Opinion Research and Strategic Plan for the Department of Health and Human Resources

1
Opinion Research and Strategic Plan for the
Department of Health and Human Resources
2
Table of Contents

• Page
• Overview 3
• Quantitative Methodology 5
• Quantitative Findings 9
• Focus Group Methodology 45
• Focus Group Findings 48
• Target Audience 60
• Conclusions 70
• Marketing Strategy 73

3
Overview

• In March 2000, RMSR completed 523 telephone
  interviews with participants or eligibles
• From December 1999 through February 2000, RMSR
  conducted 8 focus groups with participants,
  eligibles and workers
• The results provide insights toward encouraging
  enrollment

4
Existing Situation

• Since July 1998, the CHIP program has enrolled
  8,806 children in Phase II and 1,206 children in
  Phase I
• Some estimate there are 32,000 children without
  insurance
• Goal to reach an enrollment figure of 11,000 by
  September 2000

5
Quantitative Methodology
6
Quantitative Methodology

• Conducted March 6 - April 4, 2000
• 523 completed interviews
• 4.3 margin of error at the 95 confidence
  level.
• Average length 17.5 minutes
• Screened Out Households without age 18 and
  younger, and households in which no one has been
  or is enrolled in a federal or state insurance
  program for 2 years.
• Sample - Households in WV earning less than
  25,000 annually.

