Since the inception of both Healthy Start and BadgerCare, the most successful outreach and enrollment initiative has been outstationing. “It has really changed the way that people apply for Medicaid,” says Bonnie Kuhr of the N.E.W. Community Clinic. “People who would hesitate to go down to a county human services office to apply for benefits are a lot more comfortable sitting in the clinic where they get their health care and applying with an outstation worker.”

Outstationing is the practice of placing Medicaid eligibility workers in community settings. This can happen in several ways—at the Family Health Center of Marshfield, an outstation site for Healthy Start since the early 1990s, the outstation workers are clinic employees who help patients file applications with their county human services office; in Milwaukee, the county has partnered with Community Advocates to assign county eligibility workers to a variety of community sites on a full-time basis, and establish caseloads from families in the neighboring areas. “What is exciting about the Milwaukee project,” says Ken Germanson of Community Advocates, “is that it is making access easier and more friendly for families, taking away the need for such applications to be made in large ‘welfare offices’ where the bureacracy was often frightening and demeaning for some families.”

Forging Community Relations

Statistically, outstationing’s numbers speak for themselves. A survey done by Kenosha County Human Services found that between June 1, 1999 and September 30, 1999—a four-month period—over 11,000 inquiries were made about Medicaid, over 4,200 appointments were made, and nearly 3,300 Medicaid applications were taken at 60 outstation sites in eight counties. That represents ten percent of the family Medicaid enrollments statewide for that period.

For clinics, outstationing makes sense not only from a community relations perspective, but a financial one as well. “What we’ve heard from providers across the state is that outstationing not only enhances their positive public profile in the community,” says Bobby Peterson of ABC for Health, “but that through enrolling their patients, they’ve been able to generate significant revenue streams for their clinics. In rural areas, where we constantly see medical facilities struggling, this can make the difference between a clinic staying solvent or going under.”

Fast, Friendly and Effective

For clients, outstationing is an efficient way to deal with the application process. Of clients surveyed by Kenosha County, 86 percent were seen by an outstation worker within 15 minutes, and the remainder within 45 minutes. This efficiency is borne of the fact that, in a clinic or hospital, seeing the outstation worker is a part of the appointment process.

Outstationing is not only effective, it’s friendly as well. At the Marshfield Clinic’s Patient Assistance Center, 91 percent of 350 patients surveyed said they were comfortable applying for Family Medicaid at the Marshfield Clinic. Contrast this with 40 percent of respondents who said they were comfortable applying at the county agency or tribal office, and the difference in patient perceptions between the outstation environment and county human services becomes clear. With this record of success, it’s also clear why so many are working so hard to preserve outstationing.

Comments from the Covering Kids Coalition Forum on Outstationing

Outstationing is a feature of two points in the Covering Kids Wisconsin Five Point Plan—those that promote Customer Service Innovations at County DHS Offices and Community-Based Enrollment Assistance. Outstationing has been a clear success, but it takes money that is in short supply right now. To shine a spotlight on the value and uncertain future of outstationing, the Covering Kids Wisconsin Statewide Coalition hosted a forum in November that brought together people from county human service agencies, the state Department of Health and Family Services, and community-based organizations and clinics that host outstation sites. Here’s what they had to say:

Benefits

“Our outstationing efforts have brought the health care providers and the economic support agencies closer together, forming networks that can assist our community members. We have a strong bond in developing these networks as we have a common goal to improve the way of life for our clients in common.”
— Pat Beining, Marshfield Clinic

“Outstationing has been of tremendous benefit to the community because it has increased access to entitlement programs for low-income families and generally improved customer service and reduced the stigma associated with applying in a familiar location. By being in the community, we made it easier for people to accept the help.”
— Jill Erickson, Milwaukee Co Human Services

“Outstationing has been positive because, since Wood County is so rural, it can be difficult for people to get around, and also some people don’t want to come in to our office because of the stigma.”
— Doreen Lang, Wood Co Social Services

“In Milwaukee, the relationship between the worker and the umbrella organization has been productive—the worker is a part of that organization for all practical purposes. It’s a DHS worker, but the behavior at these sites is such that you can’t tell the difference. And the organizations really give support.”
— Ramon Wagner, Community Advocates

“The public relations benefit is absolutely fantastic, but doesn’t show up on a balance sheet.”
— Gordon Burdick, Dane Co Human Services

Challenges

“We’ve had a 35 to 40 percent turnover rate with our economic support specialists in the last two years or so. And that’s expensive because we have to hire the staff, then train them—and training is about a 12-week process. So, as we are losing experienced workers, we are bringing on new workers and it’s been difficult to transition those new workers to the outstation sites.”
— Jill Erickson, Milwaukee Co Human Services

“Medicaid simplification has increased the number of applications that we are receiving and the number of outstation appointments we are scheduling.... Our outstation workers are carrying a caseload and those caseloads are growing faster than we can keep up with.”
— Gordon Burdick, Dane Co Human Services

“At Marshfield, we send applications to all counties for eligibility determinations. The challenges we face are inconsistencies with interpretation of Medicaid policy and child support issues across the state of Wisconsin. Money is always an issue. Our local counties would like to expand efforts and combine with ours to enhance services. The state encourages these types of activities, but there are no funds available to move forward.”
— Pat Beining, Marshfield Clinic

“The state is running out of enhanced funding for Medicaid outstationing, which will run out at the end of the year.”
— John Haine, Wisconsin DHFS

Possibilities

“We started out with...clinics and hospitals and CBOs throughout the community. As time went on, we began to go to food pantries and health fairs and really extend our reach throughout the community... We’ve started to transition to new outstations identified by advocates in the Milwaukee community, such as community learning centers within the public schools and family resource centers.

