Moving Beyond Enrollment:
A Card Is Not Health Care

In 1997, the public policy challenge regarding health care access was to advance the understanding that "eligibility did not equal enrollment". The State Children's Health Insurance Program (SCHIP) was adopted to act on this understanding and to enroll some of the 10 million uninsured children in the U.S. The challenge for health access in the year 2000 is to understand that "enrollment does not equal health care". A subsequent program initiative is necessary to help children and their families who have health insurance cards as a result of SCHIP and Medicaid get real health care services. We need to extend the goal and move beyond enrollment.

To this end, AHEC/Community Partners, working in Massachusetts, has undertaken several programs that focus on Moving Beyond Enrollment activities. These programs are built on the foundation of innovative, community-based outreach programs and strategies for which Massachusetts has been recognized as a leader. The ultimate goal is to develop community-based systems that can respond to the health needs of people enrolled in SCHIP or Medicaid by connecting them to providers or appropriate medical services.

Specifically, it is important to understand that receipt of a Medicaid or SCHIP card is just the first step in the continuum that should end with the appropriate use of health and medical services. Along the road from enrollment to utilization, effective outreach programs must assist people with an array of often time-consuming post-enrollment issues including: administrative problems (non-working cards, additional verifications, etc.), health plan and provider selection, health plan member education, instruction on how to use managed care and ultimately the making of an initial visit to a provider. These follow-up services are especially needed for individuals and households who either have never had health insurance or have been without insurance for a long time. The goal of Moving Beyond Enrollment is to help people get the appropriate services, begin to understand the needs and benefits of prevention, and ultimately to improve their health.

AHEC/Community Partners has begun the following Moving Beyond Enrollment initiatives in the year 2000:
· A federally funded, Rural Health Outreach Program that builds upon successful community-based outreach programs and seeks to provide post-enrollment follow-up services. The program, called Moving Beyond Enrollment, is intended to assist individuals and households connect to the appropriate health care provider and/or health/medical services. The program is funded for three years
· A pilot mini-grant program funded through the University of Massachusetts Medical School, to ten community-based outreach programs. This funding allowed these programs to expand services beyond outreach and enrollment and implement a variety of strategies that help connect individuals to appropriate providers or services.


In addition, as of May 2000, the Commonwealth of Massachusetts, through its innovative Health Care Access and Outreach Services mini-grant program began encouraging community-based outreach programs to provide post-enrollment follow-up and support services. In 1998, the National Governors' Association deemed this mini-grant program a Best Practice for its ability to engage and partner with community groups in providing outreach and enrollment. This expansion of programmatic scope is an acknowledgement of the need for continuing, community-based activities to support individuals from outreach through enrollment to utilization of medical services.

AHEC/Community Partners firmly believes that given the evolution of SCHIP and the pressing need to improve the health of our children and families, Moving Beyond Enrollment needs to be embraced as the next step for health access public policy. The objective should be to utilize the effective partnerships developed through SCHIP at the federal, state and community levels, to support those newly insured people in receiving the actual health care they need and deserve.

CONTACT INFORMATION:
For further information regarding the development and implementation of Moving Beyond Enrollment initiatives, please contact AHEC/Community Partners.

Michael DeChiara or Anne Rosen