’t make any money on it, but we want to keep this program alive.  Carrie – if  you have question on the Qualified Health Plan – just ask Jim Maguire with questions.  I also have brochures on the table in back. 
• Sharon – I’ve got to get 3 jobs – though I’m past that now.  Now I have to pay $3,500 before I can use healthcare.  I’m diabetic, and I can’t get anything.  Jorge - stay close to the eligibility rules.
• James – Molina is listening and has put programs in place to experiment with filling some of our needs.

Reports

Advocacy Committee

• Brandon Chun, MDC - bchun@mdc-hope.org
• Update on Policy Group work
  • We are looking at some of the policies, practices, and regulations upstream – to see where we can eliminate or minimize some of the barriers we are seeing. 
  • Transportation is one of the major issues.
  • With regard to Sound Transit or Pierce Transit – we use ORCA (https://orcacard.com/ERG-Seattle/p1_001.do )– a transit pass that works like cash or like a pass
  • Sound Transit has ORCA LIFT ( https://kingcounty.gov/depts/transportation/metro/fares-orca/orca-cards/lift.aspx ) – around 50% discount on public transit– King, Snohomish, Kitsap, all signed in to this program. not Pierce.  Doing research to see why Pierce Transit made that decision. 
  • In addition, rural routes have been compromised or eliminated – what tangible action can we do to restore some of these routes.  We have a meeting with Pierce Transit planned or next week
  • Have a meeting scheduled with Tacoma City Councilmember Ryan Mello – who also sits on the Pierce Transit Board.  Talking about how they can be sponsors of some of these initiatives. 
  • We have our own ideas individually, but we’d like to get everyone’s priorities so we can pursue the work of the Coalition
  • Idea - looking at Screening fee issues – why can landlords keep asking for their own screening fees which makes getting a lease expensive and challenging.
  • Idea - part of the challenge of Hire253 is the challenge of transportation – getting an ORCA card would make all the difference – could the advocacy group reach out to Pierce Transit for folks exiting homelessness.  Pierce County has no income level discount for Transit.
  • Kelley – I have amazing data – we increase employment and retention by over 80% - because of the bus passes.  Brandon – we are working on using that. 
  • Brandon – we need stories and testimonies – those credible experiences helps shift the decision making – we’ll create a list of folks that can do that. 
  • Theresa – How many of you can get these ½ price passes from Pierce County transit?  James – they do cost money.  Theresa – Pierce Transit is experimenting with this. 
  • Sharon – I want to say thank you to the homeless coalition.  I not only have 3 jobs, but I’m getting housed next Friday.  (clapping).  There are barriers out there – I wasn’t able to get the help with resources without pushing hard to get them.  There are kids in the shelter that want to commit suicide.  We are trying to talk – they have nominated me as the homeless speaker.  We are also working on getting a veteran speaker.  It is hard to get sleep with my challenging schedule and the rules at the shelter. 
  • Neal – A possible outlet for future advocacy – recently house bill 1298 – the ban the box initiative (http://apps2.leg.wa.gov/billsummary?BillNumber=1298&Year=2017&BillNumber=1298&Year=2017 )– if we could possible put similar legislation applying to housing providers – like only asking for very specific infractions.  Would like to have housing providers rely on a central screening application.  Brandon – we need to check and see what other groups are doing.  Barbara – the Department of Corrections and reentry council – including Sentator Darnielle - are working on this.
  • Idea – I attended a housing forum in Othello – having to put Social Security Number as a tenant can cause barriers.  There are other changes that can have an enormous effect on things.

Good of the Order

• Martha - December 1^st and December 8^th- Shelter253 training – training for the general public on volunteering or setting up a shelter.  Lessons on how to help us out with shelter as a volunteer or a donation.  Both start at 11am.  The December 1^st is at the Salvation Army Church in Tacoma and the December 8^th is at the Salvation Army Church in Puyallup.  Looking to have one in Gig Harbor as well.
• Theresa - 99 socks project – - if folks are interested in helping – this is for the stability site – Christmas stockings for everyone who is there – I talked with Faatima Lawrence and Emerald Gipson (with the stability site. –ed) about what they need and would fit In a stocking.  We are happy to take insulated tumbler donations, as we’d like to give each resident one.  Want to get everything by December 14^th.  Lots of small things can make a difference.  If you have 5 hand warmers or 2 snack bars, those are all welcome.  We need some stocking caps – some will be hand knit, some will be from the dollar store – it is all good.  Putting them together on December 20^th (a Thursday).  Martha – we will put a basket here to allow folks to bring stuff.  Will deliver on Christmas Eve day between 11am and 3pm.  Haven’t set a time yet to see when folks are able to make it.
• Theresa - The stocking were donated from the Bombas sock company (https://bombas.com/ - a cool company that donates a pair of socks to folks in need for every pair purchased. –ed)   –
• Theresa – We should have the G Street community – we should have them all come some time to talk about what they do. 
• James- The resource surveys need to be returned to create the interactive map of resources.   Al – what do you do if your offerings change – can we edit them ourselves?  James – you can let us know about the change. 
• James – Pierce County Councilmembers Talbert and Richardson, working with James and Gerrit, put an initiative together for tiny homes.  Funding of $250k to make a 10 tiny home community with land and such donated to create a community.  We’ve been working on it for months, finally it received bipartisan support and was approved.  After it was approved and in the budget, Pam Roach e-mailed some concerns.  One-on-one conversations with councilmembers can be very helpful – we’d highly encourage you to reach out to her.
• Associated Ministries has their open house next Friday, December 7th, from 11am-1pm at 901 South 13th Street, Tacoma, WA.  Get snacks, a tour and see what they do and how they do it.  Kelley – do you have office cats?  Yes
• Al – Human Rights Commission sponsored a forum on hospital charity care – if you have 300% of federal poverty level or lower, then apply to the hospitals for financial assistance.  Be aware, that is for just hospital care.  There is also a doctor level, though.  Multicare lists all their physicians that accept charity care determinations.  Have clients get primary care doctor – not urgent care – and ask about financial assistance.