7
Sampling Criteria
Households With Children 6 Through 18 years
Potential CHIP Eligible
Medicaid Eligible
CHIP Eligible
100 FPL
150 FPL
200 FPL
Family of Four 16,700 25,050
33,400 FPL Guidelines
FPL Federal Poverty Level
8
Sampling Criteria
Households With Children Birth Through 5 years
Potential CHIP Eligible
Medicaid Eligible
CHIP Eligible
133 FPL
150 FPL
200 FPL
Family of Four 22,210 25,050
33,400 FPL Guidelines
FPL Federal Poverty Level
9
Quantitative Findings
10
WV Household Statistics
Households with Persons Age 18 or Younger
Without Health Insurance
Households with Persons Age 18 or Younger
22 Yes
32 Yes
68 No
77 No
1 Dk/Na
N923
N2859
11
Program Participation
N425
Medicaid N218
TANF N62
SLMB N52
QMB N50
29 participated in more than one federal or
state program in the past two years
CHIP N43
12
Classification of Respondents
19 Eligibles N98
81 Participants N425
N523
13
Awareness of Programs
Medicaid
13
32
29
25
1
CHIP
47
17
24
2
10
TANF
22
54
9
13
3
SLMB
2
7
17
69
4
QMB
9
78
3
5
4
14
Rating the Programs
QMB (N45)
18
47
18
7
11
Medicaid (N319)
17
46
12
22
3
CHIP (N142)
18
18
8
38
18
SLMB (N51)
16
39
29
6
10
TANF (N113)
13
22
40
8
17
15
Program Satisfaction
88 of CHIP participants are satisfied or better
CHIP
Medicaid
QMB
TANF
SLMB
16
Program Aspects (Aggregate)
N406
Completing the Application Process
11
14
75
Number of Health Care Providers
69
14
17
Level of Benefits Provided by the Programs
11
71
18
Information provided on Rules and Regulations
18
12
70
Fairness of Eligibility Requirements
11
66
22
Helpful and Courteous DHHR Personnel
23
65
14
17
Level of Benefits
85 of the participants in CHIP were
very/ somewhat satisfied with the program benefits
18
Helpful and Courteous DHHR Personnel
Overall, two out of three households (65) find
the DHHR personnel helpful and courteous
19
Information on Rules and Regulations
86 of the participants in QMB were very/somewhat
satisfied with the information they received on
the program
20
Fairness of Eligibility Requirements
One out of three participants (32) in TANF are
very/somewhat dissatisfied with the fairness of
the programs eligibility requirements
21
Previous Experience
N523
52
Income too high
76 No
19 Yes
Asset level too high
5 Dk/Na
10
They didnt tell you
6
4
Didnt understand Info
1 out of 5 households have been denied
enrollment in a federal or state program
22
Program Concerns (Aggregate)
Fairness of financial eligibility requirements
Not enough outreach
Low household asset eligibility
Lack of privacy and confidentiality
Limited DHHR office hours
Applications are completed in same office
23
Fairness of Eligibility Requirements
74 of respondents from the Southern region have
a lot or some concern
24
Not Enough Outreach
70 CHIP participants have a lot or some concern
about lack of outreach efforts
25
Low Household Asset Eligibility
38 of QMB participants have very little or no
concern at all about asset eligibility
26
Barriers (Aggregate)
Too much red tape
Lack of awareness
Previously denied
Required to find work
Resistant to utilize welfare programs
Limited number of years
27
Barrier - Too Much Red Tape
69 of eligibles believe that too much red tape
is one of the major reasons why people are not
enrolling
Aggregate Mean 3.79
28
Barrier - Lack of Awareness
62 of respondents believe that people are not
enrolling due to lack of awareness.
Aggregate Mean 3.73
29
Barrier - Previously Denied Benefits
63 of eligibles believe that households who were
previously denied benefits will not enroll again.
Aggregate Mean 3.61
30
Benefits (Aggregate)
No one should be without health insurance,
especially children
95
1
2
Many West Virginia families do not have access to
affordable health insurance
92
1
4
Many West Virginians truly need and depend on the
state
90
3
4
A partial assistance or co-payment plan should be
available for purchase
84
5
5
The CHIP program in an insurance program, not a
welfare program
56
10
4
The welfare reform program has been a success in
West Virginia
56
25
9
31
Benefits
The welfare reform program has been a success in
West Virginia
32
Benefits
The CHIP program is an insurance program, not a
welfare program
33
Benefits
A partial assistance of co-pay plan for state
health insurance programs should be available to
households for purchase
34
Disseminating Information
28
23
24
19
17
9
14
13
16
12
Direct Mail
11
Outreach Worker
10
TV Advertisement
School System
Aggregate
Eligibles
Participants
35
Messenger (Aggregate)
WV DHHR
County Health Department
Local DHHR Office
Social Service Organizations
WV Healthy Kids Coalition
36
Messenger - WV DHHR
82 of QMB participants have a favorable opinion
of the DHHR
Aggregate Mean 4.00
37
Messenger - Local DHHR Office
73 of the participants have a favorable opinion
about their local DHHR office
Aggregate Mean 3.88
38
Messenger - County Health Dept
83 CHIP participants have a favorable opinion
of the county health department
Aggregate Mean 3.95
39
Trust Confidence (Aggregate)
Physician
Minister
Person who works at a health care facility
School Health Nurse
Program Enrollee
40
Media Habits - Television
Three out of five households or 60 watch TV
between the hours of 400 pm and 1100 pm
Aggregate
11 gt3 days
9 1-2 days
75 Every day
Eligibles
10 gt 3 days
13 1-2 days
71 Every day
Participants
11 gt3 days
8 1-2 days
76 Every day
41
Media Habits - Weekly Newspaper
Two out of three households read the weekly
newspaper frequently or occasionally
Frequently
Occasionally
Rarely
Never
42
Media Habits - Daily Newspaper
Almost one out of four households read the entire
paper, while 21 read only the front page section
43
Media Habits - Radio
31 listen to the radio between the hours of 600
am to 1000 am, and 25 listen between the hours
of 1000 am and 300 pm
44
Media Habits - Internet
37 of CHIP participants have access to the
Internet at home
Aggregate
Eligibles
Participants
45
Focus Group Methodology
46
Focus Group Methodology

• Eight focus group sessions
• Four venue regions of West Virginia
• Charleston/Huntington
• Twin Falls
• Clarksburg
• Princeton
• 8 to 10 participants per group
• Two hours per group

47
Focus Group Schedule

• Dec 15 Charleston State Caseworkers
• Dec 15 Charleston Outreach workers
• Jan 6 Twin Falls Americorps/Vista
• Volunteers
• Jan 11 Charleston Senior Service Workers
• Jan 13 Clarksburg Participants Eligibles
• Feb 8 Princeton Participants Eligibles

