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North Dakota H2 HEALTHCARE AND HOUSING (H2) SYSTEMS INTEGRATION INITIATIVE NORTH DAKOTA Medicaid Coverage and Other Health Care Resources The information in this document is intended primarily to provide people working in subsidized housing and homeless assistance systems basic information about available health care resources. It is also intended to provide context for a discussion on gaps in needed health care services and treatment. The following resources are covered: § Federally Qualified Health Centers: Community Health Centers; Health Care for the Homeless; Migrant Health Centers § Rural Health Services § Native American Health Resources § Veteran Health Resources § HIV/AIDS Health Resources § Behavioral Health Resources § Other Resources for the Uninsured in North Dakota § Medicaid § Managed Care HEALTH CARE RESOURCES AND MEDICAID COVERAGE A variety of health care resources for low-income people exist at the federal and state level. These resources can take the form of health care directly accessible by individuals or funding that flows through organizations that provide health care and related services. Accessing certain resources requires enrollment (and re-certification) based on specific, documented eligibility criteria. As with housing resources, many health care resources focus on particular populations, such as people experiencing homelessness, people living with HIV/AIDS, veterans, or people with disabilities. Federally Qualified Health Centers (FQHCs)1 The Federal Health Center Program serves medically underserved populations or areas, works with special populations, and provides for enhanced Medicaid reimbursement. The four types of health centers are: (1) Community Health Centers; (2) Health Care for the Homeless; (3) Migrant Health Centers; and (4) Public Housing Primary Care Health Centers. Details about Community Health Centers and Health Care for the Homeless Programs are below. According to the Community HealthCare Association of the Dakotas, there are 5 FQHCs in North Dakota. Community Health Centers2 Community Health Centers (CHCs) deliver comprehensive, high-quality preventative and primary health care to patients regardless of their ability to pay. They also provide oral health and behavioral health care tailored to the needs of the communities they serve. CHCs offer a sliding fee discount to based on income. According to HRSA, there are 4 CHCs in North Dakota: • Coal Country CHC • Family HealthCare Center • Northland Health Partners CHC • Valley CHC 1 Community HealthCare Association of the Dakotas, “Find a Community Health Center in the Dakotas,” http://www.communityhealthcare.net/find-a-chc-site 2 HRSA Health Center Program, “2014 Health Center Program Grantee Profiles: North Dakota,” http://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2014&state=ND#glist 1 HEALTHCARE AND HOUSING (H2) SYSTEMS INTEGRATION INITIATIVE NORTH DAKOTA Medicaid Coverage and Other Health Care Resources Health Care for the Homeless (HCH) Programs3 HCH Programs emphasize a multi-disciplinary approach to delivering care to homeless persons, combining aggressive street outreach with integrated systems of primary care, mental health and substance abuse services, case management, and clinical advocacy. Emphasis is placed on coordinating efforts with other community health providers and social service agencies. There is one federally-funded HCH Program in North Dakota: Homeless Health Services in Fargo. Homeless Health Services4 Homeless Health Services (HHS) is a program of the Family HealthCare Center in Fargo. The project maintains a primary care clinic in the downtown area at St. Mark's Lutheran Church. Services include management of acute and chronic health problems, preventive care, HIV/AIDS screening, and patient education. Patients receive case management services, including referrals for mental health and substance abuse services. Outreach is provided by staff at area shelters and other community sites serving people who are experiencing homelessness. Family HealthCare has in-house enrollment specialists to assist uninsured patients with Medicaid applications. Linkages: Homeless Health Services has linkages with Fargo Cass Public Health, Merit Care Medical Center, Southeast Human Service Center, Lakeland Mental Health, area shelters, and transitional housing sites. Statistics: Estimated homeless population: 5,000; Patients served annually: 1,020 Migrant Health Centers5 The Migrant Health Center Program provides support to health centers to deliver comprehensive, high quality, culturally-competent preventive and primary health services to migratory and seasonal agricultural workers and their families with a particular focus on the occupational health and safety needs of this population. There is one Migrant Health Center program in North Dakota: Community Health Services Inc., which operates in Grafton. Rural Health Services Critical Access Hospitals (CAHs) and Rural Health Clinics (RHCs) are the safety net providers for rural and remote communities in North Dakota. 