“We are trying to come up with new ways to fund our activities. Starting next year we are giving the option to hospitals to purchase the services of eligibility workers at their site wherever the volume of applications is justified.”
— Jill Erickson, Milwaukee Co Human Services

“If health care providers can use this tool—namely outstationing—effectively, they can really cut down their bad debt.”
— John Haine, Wisconsin DHFS

“We are redefining the model right now of what income maintenance is: education, outreach, information and referral, advocacy—these are all parts of it. So having community organizations working with a DHS outstation worker creates a supportive environment where agency staff can help the worker by doing outreach and scheduling appointments. The agency is not only providing space, but also certain access and income maintenance functions.

“The future challenge is to get funding agencies to recognize the efforts of groups out in the community that are expending resources for these functions.”
— Ramon Wagner, Community Advocates

Resource and Referral Trainings

After the resounding success of its first Resource & Referral Training in Marathon County on April 5-6, the Covering Kids pilot project at Family Health Center of Marshfield has sponsored similar trainings in all four of its pilot counties this fall.

The first event established the model of collaboration and inclusiveness that subsequent events have followed. In Marathon County, several groups were involved in planning and organizing the event, among them Rural Health Initiative, Economic Support, Public Health, and UW Cooperative Extension. In other pilot counties, the local Covering Kids coalition members took the lead in planning. The coalitions identified a wide array of resources in their county that help families connect to health care coverage and supportive services. The agencies that provide these services were each given a slot on the agenda to describe their services, eligibility criteria, and how to make appropriate referrals. Some of the agencies included: Social Security Administration, Public Health, Family Resource Centers, Birth to Three Program, WIC, Head Start, and representatives from the Hmong and Hispanic communities. Participants also received resource materials to take back to their agencies.

One of the highlights of the event is a role-play that shows how families work with staff from Marshfield Family Health Center, Social Services, and Automated Health Systems to obtain Medicaid coverage. The role-play brings to life the complex issues and information families have to deal with during the application and HMO enrollment process.

In addition to very positive feedback from participants, the trainings have enhanced the spirit of networking among the agencies, particularly between health departments, providers, and social services.

Back-to-School 2001 Health Fair

Hot dogs, face-painting clowns, and lots of giveaways—a potent combination to draw kids and their parents out on a steamy August afternoon. That was the scene at the “Back-to-School 2001” Health Fair, an event put together in three short months through the hard work of Community Advocates, Milwaukee Health Department’s Paula Roberts, Jill Erickson of Milwaukee County DHS, and other members of the Enrollment Outreach Committee of the BadgerCare Coordinating Network. Major sponsors included Covering Kids Wisconsin and Automated Health Systems.

The event, held August 17-18 at Washington Park Senior Center, attracted an estimated 1,750 to 2,000 individuals. Featured services included medical checkups and blood pressure screenings done by volunteer doctors and nurses, eye checks by LensCrafters, and immunizations by the Milwaukee Health Department. Eligibility workers from Human Services were also on site to take applications for a variety of public assistance programs—54 new applications for Medicaid were taken,
plus others for GAMP, child care, and Head Start.

Fun was the emphasis for the kids, who enjoyed the free coloring books, hot dogs, tattoos, and balloons given away by roughly 30 exhibitors. Perhaps the biggest hit of the event was the on-site broadcasts by two urban radio stations popular in the African-American community: “Wisconsin’s Black Voice” WNOV broadcast from 3-6 pm on Friday and did interviews with participants; and WKKV sent a mobile broadcast unit.

Organizers expect this to become an annual event. It has already increased collaboration among providers, advocates, public agencies, and community-based organizations, to the benefit of the children and families they serve.

Kits and Resources Featured in ABC for Health's Website

The RV is back in the parking lot, but the BadgerCare Express rolls on. The next stop is ABC for Health’s newly redesigned website, where we’re posting both the 3 Steps and AdvoKit with updates and additions, so you can have ready access to the whole kit, or just the part you need. If you weren’t able to attend a BadgerCare Express workshop, you can still download the kit by registering at the site. This way, we’ll know how to reach you with news about kit updates, upcoming events, and new resources.

One new resource we’re working on right now is a fact sheet on BadgerCare and COBRA to help newly laid-off workers preserve their coverage. And we’re always open to suggestions for other topics on health care coverage and access.

Be sure to stay connected to our growing network and let us know what you need. Your active involvement is the best way for all of us to keep our clients covered.

What BadgerCare Express Participants Said

"Great networking, organization, info and training"

"I have many clients applying for and on Medical Assistance. When a question arose I was clueless. Now I have something under my belt."

"This is the third Covering Kids workshop I've been to. Each time it has been very helpful. It has kept me current on how to help families through the application process. Thank you!"

Many thanks to our co-sponsors

back to top