48
Focus Group Findings
49
Awareness

• Informational efforts need to be stepped up,
  especially for CHIP
• Enrolling in government insurance programs is
  perceived as terribly complicated
• Direct correlation between awareness and lack
  of/prominence outreach throughout West Virginia
• All agree there is a great marketing need

50
Administration Structure

• There is sentiment for a stand alone CHIP program
• Even state workers cite inconsistencies in
  administration
• RAPIDS automatic screening confuses
• Hospitals and senior centers are assets to be used

51
Perceptions

• Some feel belittled by going to the welfare
  office, some dont
• The welfare stigma is alive and well
• Hassle factor stereotype persists about local
  DHHR offices
• Need to reach parents who work
• Medicaid penalizes you for working - you make
  money, you lose coverage

52
Experiences

• Frustration over RAPIDS extends to workers as
  well as clients
• Those enrolled in CHIP view it quite positively
• DHHR is understaffed and overworked
• Hospitals are particularly well-versed on Medicare

53
Benefits

• The CHIPs application is seen as an easy
  application to mail
• Once explained and understood, there is
  tremendous interest in CHIP
• Coverage of surgery, equipment and medication for
  seriously-ill praised
• SLMB appeals to people because it helps with Rx
  bills

54
Barriers

• Lack of awareness is compounded by lack of
  outreach workers outside Kanawha County
• Govt employees are limited in their knowledge of
  insurance programs
• The rules are not the same everywhere
• Eligibility process is confusing

55
Information Sources

• Schools
• Doctors offices
• Clinics
• Television
• Bureau Sr. Services
• DHHR office

• Libraries
• Churches
• Mail-in forms
• Dental clinics
• Neighbors
• Health fairs

56
Marketing Vehicles

• Healthy Kids Coalition
• School lunch program
• Daycare centers
• Health fairs
• Head Start
• Pediatricians
• Teachers
• Television

• Newspapers
• Billboards
• Talk shows
• Newsletters
• Direct mail
• Posters in various locations
• Childbirth Kits

57
Messages

• An insurance program, not a welfare program
• Tie to immunizations and physicians
• You can work and still get insurance for your
  children
• No one should be without health insurance,
  especially a child

58
Messengers

• For CHIP - use real-life people whose kids have
  benefited from the program
• For senior programs - use adult children of
  Medicare-age parents
• Doctors and working mothers
• Some consideration for a Kathy Mattea, based upon
  Kentucky experience

59
Conclusions

• Confusion
• over eligibility thresholds and asset tests
• between Medicaid and CHIP eligibility
  requirements
• Screening RAPIDS program
• Desire for plain-English marketing

60
Target Audience
61
Are There Eligible Households in WV?
33 CHIP Eligible N32
19 Eligibles
81 Participants
49 Medicaid Eligible N48
18 CHIP Potentials N18
62
Location of Target Audience
North Central Region Medicaid Eligibles
35 CHIP Eligibles 34 CHIP Potentials 22
Eastern Mountains Medicaid Eligibles 10 CHIP
Eligibles 19 CHIP Potentials 28
Southern Region Medicaid Eligibles 29 CHIP
Eligibles 22 CHIP Potentials 33
63
Target Audience Profile

• ELIGIBLES POTENIALS
• Medicaid CHIP CHIP
• Age
• 18-24 17 0 11
• 25-34 23 47 28
• 35-44 35 22 33
• 45-54 19 19 17
• Education
• Less High 8 16 11
• High School 60 34 67
• College 8 25 0

64
Target Audience Profile

• ELIGIBLES POTENIALS
• Medicaid CHIP CHIP
• Employment
• Full-time 29 44 44
• Part-time 15 9 17
• Homemaker 31 22 28
• Status
• Married 65 69 72
• Divorced 13 19 22
• Lived in Area
• Less 10 years 31 22 28
• 10-20 years 27 19 22
• More than 20 years 42 59 44

