Removing barriers to care | Medicaid and affordable care
Providence has long been a champion for affordable health care, and our family of organizations remains deeply committed to providing quality and compassionate care to all, regardless of ability to pay. The need is clear for continued investment in affordable health insurance, including Medicaid, the largest coverage program in the country.
In 2021 more people were covered by health insurance than ever before, across all available insurance coverage options, and the total number of unique patient visits covered by Medicaid rose to record levels in the U.S. At Providence, 2021 visits to our ambulatory care centers by patients with Medicaid coverage increased by 16 percent from 2020 levels.
During 2021, Providence served 984,987 individual patients who depend on Medicaid coverage for access to care.
Providence continues to be a strong advocate at all levels of government for preserving access for the millions of individuals and families who depend on Medicaid for their care. This and other important safety net programs need our ongoing support, and Providence is proud to have helped secure a 6.2 percent increase in federal Medicaid funding during 2021.
Thanks to the federal government’s continued response to COVID-19, many states saw an influx in enhanced Medicaid funding in 2021, but as COVID infection rates decline, these enhanced benefits will be reduced.
For example, in Oregon, Providence is a leading voice for the preservation and expansion of Medicaid in a post-pandemic budget environment. With the enhanced Federal Medical Assistance Percentage, people who enrolled in Medicaid during a public health emergency are eligible to stay enrolled for the duration of the emergency. During COVID-19, Oregon saw record enrollment due to this expanded benefit.
When the supplemental funding will expire, Providence anticipates nearly 300,000 people in Oregon will lose Medicaid coverage. To prepare for this shift, the Providence team put systems in place throughout 2021 to help affected people close the gap by securing new insurance coverage, either through government-sponsored programs or the private insurance market. Providence is providing navigation assistance by phone and in clinics to Oregonians at risk of losing Medicaid coverage, while also advocating for additional state and federal funding to sustain the enhanced program.
Swedish runs a program for individuals who regularly visit the Emergency Department that is designed to help patients get the care and resources they need in the best setting. Many of these patients depend on Medicaid coverage and have chronic challenges in their lives that make managing their health more difficult. Swedish caregivers recognized that emergency visits will not help these patients stabilize, and created the program to better serve their medical and basic social needs.
The Emergency Department care navigator helps connect patients to care and services in the best setting for their medical and social needs.
Social worker Lacey Haymon is the care navigator for Swedish’s multi-visit patient program. She serves as the bridge between the hospital and community partners, connecting patients to available resources and helping them receive care and services in non-emergent settings. She coordinates stable housing, makes appointments, organizes transportation to and from medical appointments, and procures equipment such as wheelchairs for patients with mobility challenges. In 2021, Haymon worked directly with 87 patients, 61 of whom were enrolled in Medicaid.
One patient in particular stands out in Haymon’s memory. “A patient with Medicaid needed hernia surgery at our Swedish First Hill location, but he kept missing his pre-surgery appointments,” says Haymon. “I started attending his consultations with him, developed a recovery plan that included stable housing post-surgery, and served as his primary point of contact. After his successful surgery, he hasn’t returned to the emergency room,” says Haymon.
In Napa County, Providence’s CARE Network is a vital free resource to patients who require additional health care navigation and assistance to stabilize their health care needs. Individuals served by the CARE Network face complex health issues and socioeconomic challenges including unstable housing, inadequate insurance coverage and lack of transportation.
The goals of the community-based program are to empower the people it serves to become active partners in managing their own health. It helps to reduce the number of avoidable emergency department visits by connecting people to care and services such as medication stabilization, behavioral health and substance use treatment, housing, primary care and chronic disease management.
In 2021, CARE Network programs received community benefit that enabled caregivers to serve 3,416 unique individuals. The team knew that data would help them better understand the impact of the program and plan for future needs, so last year they partnered with analysts from Providence’s Population Health Team to develop a dashboard. Data showed that for the more than 200 people with the most complex needs, a significant reduction occurred in avoidable Emergency Department visits and hospitalizations after enrollment in the CARE Network Program. The goal is to ensure each patient receives care in the best setting for individual needs.
"Often people with with complex conditions who are under-resourced become overwhelmed and need someone they can trust to find the right resources and services within a complicated system.”
Dana Codron - regional director of community health investment
When introducing the service to a new patient, a CARE Network nurse and social worker will often make an initial home visit to assess their needs. “You learn a lot when you visit someone in their own space or home,” says Dana Codron, regional director of community health investment for Providence Northern California. “When I sat in their kitchen, I realized why they kept coming back to the Emergency Department or were missing appointments. Often people with complex conditions who are under-resourced become overwhelmed and need someone they can trust to find the right resources and services within a complicated system."
Through this model of care, the data also shows that clients are receiving acute care less often and are more frequently finding care in other more suitable settings. Plans are in the works to scale the program to neighboring Humboldt and Sonoma counties and to form new partnerships, including with Medicaid in the provision of CalAIM programming.
Federally qualified health centers, known as FQHCs, are centers that provide medically necessary primary health services and qualified preventive services to individuals and families with lower incomes. In December 2021, Providence St. Jude Medical Center, St. Jude Neighborhood Health Centers, and the City of Anaheim partnered to open a new FQHC site in Ponderosa Park, Anaheim. The health center is adjacent to a family resource center, a school and a library, creating a comprehensive campus of services in a high-need community.
The partnership resulted in a new facility where individuals and families can go to receive medical and dental care and mental health services on a sliding scale of cost. Providence St. Jude contributed $4 million to fund the building and equipment for the new health center and was instrumental in advocating with the City of Anaheim to provide the land for the health center.
Government funding for safety net programs, such as Medicaid, varies from state to state but the need for these programs is consistent. It is no longer a question of if these essential insurance programs need funding, but how to fund them. Driven by our belief that health is a human right, Providence serves as both advocate and caregiver for people who depend on affordable care options. Our government affairs team will continue to champion these essential services so that individuals and families can get the care they need to live their healthiest lives.