Stepping-Up Conference September 28, 2017 | Molina Healthcare of Ohio Deidre Palmer, MSEd, LPC, LSW
The Molina Story Three Decades of Delivering Access to Quality Care Molina Healthcare’s history and member- focused approach began with the vision of Dr. C. David Molina, an emergency department physician who saw people in need and opened a community clinic where caring for people was more important than their ability to pay. Today Molina Healthcare serves the diverse needs of over 4 million plan members and beneficiaries across the United States through government-funded programs. Molina Healthcare provides NCQA-accredited care and services that focus on promoting health, wellness and improved patient outcomes. We treat everyone like family, just as Dr. Molina did – making Molina Healthcare your extended family.
The Ohio Department of Medicaid Covered Benefits and Services
Ohio Medicaid Managed Care Benefits The following includes but is not limited to a general list of the benefits covered • by Medicaid and MCPs: Inpatient hospital services • • Outpatient hospital services (including those provided by rural health clinics & federally qualified health centers) Physician services • Laboratory and x-ray services • Prescriptions • • Dental Vision • Durable Medical Equipment (DME) • 4
Value Added Benefits • Additional • Enhanced Dental and transportation benefits Vision Coverage • Statewide Network of • Self-Service Capabilities Providers • Disease Management • 24-Hour Nurse Advice and Health Education Line Programs • Care Management • Member services line 5
Care Management
Care Coordination Molina Healthcare’s Person-Centered Approach Care Managers coordinate care and provide individualized support to each of their members We work with individuals to: • Help identify appropriate caregivers • Develop an individualized care plan • Collaborate with providers • Coordinate easier access to needed quality care and social support services
Care Management Molina Care Managers work to ensure that inmates with Substance Use • Disorders (SUD) and/or who have been identified with having a Serious and Persistently Mentally Illness (SPMI) are given the proper treatment and support to avoid reoffending. The Care Manager’s role includes assisting the member by : – Linking and Collaborating with Medical and Behavioral Health Providers and Resources – Scheduling appointments & where to obtain medications – Identifying resources necessary to secure housing, employment, food, transportation etc. – Key contact information for the MCP and CM
Ohio Department of Medicaid Managed Care Engagement with Ex-Offenders
O H O H I O O D E D E PA R T M E N T N T O F O F M a M a k i n g O h i o M E M E D I C A I D B e B e t t e r DRC Pre-Release 1. ODRC pre-release interface with Ohio Benefits Process • Sends application information for offenders Overview identified for release within 105 days 2. Direct Enrollment Unit processes applications • ODRC main office address for mailing address: 770 W. Broad Street • Physical address is where individual plans to reside upon release 3. ODM coordinates managed care enrollment, assuring care coordination, and transfer of case to residential county prior to month of release from incarceration 10/2/17 11
Issues Facing Prisons and Jails Inmates are often admitted to jail under the immediate influence of, or with • dependency on alcohol or drugs Inmates often have untreated or undiagnosed mental health needs • Staffing training and education needs – higher level training needed for special • monitoring, on site treatment/care, referrals, etc. for inmates with mental health issues Lack of access to information: Immediate need for information about an inmate’s • health, mental health and disabilities to assist with decision making Overcrowding resulting in stretched staff capacity to address health related issues • Need for collaboration with outside agency and stakeholders including managed • care
Opportunities for Collaboration Between Managed Care and Local Agencies and Organizations Connect with consumers and each other to facilitate the sharing of • information about the needs and wants of consumers Find and refer consumers to qualified healthcare providers to ensure • timely and appropriate access to care. Contact MCPs for member materials, such as ID cards, member • handbooks, etc. Help consumers identify and access covered and value-added benefits, • including medical services, medications, transportation to medical appointments, Refer individuals to MCP care coordination and case management • programs Participate in MCP Member Advisory Councils and local re-entry coalitions •
Molina Pre-Release Success Stories and Community Partnerships
Molina Pre-Release Success Story Mr. W is a 23 year old male diagnosed with Anxiety, ADHD, Mood Disorder, PTSD, • Schizophrenia, Substance Use Disorder, Trauma Related Joint Disorder and Thyroid disorder. His Molina Care Manager contacted him for follow up post release and assisted • the member with finding a Dentist and Primary Care Physician by providing him a list of providers near his location. Mr. W. reported that he was eager to see a dentist because he had lost many of his • teeth from using methamphetamines. • Mr. W reported that he was able to attend his scheduled Dentist and Primary Care Physician appointments and plans to continue to work with his Dentist to receive dentures. Mr. Watson reported that he is also engaged in Behavioral Health with a local Substance Abuse Provider. Mr. W remains enrolled in Care Management and reported to his Molina Care • Manager that he plans to complete college applications. He also expressed gratitude to his Molina CM for providing support during his transition.
Community Partnerships Why Collaborate? 1. Prevents Duplication of Work - Community organizations are running effective community reentry programs. 2. Removes Barriers - Pilot demonstration programs address social issues that stand in the way of MCP members receiving healthcare -Partnerships help to address issues that contribute to recidivism i.e. lack of employment and job training
Dress for Success Partnership- Pilot Referral program targeting members in Cleveland, Central Ohio and Cincinnati • Areas Prioritizes members recently released from incarceration • Participating members receive free suiting, access to career resources, and job • retention coaching services to help them find and keep gainful employment • Molina’s Care Managers track program completion, program impact, adherence to required medical appointments and utilization of health insurance benefits.
Columbus Urban League Partnership- Pilot Referral program for members in Central Ohio • Will help over 3 0 male Molina members address various issues that • negatively impact healthcare including: Workforce readiness – Challenges facing ex criminal offenders – Stress and anger management – Credit score improvement and budgeting – Broken bonds between children and their fathers – • The community reentry component will link an unlimited number of Molina members to community resources for housing, transportation, housing and employment As part of the workforce readiness component, 20 of the participating • members will obtain interview appropriate attire and mentors who can provide career advice and support
Church and Community Development for All People Partnership- Workforce Development Pilot Referral program for members in Central Ohio • Workforce training program to be offered this September as • part of the new workforce development space on the campus of Residences at Career Gateway. • Molina supporting training programs and job fairs, and providing member benefits information and referrals • Prioritizes members recently released form incarceration, seeking job training and employment opportunities.
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