6 Critical Access Hospitals (CAHs) “Critical Access Hospital” is a designation given to certain rural hospitals by the Centers for Medicare and Medicaid Services (CMS). The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. This is accomplished through cost-based Medicare reimbursement. To ensure that CAHs deliver services to improve access to rural areas that need it most, restrictions exist concerning what types of hospitals are eligible for the CAH designation. The primary eligibility requirements for CAHs are: 3 National Healthcare for the Homeless Council –North Dakota Profile, https://www.nhchc.org/hchdirectory/nd/ 4 National Healthcare for the Homeless, “Homeless Health Services,” https://www.nhchc.org/directory/homeless-health-services-2/ 5 Community HealthCare Association of the Dakotas, “Find a Community Health Center in the Dakotas,” http://www.communityhealthcare.net/find-a-chc-site and Community H ealth Services, Inc., http://chsiclinics.org/ 6 University of North Dakota Center for Rural Health, “North Dakota Hospitals,” https://ruralhealth.und.edu/projects/flex/hospitals 2 HEALTHCARE AND HOUSING (H2) SYSTEMS INTEGRATION INITIATIVE NORTH DAKOTA Medicaid Coverage and Other Health Care Resources • 25 or fewer acute care inpatient beds • Location more than 35 miles from another hospital • Maintained annual average length of stay of 96 hours or less for acute care patients • 24/7 emergency care services According to the University of North Dakota Center for Rural Health, there are 36 CAHs in the state. [For a list of CAHs in North Dakota, please see Appendix A at the end of this Worksheet.] 7 Rural Health Clinics (RHCs) A Rural Health Clinic is a federally qualified health clinic (but not a part of the FQHC Program) that is certified to receive special Medicare and Medicaid reimbursement. CMS provides advantageous reimbursement to increase rural Medicare and Medicaid patients' access to primary care services. CMS reimburses RHCs differently than it does other facilities. CMS is required to pay RHCs using a prospective payment system (PPS) rather than a cost-based reimbursement system. RHCs receive an interim payment from Medicare, and at the end of the year, this payment is reconciled using the clinic's cost reporting. For services provided to Medicaid patients, states can reimburse using PPS or by an alternative payment methodology that results in a payment equal to what the RHC would receive under PPS. Regardless of whether the patient sees a mid-level provider or a physician, the RHC must receive the same amount for its services. As of 2015, there were 55 Rural Health Clinics in North Dakota. [For a list of Rural Health Clinics in North Dakota, please see Appendix B at the end of this Worksheet]. Native American Health Resources Native American Development Center8 The Native American Development Center (NADC) works to connect Native Americans relocating to the Bismarck-Mandan community to find services, including behavior health services and mentorship programs. NADC provides referrals to a supportive professional network of psychologists, behavior health providers, attorneys, and medical doctors to serve Native American individuals and families. Indian Health Service – Great Plains Area Office9 Indian Health Service’s Great Plains Area Office in Aberdeen, South Dakota, works in conjunction with its 19 Indian Health Service Units and Tribal-managed Service Units to provide health care to approximately 122,000 Native Americans located in North Dakota, South Dakota, Nebraska, and Iowa. The Area Office's service units include seven hospitals, eight health centers, and several smaller health stations and satellite clinics. Each facility incorporates a comprehensive health care delivery system. The hospitals, health centers, and satellite clinics provide inpatient and outpatient care and conduct preventive and curative clinics. 7 North Dakota Department of Rural Health, “Health Facilities: North Dakota Rural Health Clinics,” https://www.ndhealth.gov/HF/North_Dakota_Rural_Health_Clinics.htm 8 Native American Development Center, “Services,” http://nativeamericandevelopmentcenter.com/services/ and Ashley W right, “Native American Development Center Forming,” The Bismarck Tribune , Jan 9, 2014, http://bismarcktribune.com/news/local/bismarck/native-american- development-center-forming/article_fa7e9ce2-78b3-11e3-83d4-0019bb2963f4.html 9 U.S. Department
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