Coming Attractions

• December 14th – The Year in Review and Winter Party
• December 21st – No Meeting
• December 28th – No Meeting
• January 4th – Land Use Code changes in Pierce County along transit routes
• January 11th – Coordinated Care and possible talk with Senator Darnielle
• January 18th – experts panel – Is sliced bread the scientific improvement of the century, or is the convenient packaging of sliced wonder bread perhaps eclipsed by the discovery of antibiotics or the development of the radio?  Our panel of scientist and bakers will present their arguments, and you decide.  
• January 25th – Point in Time Count

Restaurant Review

Good breakfast restaurants are few and far between.  One of Tacoma’s crown jewels is Alfred’s Cafe ( https://www.facebook.com/pages/Alfreds-Cafe/113341428699600 ).  Located  near the Tacoma Dome (402 Puyallup Avenue, Tacoma, WA  98421, to be precise), this diner has been serving great breakfasts for years.  They serve lunch and dinner and cocktails and the like (people rave about the monte cristo), but I’ve only been there for breakfast.  They have great omelets and they do a nice job with the hash browns.  Their pancakes are definitely worth eating.  They also make a good sausage gravy, but they do a chorizo gravy that is genius– a nice kickstarter for those mornings where you’re recovering from some bad decisions the night before (at least I’ve heard that is the case).  And speaking of hangover cures, one place they shine is their eggs benedict.  My favorite origin story for eggs benedict comes from a wealthy New York stock broker and flamboyant man-about-town named Lemuel Benedict.  He generally horrified his aristocratic family (he had a raccoon skin coat and a cane that had a liquor flask build-in – which were rather the attention getters) with his antics and frequent appearances in gossip columns.  One morning, recovering from a night on the town, he breakfasted at the Waldorf, and thought toast with bacon and a poached egg covered by hollandaise sauce would be a cure to what ailed him.  Oscar of the Waldorf (a Swiss immigrant, maître d’hôtel of myth and legend, and later creator of the Waldorf salad and thousand island salad dressing ) gave the recipe a try, liked it, put it on the menu with a name to honor the originator.  Or so the legend goes.  Anyway, I don’t often order eggs benedict, as it is so easy to ruin (overcooked eggs and botched hollandaise sauces being the two worst offenders, in my opinion).  But Alfred’s nails it every time.  Alfred’s has quite a bit of space, somewhat subdued lighting and some nice wood furniture and paneling about the place, which all gives it a cozy feel.  , but you can end up waiting a few minutes for a table.  And you might need to park a block or two away.  But those are small prices to pay for a good breakfast.  And I always seem to bump into someone I know there, which is a pleasant reward of its own.  So, next time you are hankering for a good weekend brunch, I definitely recommend Alfred’s. 

Attendees

• James Pogue, Comprehensive Life Resources
• Jorge Rivera, Molina Healthcare
• Carrie Ching, Molina Healthcare
• John Smith, Tacoma Rescue Mission
• Lawrence Kinnaman, Tacoma Rescue Mission
• Marcus Taylor, Tacoma Rescue Mission
• Ty Dilworth, Tacoma Rescue Mission
• Gilbert Olivera, Tacoma Rescue Mission
• Luis Rivera, Tacoma Rescue Mission
• Bruce Morris, Tacoma Transportation Coalition
• Justin Tillis, Tacoma Rescue Mission
• Joseph Sanders, Tacoma Rescue Mission
• Kristinia Argent, Community Member
• Laurel Dunn-Scott, Industrial Workers of the World
• Martha Sheppard, Tacoma Salvation Army
• Sheila, Molina Healthcare
• Dru Gonia, Tacoma Salvation Army
• Ashley Cunningham, Tacoma Salvation Army
• Pamm Silver, Molina Healthcare
• Barb Kaelberer, Adovate
• Bobby Ocasio, City of Tacoma
• Jennifer Myers, Client
• Jessica Elliot, Client
• Leslie Elliot, Client
• Robert L Armstrong, Client
• Meridee Heimlich, Step by Step
• Ivette Perez-Morales, Associated Ministries
• Elaine Tuisila, Metropolitan Development Council
• Eric Hasstedt, Safe Streets
• Larry Seaquist, League of Women Voters
• Roxanne Simon, Safe Streets
• Neal Rogers, Tent City Tacoma
• Emerald Gipson, Catholic Community Services
• Richard Berghammer, Fellowship Bible Church
• Brandon Ault, Catholic Community Services
• Christine Madick, Rafael Medicus Clinic
• Becket Harvey, Catholic Community Services
• Patricia Menzies, Tent City Tacoma
• Brandon Chun, Metropolitan Development Council
• Rosemary Powers, New Connections
• Jane McKitrrick, Catholic Community Services
• Sammie Iverson, Tacoma Public Schools
• Bill Bruno, Catholic Community Services
• Mitch Austin, Valeo Vocation (welcome back, Mitch –ed.)
• Valentinya Germer, Comprehensive Life Resources
• Daniel Gross, Pierce County Aging and Disability Resource Center
• Al Ratcliffe, Me
• Jim McGuire, Molina Healthcare
• Theresa Power-Drutis, New Connections
• Abiodun Faleke, Tacoma Rescue Mission
• Kelly Blucher, Goodwill
• Gerrit Nyland, Catholic Community Services