Jessica Larson, KC CARE Health Center’s Outreach and Enrollment Coordinator, says she has been working to help patients secure health coverage since the passage of the Affordable Care Act in 2010 and the first health insurance marketplace open enrollment in 2013. And although the ACA has reached its 10-year mark, the need for easy-to-understand information and assistance has not changed.
When the health insurance marketplace first launched, KC CARE used a 100% volunteer Certified Application Counselor team, in addition to staff case managers and community health workers who took on the role, Larson said. “It was very challenging work in the beginning because the information and enrollment procedures were new to all of us. Over the years, we’ve gained immense knowledge and refined our internal processes so our patients can feel good about the expertise we provide.”
KC CARE Health Center (formerly Kansas City CARE Clinic) is one of the oldest and largest charitable care clinics in the nation. Now a Federally Qualified Health Center and Patient-Centered Medical Home, KC CARE’s services include primary care for adults and children, HIV primary care and support services, oral health and behavioral health. With a staff of nearly 170, their services are enhanced by case management, care coordination, community screenings and health education.
From 2015-2018, KC CARE received a federal navigator sub-grantee award that allowed the FQHC to expand its outreach and enrollment assistance to Clay, Platte, Ray, Cass and Bates counties, as well as in Jackson County, MO, where the clinic’s primary operations are located. That work allowed the team to build a strong base of knowledge. When the grant ended, KC CARE streamlined its team to two full-time and one part-time health insurance navigators. Until COVID-19 changed how staff operated, the navigators were located at three of the four FQHC locations: the main clinic in Midtown Kansas City, the clinic on the Research Medical Campus and at Homeroom Health, a pediatric clinic that serves children, teens and young adults that opened in 2019 through a partnership with Cornerstones of Care.
The REACH Foundation awarded KC CARE a $30,000 Enrollment Assister grant in 2018 and $20,790 in 2019. KC CARE was one of nine organizations awarded grants in 2019 within the Enroll All Eligible outcome area.
The navigators typically provide help in-person and on-site where KC CARE’s clients receive care. With the COVID-19 pandemic, the navigators are working remotely from home, but still strive to provide patients with assistance specific to each individual’s and family’s needs. Larson said the goal is to increase the number of insured consumers and improve health insurance literacy so that clients understand how to use the coverage they secure.
“We find that people not only struggle to understand how to apply but also how coverage works because many of our clients haven’t ever been able to qualify or afford coverage,” said Larson.
“Once we help someone enroll, we don’t stop our work until we walk them through what coverage can mean to them and their families.”
Referrals come from throughout the KC CARE system – from medical and behavioral health providers, the OB/GYN practice and Ryan White HIV/AIDS medical case managers. Navigator Kari Clark works with pregnant women to get them enrolled for Medicaid coverage, but says she uses those conversations to talk about coverage for children and the whole family. “Some of our parents are not aware that their children can be on Medicaid even if the parent does not qualify for coverage,” she said. “It’s important to address the whole family system, and take advantage of every conversation to remove misinformation.”
Joyce White joined KC CARE in 2019 but brought 20 years of Medicare enrollment experience to the organization. White works at the main location in Midtown Kansas City. White as well as the other team members work closely with the providers, medical case managers and other staff to connect with patients and offer their expertise. In 2018, KC CARE’s navigators were granted Tier 1 status through the Family Support Division (FSD), which allows navigators to view the MO HealthNet application status in real time and see FSD application notes. Access to the FSD information helps navigators solve issues that might delay or prevent approval for coverage.
In 2019, REACH awarded 9 grants totaling $305,369 to support health coverage enrollment and eligibility for other public benefits.
Most days, Ashley Johnson talks with parents who come to the new Homeroom Health clinic for pediatric services. Johnson says that with MO HealthNet’s Presumptive Eligibility, navigators can help pregnant women and children under age 18 secure same-day interim coverage while their applications are pending. Johnson says the 30-day temporary coverage provides “security while they wait.”
Larson says the navigator team is focused on getting results for clients, but that some will still be left with few options.