Breaking Ground: Reaching for Universal Coverage in Washtenaw County

1. Breaking Ground:Reaching for Universal Coverage in Washtenaw County Center for Healthcare Research & Transformation Covering the Uninsured Panel Discussion May 2, 2008 Ellen Rabinowitz, Washtenaw Health Plan

2. WHP Program History • Jindo lawsuit • RCHP – Indigent Hospitalization (1989) • Washtenaw County Health Care (1998) • Washtenaw Health Plan (2001)

3. WHP Mission • The mission of the WHP is to expand access to health care and improve the health status of uninsured County residents by developing programs in partnership with local health care organizations. Toward that end, the WHP promotes, organizes, arranges, and finances access to health care.

4. Washtenaw Health Plan Programs: WHP Plan A/ Adult Benefits Waiver: • State of Michigan Program administered by WHP – 27 County Health Plans manage ABW program in 72 of Michigan’s 83 counties • Eligibility criteria: single adults with incomes below 35% of federal poverty (>$300/month) • Enrollment through MI Dept. of Human Services • Current Enrollment: 1185

5. Washtenaw Health Plan Programs: WHP Plan B: • Eligibility: • Washtenaw County residency • Gross monthly income <200% of FPL ($41,300 annual income for family of 4) • Not eligible for Medicaid, Medicare or other public programs • No access to private insurance • Current Enrollment: 8205

6. WHP Plan A & Plan B Services • Primary Care • Specialty Care services determined to be “medically necessary” • Radiology • Laboratory • Hospitalization • Prescription drugs • Emergency Ambulance (Plan A only) • Mental Health

7. Washtenaw Health Plan Programs: • Washtenaw Small Business Health Plan (WSBHP): • Access to modest scope of health care services including primary care, inpatient hospital, mental health and substance abuse • Targeted to low-wage employees of small businesses • Premium equally divided between employee, employer, public subsidy • Current enrollment: 6 businesses, 24 covered lives

8. Washtenaw Health Plan Programs: • Washtenaw County Prescription Plan (WCPP): • Targeted at community members with no or limited prescription drug coverage • Discount card with average savings of 25% -30% off retail cost • All prescription drugs covered • Over 50 participating pharmacies in Washtenaw County • Current Enrollment: 2500

9. WHP Revenue Sources • Combination of local, state and federal funds • ABW funding from State of Michigan • Hospitals’ donations of uncompensated care • Pfizer grant

10. Keys to Success • Partnership for community benefit • Includes: 2 major hospital systems, county government, safety net providers • Commitment to equity among partners – no one system to bear a disproportionate burden • Commitment to provide wide array of services to a diverse population; has lead to creative program planning

11. The Vision Universal access to medical care, mental health care and substance abuse services in Washtenaw County

12. The Real Impact: • WHP member who previously utilized the ER for respiratory distress/asthma attacks 3-4 times/month. With help of WHP case managers, member has established his medical care with his PCP, has received disease management education and is now able to manage his asthma. He has gone as long as 6 months without using the ER for asthma attacks • WHP member who was released from prison to his family home. Substance abuse issues got him kicked out of the home, and unable to get a bed at the homeless shelter. He finally stopped using drugs and got a bed at the shelter. Now enrolled in the WHP, established care with a PCP, back on medication for his high blood pressure. Free from illicit drug use for 3 months, has a job and will soon have housing.