Legal Aid Society of Greater Cincinnati

215 East Ninth Street, Suite 200
Cincinnati, OH 45202
513-241-9400

Project Title
Access to Public Health Insurance Coverage in Rural Ohio
Grant Description
To increase Medicaid and Medicare coverage, including coverage access for mental health and substance abuse treatment services, in five Ohio counties
Focus Area
Strengthening Primary Care Providers to the Poor
Region Served
Adams, Brown, Clinton, Highland, and Warren Counties, OH
Award Amount
$100,000
Year Awarded
2004
Grant Duration
24 months
Results
A grant of $100,000.00 was approved on June 22, 2004 to increase access to publicly funded health insurance, as well as mental health and substance abuse services in Adams, Brown, Clinton, Highland and Warren Counties in Southwest Ohio. All grant funds were expended.

The investigation into access barriers included fifty key informant interviews with providers, agencies and organizations, and a literature and pertinent data review.  A survey instrument was then developed and 100 low-income residents of the region were surveyed.  Key findings were:

  • The adult uninsured rates in Adams, Brown, Clinton and Highland counties exceed the state average, and the child uninsured rates in Adams, Clinton, Highland and Warren counties exceed the state average.
  • Uninsured individuals and families were reluctant to seek health care for fear of medical debt and being harassed by collection agencies or sued by the provider.
  • Many people in the region are unaware of their potential eligibility for Medicaid coverage partly due to a lack of outreach by the counties who administer the programs. Even senior service agency staff were unaware of Medicaid's Medicare Savings Program for low income seniors and people with disabilities.
  • There is a lack of awareness in the region of public health insurance coverage for children whose family income is below 200% of the federal poverty limit. The total number of uninsured children in the targeted region was approximately 6,097. It is estimated that 3,437 of them are in families that are below the 200% poverty limit and should qualify for Medicaid coverage.
  • There are few mental health and substance abuse providers, and fewer still who will serve indigent persons. Of those agencies that do offer service, waiting lists are long and people often give up before they can be served.

An advocacy plan with initiatives were developed, the initiatives were:

  • Facilitate enrollment for 300 low-income elderly and disabled residents through Medicaid's Medicare Savings Programs. A total of 1,764 low-income elderly and disabled residents in the targeted counties obtained public health insurance through this program.
  • Increase public health insurance coverage through improved hospital billing policies and procedures. This effort is underway with a hospital in one of the targeted counties.
  • Launch a pilot project in which local employers in the regional counties would facilitate Medicaid enrollment for low-wage workers and their families. This effort was unsuccessful, as the enrollment process was believed to be too cumbersome by many employers.
  • Form a Health Access Coalition in the targeted counties. Participants in the four community meetings indicated no interest in forming another coalition. However, the grantee indicated it will continue to build relationships in these counties to generate increased interest.

A total of 36 agencies attended a series of four community meetings in Wilmington, Georgetown, Hillsboro and Lebanon during Cover the Uninsured Week in May, 2006. At these meetings training was provided on how to access underused public health insurance.

Pre-and post tests were administered at training meetings. Correct answers on pre-tests were 35% and on post-tests were 94%. 100% of training participants indicated increased knowledge about access to public health insurance. Medicare Savings Program enrollment increased by 1,764 persons in the targeted counties.

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Project Title
Cincinnati Child Health-Law Partnership
Grant Description
To establish a medical-legal partnership between Legal Aid and Cincinnati Children's Hospital Medical Center located in the hospital
Focus Area
School Aged Children's Healthcare
Region Served
Hamilton County, OH
Award Amount
$100,000
Year Awarded
2007
Grant Duration
24 months

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Project Title
Cover the Uninsured Week
Grant Description
To connect the uninsured and underinsured with health care access and coverage and to inform the community about the issues related to being uninsured
Focus Area
Community Primary Care
Region Served
All eight HFGC OH Counties, Boone, Campbell, and Kenton Counties, KY
Award Amount
$37,500
Year Awarded
2008
Grant Duration
6 months

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Project Title
Guide to Getting Health Care for People without Insurance
Grant Description
To create and distribute a guide to help uninsured Hamilton County residents access healthcare
Focus Area
Community Primary Care
Region Served
Hamilton County, OH
Award Amount
$76,500
Year Awarded
2005
Grant Duration
12 months

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Project Title
Health Access Advocacy Project
Grant Description
To establish a Health Access Advocacy Project
Focus Area
Community Primary Care
Region Served
Clermont and Hamilton Counties, OH
Award Amount
$235,000
Year Awarded
2000
Grant Duration
36 months
Results Legal Aid initiated the Health Access Advocacy Project (HAAP) in November 2000. In the first three months of the project, HAAP has represented 79 people with healthcare access problems. These cases involve helping people who were denied or terminated from Medicaid, assisting people in applying for Medicaid, and using programs like the Hospital Care Assurance Program and the Hamilton County Hospital Levy to relieve medical debt.

HAAP has already provided training to over 300 health care and social service providers on healthcare access issues. These training include "Bridging the Gap for the Uninsured," a November training on Community Benefits, HCAP and the levy, a January training co-sponsored with the Ohio Hospital Association on Medicaid reinstatement and another January training co-sponsored with the Ohio Department of Mental Health on Medicaid spend-down.

Collaborative advocacy efforts include working with the Ohio Department of Job and Family Services to restore Medicaid to 133,000 Ohioans who lost it during implementation of welfare reform and leading the Eligibility Committee of the Southwestern Ohio Community Access Project working to create a registration system that will make it easier for uninsured people to access health care. HAAP is staffing the Greater Cincinnati Healthcare Access Project which brings together uninsured people and community advocates to dialogue with hospitals about improving access to care.

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Project Title
Medicaid Expansion Assessment
Grant Description
To provide an update and assessment of current estimates of the number of uninsured persons for the state of Ohio that assisted providers and policymakers in supporting sound policy recommendations for expansion of health insurance coverage
Focus Area
Strengthening Primary Care Providers to the Poor
Region Served
Adams, Brown, Butler, Clermont, Clinton, Hamilton, Highland, and Warren Counties, OH
Award Amount
$5,000
Year Awarded
1999
Grant Duration
12 months
Results The study report was presented to the public and to state policymakers. The results clarified cost projections for expanding Medicaid to 150% for parents and other guardians. The report estimates that approximately 31,000-58,000 people would apply for an expanded Medicaid program, and the total cost of their coverage would be $46.6 million to $86.5 million. Since the state share of Medicaid expenses is 42%, the cost of an expanded program to the State of Ohio would be between $19.6 million and $36.3 million.

Dissemination of the report has included:

  • Press conference at the Ohio Capitol Building jointly sponsored by the Ohio United Way, Federation for Community Planning, and the Ohio State Legal Services Association
  • News article in the Columbus Dispatch
  • Presentations by the Government Relations Manager of the Cincinnati United Way & Community Chest before local and statewide funding coalitions
  • Public presentation (with other data) at Foundation Access Symposium

Findings:

The validity and reliability of the data were endorsed by the state's Office of Management and Budget. The study proved to be a cost-effective approach for generating useful information about the cost of expanding medical coverage for uninsured adults.

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Project Title
Ohio Healthy Workers Insurance and Premium Assistance
Grant Description
To provide general operating support for capacity building work to expand health coverage for uninsured Ohio workers
Focus Area
Community Primary Care
Region Served
OH - Statewide
Award Amount
$90,000
Year Awarded
2006
Grant Duration
12 months

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