65
Probability of Enrollment
24 Somewhat Likely
53 Very Likely
10 Somewhat Unlikely
8 Very Unlikely
4 Dk/Na
N98
66
Receive Information
N406
A friend or family member told you
You went to the DHHR office yourself
Hospital or health care provider
Social or outreach worker
School or child education effort
67
Media Habits - Television
47 CHIP eligibles watch between 400 - 800 pm
while 43 Medicaid Eligibles and 36 CHIP
Potentials watch between 800 - 1100 pm
Medicaid Eligible
8 gt3 days
73 Every day
10 1-2 days
CHIP Eligible
13 gt 3 days
16 1-2 days
69 Every day
CHIP Potential
11 gt3 days
17 1-2 days
72 Every day
68
Media Habits - Newspapers

• ELIGIBLES POTENIALS
• Medicaid CHIP CHIP
• Weekly Newspaper
• Frequently 40 44 39
• Occasionally 19 13 28
• Never 21 28 17
• Daily Newspaper
• Everyday 27 28 22
• Once/Twice Week 23 13 17
• Never 25 41 33

69
Media Habits - Radio

• ELIGIBLES POTENIALS
• Medicaid CHIP CHIP
• Radio
• Everyday 60 66 61
• Once/Twice Week 19 13 11
• Never 8 13 6

52 of CHIP potentials listen between the hours
of 600 - 1000 am while the eligibles are split
between the other hours during the day from 600
am to 700 pm. 80 Medicaid eligibles, 89 CHIP
eligibles and 94 CHIP potentials listen to the
radio weekdays.
70
Conclusions
71
Conclusion

• Lack of awareness is significant
• ? Opportunity - Once enrolled, the CHIP
  satisfaction level is extraordinary -- 88.
• The Medicaid Program has the largest number of
  households participating
• ? Education and distribution of information
• Lack of outreach is reason program is missing
  several eligibles

72
Conclusion (contd)

• Schools, Direct Mail and Outreach are recommended
  as the best vehicles for reaching potential
  eligibles
• 84 favor co-pay concept
• 75 are favorable toward DHHR
• WV Healthy Kids Coalition -- 68 unaware or
  dont know -- not yet well-known
• They watch TV, but prefer direct mail

73
Marketing Strategy
74
Recommendations

• Simplify the process -- plain English
• Stress no one should be without insurance,
  especially a child.
• More outreach throughout West Virginia --
  especially in south/north central
• Communicate in a more aggressive way to medical
  and social workers
• Beef up efforts to standardize administration of
  programs in the 55 counties

75
Promotion - Track 1 (Centralized)
DHHR or ADM
Implementing Organization
Television
Direct Mail
Method
Audience
Medicaid Eligible 800 - 1100 pm
CHIP Eligible 400 - 800 pm
Target Audience
Colorful brochure promoting free health
insurance for children
Messenger
Physician
76
Track 1

• What can we do to increase awareness
• Direct Mail - cost effective
• Television Ads
• One page handout on the programs at all DHHR
  offices
• New, plain-English brochures
• Correct RAPIDS deficiencies

77
Promotion - Track 2 (Decentralized)
DHHR or ADM
Overseeing Organization
Local (county) DHHR Office
Implementing Organization
Outreach workers/Social Service Organization
Method/Messenger
Hospitals
Community Meetings
Place
Schools
Children should not be without health insurance.
Message
78
Track 2

• Increase emphasis on outreach -
• Grass roots Program
• Coordinate immediately between FA and DHHR
• Step up training for DHHR persons in Charleston
  and at the county level about the rules and
  regulations of federal and state programs
• Repeat, repeat, repeat -- the message, the
  messenger

79
Major Message Point

• The rules have changed for CHIP
• Inform households that a co-payment plan is
  available - new annual income limit is between
  150 - 200 FPL.

80
Projections

• In 1990 there were 398,167 households earning
  less than 25,000 annually.
• Based on research
• 322,515 households are currently participating in
  a federal or state program
• 75,612 households are potentially eligible to
  participate in a federal or state program